Abstract
BackgroundThe aim of this study was to evaluate the efficacy of laser myringotomy (LM) compared to ventilation tube (VT), and to assess the clinical success criteria of LM-assisted VT insertion as the flexible alternatives avoiding GA for the treatment of bilateral consistent otitis media with effusion (OME).Methods and FindingsLM under topical anesthesia was followed by VT insertion in cooperative children using Acuspot® 712 CO2 laser micromanipulator attached microscope. Sixty children failed VT and bilateral laser tympanostomy was done (group LL), and 130 children tolerated VT on one side but LM on the other side (group LV). The efficacy of LM was compared to VT regarding recurrent effusion and reoperation as the outcome measure; firstly, by ear-to-ear matched pair analysis in LV, and secondly between LL vs. LV. Long-term outcome was compared to control group who received both VT under GA (group GAVT) regarding the outcome of additional VT and GA.ResultsThe effectiveness of LM per ear was equivocal as 46.9% and 40.8% in LV and LL respectively; but the effectiveness per children was further lower in LL as 28.3%, which was a limitation of LM for bilateral OME. LL required reoperation in 71.7% mostly requiring impending GA in 51.7% within 4.7 months, thus was a controversial treatment. But LV required GA in 20.8% during the 27.2 months long-term follow-up, which was second set of VT and adenoidectomy that were also comparably required in GAVT control with multiple GA.ConclusionStandard GAVT was more recommended for bilateral OME than bilateral LM (LL) in our practice. But LM was selectively effective for some children, that combined approach with LM plus VT provided comparable period to outgrow OME as effectively as GAVT, when LM was supplemented with one VT side with recovered hearing.
Highlights
Otitis media with effusion (OME) is the most common cause of hearing loss and ventilation tubes (VT) is accepted as a standard surgical treatment, which is the most common operation in young children requiring multiple general anesthesia (GA) [1] [2]
The effectiveness of laser myringotomy (LM) per ear was equivocal as 46.9% and 40.8% in LV and LL respectively; but the effectiveness per children was further lower in LL as 28.3%, which was a limitation of LM for bilateral otitis media with effusion (OME)
Standard GAVT was more recommended for bilateral OME than bilateral LM (LL) in our practice
Summary
Otitis media with effusion (OME) is the most common cause of hearing loss and ventilation tubes (VT) is accepted as a standard surgical treatment, which is the most common operation in young children requiring multiple general anesthesia (GA) [1] [2]. LM-assisted VT insertion overcame the frequent LM failure and reduced GA, but the limited feasibility of LMassisted VT in young children requires the integration of two procedures [5]. In our clinic, these children have been allocated to ‘‘flexible integration of laser tympanostomy and ventilation tube insertion under topical anaesthesia’’ (FITT) procedure before definitive GA procedure [6]. The aim of this study was to evaluate the efficacy of laser myringotomy (LM) compared to ventilation tube (VT), and to assess the clinical success criteria of LM-assisted VT insertion as the flexible alternatives avoiding GA for the treatment of bilateral consistent otitis media with effusion (OME)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
