Laser myringotomy versus ventilation tubes in children with otitis media with effusion

Abstract

Background: Insertion of ventilation tubes in children with otitis media with effusion (OME) is an accepted procedure. Laser myringotomy can be performed in the office but little is known about the outcome and influences of co-variables compared with the tube. Methods: Prospective and randomised trial with enrolment of children with chronic OME, indicated for placement of ventilation tubes. At random, laser myringotomy was performed in one ear and a ventilation tube was placed in the other ear. Follow-up was scheduled for 6 months. Success was defined as absence of effusion or aural discharge. Results: Two hundred eight children received the allocated intervention. The mean closure time of the laser perforation was 2.4 weeks and the mean patency time of the tube was 4.0 months. The mean success rate was 40% for the laser and 78% for the ventilation tube. Known variables of influence on the course of OME were used to create a logistic regression model to predict treatment effect for both therapies. Conclusion: Laser myringotomy is less effective than insertion of a ventilation tube in the treatment of chronic OME. The logistic model enables the otolaryngologist to identify the patients suitable for laser myringotomy.