The role of laser assisted tympanostomy (LAT) in treating allergic children with chronic serous otitis media

Abstract

Objectives: To assess various prognostic factors influencing the outcome in paediatric patients with serous otitis media, who have undergone laser assisted tympanostomy without ventilation tube placement. Emphasis is given to children with allergies who underwent the procedure. Method: Laser assisted tympanostomy was performed on a total of 130 ears (92 individuals) with chronic otitis media with effusion. To determine the quality of patient outcome, the following parameters were evaluated: external auditory canal anatomy, type of anaesthesia used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a history of allergies and the laser device parameters. Results: Multivariable statistical analysis demonstrated that the presence of allergies in children with chronic serous otitis media is significantly correlated with a poor outcome ( P<0.0047). Moreover, the presence of a thick tympanic membrane and/or high viscosity (glue) fluid in the middle ear cavity can also independently influence patient outcome ( P<0.025). Simultaneous adenoidectomy and/or tonsillectomy, type of anaesthesia (general versus local), external canal anatomy (wide or narrow) and sex, were not statistically important prognostic factors. The type of anaesthesia used, myringotomy size and the laser device parameters were not found to be associated with patient outcome. Conclusion: A history of allergies, the presence of a thick tympanic membrane and/or high viscosity fluid in the middle ear cavity are all contraindications for laser assisted tympanostomy without tympanostomy tubes, in children who suffer from chronic serous otitis media. The selection criteria for this procedure in the paediatric population are addressed in detail.