LASER AND INCISIONAL MYRINGOTOMY IN OTITIS MEDIA WITH EFFUSION-A COMPARATIVE STUDY
AbstractBackground: Otitis media with effusion (OME) or middle ear effusion (MEE) is a common cause of hearing difficulty in children. MEE must be detected early and managed properly to prevent conductive hearing loss in children. It was aimed to compare results of laser myringotomy and conventional myringotomy in terms of hearing improvement, recurrence of MEE and time to put ventilation tube. Methods: This randomized control trial was conducted from February 2012 to April 2014. Children of 4 years age or older with MEE were included in the study. These children were investigated with Pure tone audiometry (PTA) and tympanometry to confirm conductive hearing loss. X-Ray nasopharynx lateral view was performed for adenoids. Sixty-six patients were randomly assigned in to 2 groups, (1) treated with laser myringotomy and (2) treated with classical myringotomy. The ears were evaluated for MEE, for presence of perforation and level of hearing. Results: A total of 98 ears in 66 patients underwent intervention. Middle ear effusion cleared in 44 out of 48 ears with laser myringotomy (LM) as compared to34 out of 50 ears with incisional myringotomy. The perforation was still patent in 36 ears treated with LM while it was found closed in all 50 ears with conventional myringotomy after 2 weeks. The hearing level improved with LM by 10–15 dB after first 3 months. Conclusion: The aim of management in otitis media with effusion is ventilation of tympanic cavity. Laser myringotomy is a best alternative to conventional one. It also has comparable results with ventilation tubes (VT). The ears with refractory or recurrent MEE should have VT insertion.Keywords: otitis media with effusion, middle ear effusion, laser myringotomy, adenoids, ventilation tubes, tympanometry
Rosenfeld R. What to expect from medical treatment of otitis media. Pediatr infect Dis J 1995;14:731–7.
Szeremeta W, Parameswaran MS, Issacson G. Adenoidectomy with laser or incisional myringotomy for otitis media with effusion. Laryngoscope. 2000;110:342–5.
Youssef TF, Ahmed MR. Laser- assisted myringotomy versus conventional myringotomy with ventilation tube insertion in treatment of otitis media with effusion: long term follow up. Interv Med Appl Sci 2013;5:16–20.
Roberts JE, Rosenfeld RM, Zeisel SA. Otitis Media and Speech and Language: A Meta-analysis of Prospective Studies. Pediatrics 2004;113(3):e238–48.
Hegazy MH. Diode laser myringotomy for short- term middle ear ventilation (a pilot study on children). Egyptian J Otolaryngol 2013; 29(4). 230–4.
D’Eredit R, Shah UK. Contac diode laser myringotomy for medium duration middle ear ventilation in children. Int J Pediatr Otorhinolaryngol 2006;70:1077–88.
Lin SH, Lai CC, Shiao AS. CO2 laser myringotomy in children with otitis media with effusion. J Laryngol Otol 2006;120(3):188–92.
Cotter CS, Kosko JR. Effectiveness of laser assisted myringotomy for otitis media in children. Laryngoscope 2004;114(3):486–9.
Poyrazoglu E, Cinicik H, Gungor A, Gurpinar B, Yildirim S and Candan H. The effects of incisional myringotomy and CO2 laser myringotomy on rat tympanic membranes. Int J Pediatr Otorhinolaryngol 2004;68(6):811–5.
Zanetti D, Piccioni M, Nassif N, Campovecchi C, Redaelli de Zinis LO. Diode laser myringotomy for chronic otitis media with effusion in adults. Otol Neurotol. 2005;26:12–8
Cohen D, Shechter Y, Slatkine M, Gatt N, Perez R. Laser Myringotomy in Different Age Groups. Arch Otolaryngol Head Neck Surg 2001;127(3):260–4
Koopman JP, Reuchli AG, Kummer EE, Boumans LJ, Rijnties E, Hoeve LJ, et al. Laser myringotomy versus ventilation tubes in children with otitis media with effusion: a randomized trial. Laryngoscope 2004;114(5):844–9.
Sedlmaier B , Jivanjee A, Gutzler R, Huscher D, Jovanovic S. Ventilation time of the middle ear in otitis media with effusion (ome) after co2 laser myringotomy. Laryngoscope 2002;112 (4):661–8
American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics 2004;113(5):1412–29
Yousaf M, Inayatullah, Khan F. Medical versus surgical management of otitis media with effusion in children. J Ayub Med Coll Abbottabad 2012;24(1):83–5