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David Cohen, MD; Yossi Shechter, EE; Michael Slatkine, PhD; Netta Gatt, MD; Ronen Perez, MD

Arch Otolaryngol Head Neck Surg. 2001;127:260-264.

Objective  To study the qualities of laser myringotomy (LM) as a treatment for middle ear ventilation problems.

Design  Prospective study and follow-up of consecutive cases of adults, children, and infants. Patients were observed for up to 2 years.

Setting  Children underwent LM, with or without adenoidectomy, under general anesthesia in the operating room. Adults and infants underwent LM under topical anesthesia, as an outpatient procedure.

Patients  All consecutive patients with either secretory otitis media (SOM) (adults and children) or acute otitis media (AOM) (infants) who agreed to participate were included without selection.

Intervention  Myringotomy was performed using new laser equipment, enabling a 0.1-second ablation with changeable diameter.

Outcome Measures  Close follow-up, with microscopic examination of all ears. Findings were noted on the medical charts.

Results  Among all age groups, 136 ears were followed up. Perforation lasted a mean 22 days in adults, 17 days in children, and 11 days in infants. Patient age was found to be a significant determining factor for duration of perforation (P = .002). Laser myringotomy in the anterior and inferior areas lasted longer than posterior LM (P<.001). In patients with SOM, during the time the LM was patent, all ears were ventilated. In children, 38% of SOM cases resolved after a single LM treatment. All infants with AOM recovered promptly without antibiotic treatment.

Conclusions  Laser myringotomy is a convenient, quick procedure that can be performed in the medical office with the use of topical anesthesia and is suitable for patients with AOM or for those who need short-term ventilation for SOM. It was found to be a safe alternative to ventilation tubes in these patients. In AOM, it was used instead of antibiotics and gave prompt relief from symptoms and cure of the AOM.

From the Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, Israel (Drs Cohen, Gatt, and Perez); and ESC/Sharplan, Tel Aviv, Israel (Mr Shechter and Dr Slatkine).

Corresponding author: David Cohen, MD, Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center, PO Box 3235, Jerusalem, Israel 91031 (e-mail: yossis{at}escmed.com).

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