Thermal myringotomy for eustachian tube dysfunction in hyperbaric oxygen therapy

Otolaryngologists are frequently asked to manage eustachian tube dysfunctio n (ETD) in patients undergoing hyperbaric oxygen therapy (HBO). HBO patient s with intractable ETD currently are treated by tympanostomy tube placement ; typically, these tubes are indwelling far longer than is required by the duration of HBO. Also, tubes in this population are associated with higher complication rates of persistent perforation and otorrhea. We investigated the use of thermal myringotomy as an alternative to tympanostomy tube place ment in this clinical setting. Potentially, thermal myringotomy avoids the risks and complications associated with indwelling tympanostomy tubes and w ould be a temporally more appropriate treatment during short- and intermedi ate-term HBO. In this study 13 patients undergoing HBO who would have requi red tympanostomy tube placement instead underwent bilateral thermal myringo tomies. At the fifth postoperative week, 96% of myringotomies were patent; this duration is adequate for most HBO courses. No patient required a secon d myringotomy for premature closure. The persistent perforation rate was 15 % (at the end of 6 months), which compares favorably with the rate observed with tympanostomy tubes in this unique population of poor wound healers. O nly 1 patient had otorrhea; this resolved with dry ear precautions. This st udy demonstrates thermal myringotomy to be an effective technique for middl e ear ventilation in patients undergoing HBO in whom ETD develops.