Office-based laser assisted tympanic membrane fenestration in adults and children: pilot data to support an alternative to traditional approaches to otitis media

Objectives: To determine the role of intermediate duration (similar to 3 we eks) middle ear ventilation using office-based laser assisted tympanic memb rane fenestration in resolving an episode of otitis media with effusion in adults and children who otherwise would have been treated with insertion of pressure equalization tubes. Methods: A retrospective chart review of 92 p atients (162 ears) was conducted to identify the utility and technical chal lenges associated with laser assisted tympanic membrane fenestration in an office setting. Clinical characteristics reviewed included: age, gender, du ration of effusion, season performed, and hearing and health status of midd le ear upon healing of the fenestration. Results: 69% of all patients were effusion free upon closure of the fenestration; 68% of those <3 years; 70% of those 3-7 years; and 70% of those 25-80 years. Some episodes recurred an d at final follow-up 64% had normal middle ear structure and function (rang e of follow-up = 1-18 months, mean 2.5 months, median 2.0). Shorter duratio n of effusion pre-fenestration was more often associated with return to nor mal middle ear structure and function (P < 0.01). Season performed, number of previous episodes of otitis media and pre-treatment tympanometry were no t predictive of result. No significant complications were observed. Conclus ions: The use of office-based laser assisted tympanic membrane fenestration is a reasonably safe and effective procedure for the treatment of otitis m edia in most adults and children. As a minimally invasive otologic procedur e, laser assisted tympanic membrane fenestration has great potential to dec rease the rates of both antibiotic usage and insertion of ear tubes. (C) 20 00 Elsevier Science ireland Ltd. All rights reserved.