Mediterr J Otol 2005:1(2):79-82.

Comparison of the duration of patency and closure rate between laser-assisted myringotomy and incisional myringotomy in Infants with acute otitis media

Cohen D., Engelhard D., Gatt N., Perez R., Shechter Y., Raveh D.
Dept. Otolaryngology and Infectious Diseases Unit, Jerusalem, Israel.  ent@szmc.org.il

OBJECTIVES: There has been a renewed interest in myringotomy in recent years due to the limited results of antibiotic treatment and undesirable e ffects of ventilating tubes. The purpose of this study was to compare the duration of patency and closure rate between laser-assisted myringotomy (LAM) and incisional myringotomy (IM) applications in infants with acute otitis media (AOM).

PATIENTS AND METHODS: The study included 397 consecutive infants with AOM, younger than 12 months old. All the cases were divided into two groups according to the date of presentation at which one type of myringotomy was performed, that is, before 1997 (IM, 32 ears) and from that time forth (LAM, 494 ears). After parental informed consent was obtained from all cases, myringotomy was performed as the sole procedure without the use of antibiotics, followed by monitoring for seven to eleven days. The mean time to closure and the mean closure rate were calculated for both groups.

RESULTS: The mean myringotomy size was 6 mm2 (1 mm by 6 mm) in the IM group and 2 mm2 (radius, 0.8 mm) in the LAM group. The mean time to closure significantly differed between the two groups, being 3.31±2.1 days for IM and 12.71±6.9 days for LAM (p<0.0001). Similarly, the mean closure rate was significantly lower in the LAM group  0.20±0.10 mm2/day versus 2.28±0.8 mm2/day, p<0.0001).

CONCLUSION: Prolonged LAM patency in infants provides a longer duration of ventilation to the middle ear, which increases the chance to recover and minimizes the need for antibiotic treatment. These results may also have implications for the general use of laser techniques in otolaryngology and other specialties.