Sedlmaier Benedikt, Jivanjee Antonio, Gutzler Rico, Huscher Dörte, Jovanovic Sergije
Ear, Nose and Throat Department, Medical Center Benjamin Franklin, Free University of Berlin, Germany.
Laryngoscope. 2002 Apr;112(4):661-8. doi: 10.1097/00005537-200204000-00013.
The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan.
Prospective clinical study.
In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter.
None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37; P <.05).
The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media.
本研究旨在探讨使用二氧化碳激光耳镜Otoscan进行鼓膜切开术后的经鼓膜通气时间、鼓膜愈合过程、早期和晚期并发症以及6个月内分泌性中耳炎（OME）的复发率。
前瞻性临床研究。
在本研究中，使用二氧化碳激光耳镜Otoscan对81名患有分泌性中耳炎（OME）并伴有腺样体增生且有时伴有扁桃体增生的儿童（159耳）进行激光鼓膜切开术。鼓膜手术相应地与腺样体切除术、二氧化碳激光扁桃体切开术或扁桃体切除术相结合，因此在吹入麻醉下进行。在所有耳朵中，在下前象限以12至15W的功率、180毫秒的脉冲持续时间和直径2.2mm的扫描区域创建约2mm的圆形穿孔。
所有儿童均未出现术后耳蜗前庭功能损害，如感音神经性听力损失或眼球震颤。耳显微镜和视频内镜监测记录了鼓膜穿孔的闭合时间和愈合模式。平均闭合时间为16.35天（最短8天；最长34天）。通常，在闭合时，先前鼓膜切开术穿孔处可见一层洋葱皮样的角质化物质膜。6个月后的随访中，129耳（81.1%）的鼓膜状况可通过耳显微镜和视频内镜检查，听力通过听力测定和鼓室图检查。二氧化碳激光鼓膜切开术部位外观正常且无刺激。检查的鼓膜中有2耳（1.6%）出现萎缩性瘢痕形成，1耳（0.8%）有直径0.3mm的穿孔。术后15个月的对照耳镜检查中可见穿孔已闭合。术中见有黏液分泌的耳中OME复发率为26.3%（n = 38），有浆液分泌的耳中OME复发率为13.5%（n = 37；P <.05）。
治疗OME的最重要原则是鼓室通气。二氧化碳激光鼓膜切开术通过自我愈合的穿孔实现这一点，穿孔直径大致决定经鼓膜通气的持续时间。激光鼓膜切开术在治疗OME方面与插入通气管相竞争。它可能是分泌性中耳炎手术治疗中的一种有用替代方法。
