CO2 Laser-assisted fenestration of the tympanic membrane for acute otitis media was performed in 12 patients (18 ears) for drainage from the middle ear space, and for ventilation. Using OtoLAM
TM (ESC/Sharplan, Yokneam, Israel), fenestration of the tympanic membrane of 1.8mm in diameter was created and remained patent for an average of 10.2 days (range, 4-14 days). All fenestration healed without noticeable scarring or persistent perforation. During the follow-up period (about 2months), only 1 patient (2ears) had recurrence of acute otitis media but this case had a very short period of fenestration (4days). The other patients, all of whom were infected with antibiotics-resistant bacteria, had no recurrence of acute otitis media during the follow-up period.
Oto LAM
TM appears to be a safe, cost-effective procedure, which can easily be used to perform fenestration of the tympanic membrane and obtain a longer persisting perforation than that by the usual myringotomy. With this procedure, there is a possibility of a good result in the treatment of acute otitis media.
In spite of such good points, there are the following problems
1) The fenestration persisting period was shorter than that with fenestration of the tympanic membrane for otitis media with effusion.
2) It is difficult to fenestrate a large perforation in children, whose ear canals are very small. Japanese children's ear canals are smaller than those of American and European children.
3) There are not enough examples in Japan of the use of OtoLAMTM, so we must determine the appropriate diameter and power of the CO
2 Laser for fenestration of the tympanic membrane for acute otitis media in Japanese patients.
4) It is difficult to hit CO
2 Laser at right angle to the tympanic membrane for acute otitis media because the tympanic membrane expands to the outside.
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