The Rate of General Anesthesia after Laser Tympanostomy with Ventilation Tube Insertion: A Prospective Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate if laser tympanostomy (LT) flexibly combined with ventilation tube insertion(VT) would result in the decreased rate of general anesthesia. This approach (LT+VT) would be an initial surgical approach for children with otitis media with effusion (OME). SUBJECTS AND METHOD: We made a prospective study that enrolled all the children with bilateral otitis media with effusion (OME) eligible for surgical intervention from January 2003 to December 2003, and 12 months postoperative follow-up. Laser tympanostomy under topical anesthesia was followed by VT insertion in the cooperative children. The success of treatment was defined as VT insertion under topical anesthesia or management of MEE without general anesthesia for 12 months. RESULTS: 79 children with bilateral OME were included. Overall cooperation to bilateral laser tympanostomy was 87%. Further cooperation to 1st VT was possible in 73% and 2nd VT in 45%. Overall efficacy of LT+VT was 91%. VT insertion on the cooperative children was presumed to increase the efficacy of laser tympanostomy by 24%. LT with VT might eliminate 80% of general anesthesia and the rate of G/A was 20% in our hospital. The rate of general anesthesia decreased to 9% when the child tolerated LT on both ears and to only 3% when the child tolerated at least one VT. CONCLUSION: LT with VT insertion might help to maintain high cooperation rate (87%), improved efficacy (91%), and therefore could reduce the rate of general anesthesia. LT+VT used under topical anesthesia might be an initial surgical approach for all OME children if the surgeon is willing to.

GUARDIX-SL(R) in Sinus Surgery: A Preclinical Animal Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most frequent complication of FESS (functional endoscopic sinus surgery) is stenosis of the operation site. The complication may influence the postoperative wound healing and the outcome of surgery. There are several measures proposed to prevent the complication. We sought to determine the efficacy of GUARDIX-SL which is made from sodium hyaluronate and sodium carboxymethylcellulose in soluble form. MATERIALS AND METHOD: For 7 rabbits, we made a surgical opening anterior to sinus ostium of the maxillary sinuses on both sides. We put the gelfoams soaked with GUARDIX-SL into the left openings and those soaked with normal saline into the right openings as a control group. We measured the size of the openings after two weeks. RESULTS: There was no synechiae in GUARDIX-SL group whereas we found synechiae developed in two openings in the control group. The mean area of the opening was 9.29 mm2 and 1.61 mm2 in GUARDIX-SL group and the control group (p=0.027), respectively. CONCLUSION: GUARDIX-SL was effective in reducing postoperative stenosis in the animal model.

Treatment Outcome of Laser Tympanostomy with Ventilation Tube Insertion under Topical Anesthesia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study is to find out whether laser tympanostomy (LT) with tympanostomy tube (TT) insertion has some potential role for the treatment of children with chronic otitis media with effusion (OME) under the topical anesthesia. SUBJECTIVES AND METHOD: We prospectively enrolled 89 OME children (2-7 yrs old, 139 ears) for LT with TT insertion under topical anesthesia. Following LT, TT insertion was done if the middle ear effusion was mucoid or if middle ear mucosa was inflammed, or if the child had poor prognostic factors. RESULTS: Ninety-four ears (68%) had mucoid effusion, 18 ears (13%) serous effusion, 11 ears (8%) purulent effusion, and 16 ears (12%) were dry. It was determined that TT insertion was not necessary in 26 ears (19%). TT insertion into the laser tympanostomy opening was tried on the other 113 ears. TT insertion had a success rate of 81% (91/113). After 3 months of follow-up, LT that did not need TT insertion showed 81% (21 ears) resolution rate. Therefore, the total efficacy of LT with TT insertion under topical anesthesia was 85%. CONCLUSION: Laser tympanostomy with TT insertion resulted in increased efficacy. Also, compared to knife myringotomy, it seems to have a potential role for lowering the age group of OME children whom can be managed under topical anesthesia.