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By Peggy Peck

SAN FRANCISCO (Reuters Health) – Laser-assisted tympanic membrane fenestration (LTMF), combined with tympanocentesis, can be effective in as many as 70% of patients with otitis media with effusions (OME) that is unresponsive to medical management, according to Dr. Ellen S. Deutsch of the Alfred I. duPont Hospital for Children, Wilmington, Delaware, who presented her findings here on Sunday.

But LTMF is "far from a miracle cure," Dr. Deutsch said. She discussed treatment options for acute otitis media (AOM) and OME during a panel discussion at the American Academy of Pediatrics 2001 National Conference and Exhibition.

Dr. Deutsch said that her experience with LTMF suggests that "there are probably two distinct types of patients who can benefit from this approach. The first is the very young child with AOM, who has not responded to antibiotics and who has been up for two or three nights screaming," she said. In that case, the procedure offers "the advantage of immediate symptom relief. You can solve this problem in your office within 2 hours."

The other "ideal" patient is the older child with persistent OME who "can understand the procedure and can tolerate the discomfort."

In an interview with Reuters Health, another panelist, Dr. Seth M. Pransky of the Children's Hospital and Health Center, San Diego, California, said that pediatric otolaryngologists have been reluctant to adopt LTMF because "there is nothing this procedure offers that I cannot do with a knife for a lot less money and probably better results."

Dr. Pransky said the laser "costs about $40,000 to $50,000, and most practices are not in a position to spend that kind of money." He said that even pediatric hospitals have been reluctant to invest in the OtoLAM by ESC/Sharplan Company of Bothell, Washington, a flashscanner CO2 laser.

Dr. Deutsch said her group is "a hospital-based practice so we can share the laser with other departments," making the cost not so prohibitive. Although Dr. Pransky is not a fan of LTMF he said, "I think this could be useful in a very small subset of patients: the patient who needs immediate, short-term middle ear ventilation. For example, a child with OME who is going on a long plane trip could benefit from this immediate, short-term approach."

Dr. Deutsch said her group performs LTMF with or without tube placement "using topical anesthesia as an office procedure." Older children can "sit up for the procedure, but younger children, especially those age 2 or younger, are papoosed for the procedure," she said.

For older children who are experiencing obstructive sleep apnea as well as OME, the procedure is most effective when combined with an adenoidectomy, she said.