Laser Assisted Myringotomy
DESCRIPTION
Myringotomy describes the technique used to create a temporary opening in the tympanic membrane without the insertion of a pressure-equalizing tube (PET). Tympanostomy describes the technique used to create an opening in the tympanic membrane in conjunction with the insertion of a PET. A PET insertion is usually indicated for continuous middle ear aeration for individuals with chronic otitis media with effusion (OME). Myringotomies can be used to acutely decompress the OME affected ear and thus relieve pain. Fluid can also be withdrawn during the procedure to assess for antibiotic needs.
The use of laser-assisted myringotomy is being investigated as an alternative to conventional myringotomy or tympanostomy with tube insertion. This procedure can be performed in the physician's office on anyone older than 6 months of age using only local anesthesia. The eardrum is usually anesthetized using a topical anesthesia. A video monitor is used to pinpoint the exact location for the hole. The precise location for the hole is programmed into the computer, and a CO2 laser creates a small, bloodless opening (1.0 - 3.0 mm) in the tympanic membrane. The procedure takes approximately five minutes once the eardrops have taken effect. The opening usually heals within 3-6 weeks and is normally undetectable afterwards.
POLICY
Laser-assisted myringotomy is considered investigational.
ADDITIONAL INFORMATION
It has not been demonstrated in the scientific literature that laser-assisted myringotomy is as effective as treatment with conventional myringotomy or tympanostomy with tube insertion. Well-designed, randomized, controlled studies are needed to evaluate laser-assisted myringotomy.
SOURCES
American Academy of Family Physicians (AAFP); American Academy of Otolaryngology - Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. (2004). Otitis media with effusion. Pediatrics. 113 (5), 1412-1429. Abstract retrieved August 6, 2008 from PubMed database.
American Academy of Otolaryngology-Head and Neck Surgery. (2001, March). Policy Statements. Laser myringotomy. Retrieved June 17, 2003 from http://www.entlink.net/practice/rules/laser_myringotomy.cfm.
Bent, J. P., April, M. M., Ward, R. F., & Packard, A. M. (2000). Role of otoscan-assisted laser myringotomy in hyperbaric oxygen therapy. Undersea Hyperbaric Medicine, 27 (3), 159-161. Abstract retrieved June 17, 2003 from PubMed database.
BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2007). Laser assisted myringotomy and tympanostomy (2.01.36). Retrieved August 5, 2008 from BlueWeb.
Garin, P., & Remacle, M. (1999). Laser-assisted myringotomy combined with adenoidectomy in children: Preliminary results. Acta Oto-rhino-laryngologica Belgica, 53 (2), 105-108. Abstract retrieved August 16, 1999 from PubMed database.
Klein, J. O. (2000). Management of otitis media: 2000 and beyond. Pediatric Infectious Disease Journal, 19 (4), 383-387. Abstract retrieved November 6, 2001 from PubMed database.
Koopman, J. P., Reuchlin, A. G., Kummer, E. E., Boumans, L. J., Rijntjes, E., Hoeve, L. J. et al. (2004). Laser myringotomy versus ventilation tubes in children with otitis media with effusion: A randomized trial. The Laryngoscope, 114 (5), 844-849. Abstract retrieved April 4, 2005 from PubMed database.
Reilly, J. S., Deutsch, E. S., & Cook, S. (2000). Laser-assisted myringotomy for otitis media: A feasibility study with short-term followup. ENT-Ear, Nose & Throat Journal, 79 (8), 650-657.
Silverstein, H., Kuhn, J., Choo, D., Krespi, Y. P., Rosenberg, S. I., & Rowan, P. T. (1996). Laser-assisted tympanostomy. The Laryngoscope, 106 (9, Pt. 1), 1067-1074. Abstract retrieved August 8, 1999 from PubMed database.
Szeremeta, W., Parameswaran, M. S., & Isaacson, G. (2000). Adenoidectomy with laser or incisional myringotomy for otitis media with effusion. The Laryngoscope, 110 (3, Pt. 1), 342-345.
ORIGINAL EFFECTIVE DATE: 6/1/2000
MOST RECENT REVIEW DATE: 9/25/2008
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