Active mucosal chronic otitis media (COM) is a condition characterised by otorrhoea secondary to chronic inflammation of the middle ear and mastoid mucosa associated with granulations and a tympanic membrane perforation. Surgical intervention is often required, but concurrent mastoidectomy with tympanoplasty remains a controversial treatment option for mucosal COM. The use of laser is well established for squamous disease, but it has never been reported for mucosal disease. In this study the authors have performed a retrospective review of 70 ears operated on by the senior author. The patients who were included were those with active mucosal COM and intra-operative observation of granulation tissue. All patients underwent complete cortical mastoidectomy and tympanoplasty. A hand-held fibre 980nm diode laser was applied on macroscopic granulation tissue observed in the middle ear and mastoid cavity, and over all bone and soft tissue surfaces to eradicate microscopic disease. The mean follow-up was 22 months. The reported success rate of 94.3% is very impressive. They also reported a mean post-operative air-bone gap of <20dB in 74.3% of patients, and complications of transient vertigo (n=2), wound infection (n=2), and temporary facial nerve palsy (n=1). Interestingly, the authors report that there were no complications relating to thermal damage from the laser. They acknowledge that all the patients included in this study underwent mastoidectomy as well as tympanoplasty, which may have led to such high success rates, but a recent systematic review has suggested no benefit of concurrent mastoidectomy versus simple tympanoplasty in the management of mucosal COM. The authors surmise that the concurrent use of laser during surgery is what has led to the high success rate. There are limitations within the study such as the retrospective nature and the lack of a comparison group. Nonetheless, this is a novel pilot study, and larger prospective studies would be useful. 

Laser-assisted tympanomastoidectomy for active mucosal chronic otitis media.
Wilkie MD, Tahery J.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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