Management of Persistent or Recurrent Otorrhea after Open Cavity Tympano-Mastoidectomy: Laser Application

Kim, Jin Hong; Cho, Sung Bae; Kim, Tae Hyung; Kim, Su Jin; Cho, Young Hong; Lee, Dong Myung

Abstract

BACKGROUND AND OBJECTIVES: Persistent and recurrent otorrhea following open cavity tympano-mastoidectomy can be a serious problem for the patient and the otologic surgeon. Frequent post-operative otorrhea hallmarks surgical failure. Medical treatment may often yield resolution, but a significant number of patients would still require re-operation. So we applied CO2 laser cauterization to draining cavity. The objective of the present study was to introduce the CO2 laser cauterization on draining cavity, and to describe the clinical course of the laser treatment. MATERIALS AND METHOD: Twenty-one cases of post-operative persistent or recurrent otorrhea were diagnosed at our hospital from January 1999 to December 2000. Fifteen cases were selected in this study. The selection criteria included chronic ear patient, open cavity tympano-mastoidectomy, absent residual or recurrent cholesteatoma. The minimum duration of follow up was 6 months. All cases were locally anesthetized with 10% xylocaine. The CO2 laser was Shaplan 100 which was connected to a microscope. The interval of CO2 laser cauterization was one week.
RESULTS
All of 15 cases were cured completely. There was no recurrence during the follow up period. The locations of granulation tissues were tegmen (10 cases), mastoid tip (6 cases), retro-facial or facial ridge (4 cases), and sino-dural angle (4 cases). The mechanical causes of retention of debris in open cavity procedures included insufficient meatoplasty (3 cases) and high facial ridge (2 cases). The times of CO2 laser coagulation ranged from 2 to 5.
CONCLUSION
Based on our research on the effect of CO2 laser among patients with draining cavity, we concluded that : 1) CO2 laser cauterization was an efficient method for the management of draining cavity, 2) CO2 laser cauterization has benefits which reduced the frequency of OPD visits and 3) CO2 laser cauterization provided a delicate, selective removal of granulation tissues.