ear surgery effective for some ear infection?

2009-05-26 08:33

DURHAM -- Thirty years ago, Kevin Crist underwent a painful and not entirely successful surgery on his middle ear -- a procedure that until very recently remained the only intervention to correct a common problem among children.

His surgery, like most of those still performed in the United States for complications of eustachian tube dysfunction, lasted an hour-and-a-half, left him in pain for days with gauze packing his ear, and ultimately didn't help his hearing.

This week, his 14-year-old daughter, Sophia, became one of a small number of youngsters to benefit from a new generation of technology to repair her middle ear.

Her procedure at Duke Children's Hospital used a carbon dioxide laser beam to smooth a bubble of tissue on her ear drum. The procedure lasted less than 10 minutes. When she awoke, her hearing was immediately better, and she had little pain.

"I'm jealous," Kevin Crist said of his daughter's experience.

Dr. David Kaylie, a Duke surgeon who is using the laser intervention as part of a study that now includes about 40 patients, said he considers the technology a major improvement over the old surgery in many instances. He will present a report about his study this fall at a meeting of the American Academy of Otolaryngologists.

"It's very, very quick, with instant results, so it's very satisfying," Kaylie said.

If proven as a viable alternative to the current surgery, the procedure could gain wide appeal, given how prevalent middle ear problems are among children.

One study found that 69 percent of children under the age of 6 who had a sinus infection also had elevated ear pressure. For most, it's a temporary problem that corrects itself as they grow.

But for some children, problems persist when their anatomy or chronic infections prevent their eustachian tubes from properly draining from the back of the nose to the middle ear.

Poor drainage creates pressure on the thin membrane of the eardrum. This membrane has an elasticity like plastic wrap, but it can get stretched out and even blow a hole if it's under constant pressure. The problem is a major cause of hearing loss.

Surgery is required to patch the hole with grafts of tissue harvested from elsewhere in the ear. In addition, a tube is implanted to improve drainage.

In cases where the eardrum hasn't ruptured, surgery may still be required if hearing loss and infections persist. In those cases, doctors usually have to puncture a hole in the stretched membrane, then do the grafting and implant a drainage tube.

Those are the cases Kaylie is targeting with the laser intervention. The high intensity light beam tightens the retracted tissue and eliminates the need to create and patch a hole in the eardrum. He still implants the tube, but the procedure takes just minutes. Kaylie said most of his patients report improved hearing immediately.

There are skeptics

Other ear, nose and throat doctors, however, urged caution about the procedure.

Dr. Craig Buchman, a professor of otolaryngology at UNC-Chapel Hill, said laser technologies have been used before in ear surgeries, with limited success.

In addition, he said, only a small subset of patients would be good candidates, because eardrum retractions don't necessarily cause problems.

"Unless there's ongoing progression" with hearing loss, Buchman said, "patients may require something other than just tightening."

But he said he was eager to see the results of Kaylie's study.

For Sophia, the laser option was especially welcome as an alternative to the procedure her father had. She had recently undergone a major surgery to correct a spinal condition related to her dwarfism and was leery of another operation.

"This was a perfect solution," said her mother, Victoria.

Sophia said she awoke from the procedure with no pain, and she resumed her usual activities within hours of leaving Durham.

"I'm happy they've come up with something better these days," she said.

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