Thermal myringotomy for eustachian tube dysfunction in hyperbaric oxygen therapy

Otolaryngologists are frequently asked to manage eustachian tube dysfunction (ETD) in patients undergoing hyperbaric oxygen therapy (HBO). HBO patients with intractable ETD currently are treated by tympanostomy tube placement; typically, these tubes are indwelling far longer than is required by the duration of HBO. Also, tubes in this population are associated with higher complication rates of persistent perforation and otorrhea. We investigated the use of thermal myringotomy as an alternative to tympanostomy tube placement in this clinical setting. Potentially, thermal myringotomy avoids the risks and complications associated with indwelling tympanostomy tubes and would be a temporally more appropriate treatment during short- and intermediate-term HBO. In this study 13 patients undergoing HBO who would have required tympanostomy tube placement instead underwent bilateral thermal myringotomies. At the fifth postoperative week, 96% of myringotomies were patent; this duration is adequate for most HBO courses. No patient required a second myringotomy for premature closure. The persistent perforation rate was 15% (at the end of 6 months), which compares favorably with the rate observed with tympanostomy tubes in this unique population of poor wound healers. Only 1 patient had otorrhea; this resolved with dry ear precautions. This study demonstrates thermal myringotomy to be an effective technique for middle ear ventilation in patients undergoing HBO in whom ETD develops.