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Docs Debate Using Lasers on Kids' Ears

Technique touted as painless but not trauma free

SUNDAY, Aug. 26, 2001 (HealthDayNews) -- The laser already has been heralded as a miracle treatment for correcting vision, but could it play the same breakthrough role in treating kids' ear infections?

Some experts say it could, but there are skeptics, too.

The recent introduction of laser technology to treat chronic ear infections marks a radical departure from the traditional treatment, which calls for placing a child under general anesthesia and then fitting his or her ears with ventilation tubes to prevent further infections.

That procedure has proven extremely safe. But the notion of placing a toddler under general anesthesia can make many parents cringe.

With the laser technique, however, children are given only a local anesthetic in a doctor's office. Then a laser zaps a tiny hole in each eardrum to alleviate the pressure and drain fluid from infected ears.

The laser technique also can be used to place tubes in a child's ears, with the tubes generally staying in for about a year before falling out. The tiny holes, on the other hand, stay open for about three weeks before closing.

But some doctors find that preferable.

"Laser office ventilation allows the eardrum to stay open for three to four weeks so that you have an intermediate-term ventilation as opposed to the long-term ventilation with the tubes," says Dr. Gordon Siegel, a Chicago otolaryngologist and instructor at Northwestern University Medical Center.

That's all that's needed to clear up a nagging infection for some children, Siegel says.

"It's an excellent procedure that negates the need for tubes in many children and certainly decreases the number of antibiotics required," he adds.

Besides eliminating the need for general anesthesia, the laser procedure is relatively painless, but experts say it's not necessarily trauma-free. For instance, the child must be held perfectly still.

"Having holes made in the ears can be incredibly traumatic in the office as well as in the hospital," Siegel says. "Children don't understand what's going on. They scream, and that's not only traumatic for them but for the parents who, instead of just being in the waiting room, are providing the hands that will restrain the child."

Dr. Craig Derkay, past chairman of the American Academy of Otolaryngology's pediatric committee, sees other drawbacks to the laser approach.

"It's good for selected patients who only need to have their middle ear open for longer than a day or two," Derkay says. "But the fact is, that doesn't cover many children."

"Most of the children with these frequent infections are in the 1- to 2-year-old range and need to have a tube in for a year to get to a point where their immune systems have matured and they can regulate their own middle ear pressure," he says. "Just having their ear open for three weeks is not adequate because they're going to continue to have episodes of recurring infections."

And with the equipment priced at about $75,000, doctors themselves might find the laser technology a bit traumatizing.

"The reimbursement that insurance companies pay the doctors to do this procedure is roughly $100, so it's not a very cost-effective way to treat children's ears," Derkay says. "If someone else owns the machine, I guess you could use it a lot and pay for it. But if you had to pay for it yourself, you'd really have to do a lot of over-operating in order to recoup the cost."

Derkay also questions how many parents would prefer the office trauma to general anesthesia.

"Among the benefits touted about this are that you don't have to go under general anesthesia, but you still have to physically restrain the patient, and that's really not a pleasant thing to put a child through," he says. "If it was my child, I'd rather they breathe some laughing gas than feel scared and tightly wrapped-up in restraint or held down."

What To Do

For more on the benefits and drawbacks of laser treatment for ear infections, read a point/counterpoint article provided by the American Academy of Otolaryngology.

And for more information on children's ear infections, visit the American Academy of Pediatrics online.

SOURCES: Interviews with Craig S. Derkay, M.D., professor of otolaryngology and pediatrics, Eastern Virginia Medical School, Norfolk, Va.; and Gordon Siegel, M.D., general otolaryngologist, Midwest Ear, Nose and Throat Ltd., Chicago, and instructor, Northwestern University Medical School, Chicago
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