CO2 Laser Myringoplasty

Abstract

1) To describe a cost-effective, minimally invasive technique for treating tympanic membrane atelectasis, and 2) to present data on hearing improvement in patients receiving this as the basis for a future prospective study. Report of hearing and clinical outcome over a 4-year period. Tertiary center. Patients with tympanic membrane atelectasis and hearing loss. Valsalva, hydrodissection, or manual dissection reinflated the atelectatic segment under mask anesthesia. A CO2 laser hand-held fiber contracted the tympanic membrane. Then, myringotomy and pressure equalizing tube placement was performed. Status of the tympanic membrane, patency of the tubes, and pure tone average air-bone gap on preoperative, postoperative, and most recent audiograms. Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative air-bone gap was 15 dB, and this significantly improved to 7 dB (p < 0.001) postoperatively. Hearing improvement remained significant in the 17 patients with greater than 2 years' follow-up (7 dB, p = 0.007). Patients with effusion had worse preoperative air-bone gap (19 dB) compared with dry ears (12.5 dB, p = 0.02). However, postoperative and long-term air-bone gaps were not significantly different in the 2 groups (p = 0.3). Patients with myringostapediopexy that required or failed mechanical elevation did not have significant hearing improvement. Laser myringoplasty for treatment of tympanic membrane atelectasis using a hand-held flexible fiber CO2 laser is feasible and may improve hearing immediately and long term. It is not useful in severe adherent atelectasis. More studies are indicated to confirm its overall cost-effectiveness and competitiveness with traditional methods of managing atelectasis.