CO₂ laser myringoplasty: A minimally invasive technique for treating tympanic membrane atelectasis

Objective: 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. Study Design: Report of hearing and clinical outcome over a 4-year period. Setting: Tertiary center. Patients: Patients with tympanic membrane atelectasis and hearing loss. Intervention: Valsalva, hydrodissection, or manual dissection reinflated the atelectatic segment under mask anesthesia. A CO ₂ laser hand-held fiber contracted the tympanic membrane. Then, myringotomy and pressure equalizing tube placement was performed. Main Outcome Measures: Status of the tympanic membrane, patency of the tubes, and pure tone average air-bone gap on preoperative, postoperative, and most recent audiograms. Results: Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative air-bone gap was 15 dB, and this significantly improved to 7dB (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 (19dB) 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. Conclusion: 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.