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

Marisa Ryan, David Kaylie

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1694-1698
Number of pages5
JournalOtology and Neurotology
Volume34
Issue number9
DOIs
StatePublished - Aug 30 2013

Fingerprint

Myringoplasty
Tympanic Membrane
Pulmonary Atelectasis
Gas Lasers
Hearing
Air
Bone and Bones
Lasers
Ear
Hand
Carbon Monoxide
Masks
Hearing Loss
Cost-Benefit Analysis
Dissection
Anesthesia
Outcome Assessment (Health Care)
Prospective Studies
Pressure
Costs and Cost Analysis

Keywords

  • Atelectasis
  • CO laser
  • Hearing
  • Myringoplasty
  • Retraction pocket

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

CO2 laser myringoplasty : A minimally invasive technique for treating tympanic membrane atelectasis. / Ryan, Marisa; Kaylie, David.

In: Otology and Neurotology, Vol. 34, No. 9, 30.08.2013, p. 1694-1698.

Research output: Contribution to journalArticle

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abstract = "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.",
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