CO2 laser myringoplasty

Introduction: We performed laser myringoplasty to treat retraction pockets of the tympanic membrane using a CO2 laser via flexible photonic band-gap fibers manufactured by Omni-Guide. Similar techniques to treat retraction pockets using laser myringoplasty have been described with both the CO2 and KTP lasers. Objective: To report the efficacy of treating tympanic membrane retraction pockets using laser myringoplasty with a novel hand-held flexible photonic band gap fiber CO2 laser. Methods: A hand-held flexible photonic band gap fiber CO2 laser system (Omniguide) was used to treat tympanic membrane retraction pockets. Prior to use of the laser, attempts were made to release membrane adherent to the middle ear space structures. Tympanostomy tubes were placed in all patients. Results: Laser myringoplasty was performed on nineteen patients, for a total of 24 ears. Audiograms were performed on average three weeks after surgery. Air- bone gaps were calculated for pure tones at 0.5, 1, 2 and 3 kHz. The average preoperative ABG for the 25 ears was 13.9dB. The average postoperative ABG was 8.5dB. (P=0.02) The twenty ears with no effusion experienced an ABG closure from 12.1dB to 7.8dB whereas the four ears found to have an effusion had an average ABG closure from 22.7dB to 7.00dB. Conclusion: Laser myringoplasty using the Omni-Guide hand-held flexible fiber CO2 laser independently produces hearing improvement. The handheld laser allows the surgeon to control the amount of energy delivered to the tympanic membrane and allows the surgeon to work outside of direct line of sight of the microscope resulting in improved accuracy and precision of the procedure. Ears found to have effusions experience the greatest hearing improvement. Patients with membrane adherence not amendable to valsalva may be at greater risk for sub-optimal hearing results. © 2010 Copyright SPIE - The International Society for Optical Engineering.

Duke Scholars

Author David Marcus Kaylie Otology, Neurotology & Skull Base Surgery