Minimally Invasive Laser Contraction Myringoplasty for Tympanic Membrane Atelectasis *

Abstract

OBJECTIVE: We sought to develop a minimally invasive surgical technique using the CO₂ laser to reduce or eliminate tympanic membrane atelectasis in a select group of patients.

STUDY DESIGN: Thirty-seven ears with varying degrees of tympanic membrane atelectasis underwent CO₂ laser myringoplasty with the patients under intravenous sedation in the operating room setting. Atelectasis severity was graded for each patient and documented before and after laser myringoplasty through photodocumentation. Patients were followed for 1 year with comparison tympanic membrane photography.

SETTING: The study was conducted in a tertiary care private otology-neurotology practice.

RESULTS: Laser myringoplasty significantly reduced retraction pocket severity in most patients. No patients required resection of the retraction pocket or tympanoplasty. The most favorable outcomes were observed in patients with atelectasis addressed early rather than later in its more advanced stages.

CONCLUSION: Laser contraction myringoplasty can reduce or eliminate atelectatic areas of the tympanic membrane through immediate contraction and “tightening” of the tympanic membrane tissues. Clinicians should use a standardized tympanic membrane atelectasis grading format.

SIGNIFICANCE: A minimally invasive surgical technique for addressing tympanic membrane atelectasis is described, and a tympanic membrane at-electasis grading system is presented based on size, location, and depth of the atelectatic region.