Hearing Improvement after CO 2 Laser Myringoplasty

Abstract

Objective: 1) Report hearing improvement after CO₂ laser myringoplasty using handheld fiber. 2) Describe method for CO₂ laser myringoplasty.

Method: Retrospective study of hearing over a 4-year period of patients with atelectacic TM and hearing loss. CO₂ laser myringoplasty performed using handheld fiber to contract TM at 2W 100-msec pulse. Attempts to reinflate the retraction pocket were performed using Valsalva, hydrodissection, or manual dissection. Tympanostomy tubes were placed in all patients.

Results: Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative ABG was 15 dB. The average postoperative ABG was significantly improved at 7 dB (P < .001). Hearing improvement remained significantly improved in 17 patients with greater than 2 years follow-up with final ABG of 7 dB (P = .007). The presence of effusion on hearing was assessed. Patients with effusion had worse preoperative ABG (19 dB) compared to dry ears (12 dB) (P = .02), however, postoperative ABG and long-term ABG was not significantly different in the 2 groups (P = .3). Patients with myringostapediopexy that could not be elevated did not experience significant hearing improvement.

Conclusion: Laser myringoplasty for treatment of TM retraction using a CO₂ laser with handheld flexible fiber significantly improves hearing immediately and in long term follow-up. This system allows precise control of energy delivery to the TM. It also allows for laser delivery outside of direct line of sight. Patients with hearing loss and no effusion had significant immediate hearing improvement. Patients with effusions experience the greatest hearing improvement. Patients with TM adherence to ossicles that cannot be elevated with Valsalva are at greater risk for suboptimal hearing results.