HNO · 2009
[CO2-laser-assisted de-epithelialization of perforation margins of persistent tympanic membrane perforations. An alternative to conventional surgical procedures].
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Bessler C, Haisch A, Jovanovic S, Sedlmaier B
Аннотация
INTRODUCTION: The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated.
MATERIAL AND METHODS: A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested.
RESULTS: Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment.
CONCLUSION: A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.
MATERIAL AND METHODS: A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested.
RESULTS: Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment.
CONCLUSION: A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.