Results of CO2 laser stapedotomy with Teflon piston prosthesis and autologous blood seal.

OBJECTIVE: To study the hearing results and complications in otosclerotic patients who underwent Carbon dioxide (CO2) laser stapedotomy using Teflon piston prosthesis and autologous blood seal. MATERIAL AND METHOD: The charts of all primary CO2 laser stapedotomy procedures performed at Bangkok Metropolitan Administration Medical College and Vajira Hospital between 1997 and 2005 were reviewed. Patients who used Teflon piston prosthesis and autologous blood seal and had follow-up data of more than one year were selected for inclusion in the study. Any patients who underwent CO2 laser stapedotomy for diseases other than otosclerosis or those with inadequate postoperative data were excluded. The hearing results from preoperative and postoperative (most recent follow-up) periods were analyzed using closure of air-bone gaps and postoperative sensorineural hearing loss (SNHL) at pure-tone average (PTA) and different frequencies. Major complications were recorded. RESULTS: The present review yielded 73 primary CO2 laser stapedotomy procedures performed between 1997 and 2005, and 36 patients who underwent 40 CO2 laser stapedotomies met the criteria for analysis. The hearing outcomes were followed for an average of 22 months. The average preoperative and postoperative PTA air-bone gaps were 32.7 and 7.5 dB, respectively. The rate of patients who had postoperative PTA air-bone gaps within 10 dB was 77.5% and within 15 dB was 95%. There was a significant closure of air-bone gaps at PTA and at all frequencies (the frequencies from 0.5 to 4 kHz) and the closures of air-bone gaps at 0.5, 1, and 2 kHz were statistically better than at 4 kHz. The overall rate of postoperative SNHL was 7.5% at high pure-tone bone conduction average. There were no major postoperative complications. CONCLUSION: CO2 laser stapedotomy with Teflon piston prosthesis and autologous blood seal is a safe and effective treatment for otosclerosis. The procedure provides acceptable hearing results and gives the more air-bone gap closure at the low and mid frequency ranges without significant postoperative SNHL and other serious complications.

Early and late hearing outcomes after CO2 laser stapedotomy.

BACKGROUND: Carbon dioxide (CO) laser stapedotomy is now one of the standard surgical treatments for otosclerosis. However, there are little normative data of the course of postoperative hearing acuity and the course of postsurgical depression of cochlear function of this technique. OBJECTIVE: To compare the hearing outcomes between early (between 1 to 3 months) and late (more than 1 year) postoperative periods in otosclerotic patients who underwent CO2 laser stapedotomy. MATERIAL AND METHOD: The charts of 73 primary CO2 laser stapedotomy procedures performed at Bangkok Metropolitan Administration Medical College and Vajira Hospital between 1997 and 2005 were reviewed. Only patients with early postoperative audiometric data between 1 to 3 months and with long-term postoperative audiometric data more than 1 year were selected for inclusion in the present study. Any patients who underwent CO2 laser stapedotomy for diseases other than otosclerosis and those who had revision surgery were excluded from the present study. The early and the late postoperative hearing outcomes were compared using postoperative closure of air-bone gaps and postoperative sensorineural hearing loss at pure-tone average and different frequencies. RESULTS: A group of 26 patients who underwent 30 CO2 laser stapedotomies met the criteria for analysis. The hearing outcomes were followed at the early and the late postoperative periods for an average of 1.8 and 36.2 months, respectively. The present study indicated that closure of air-bone gaps at pure-tone average and individual frequencies began in the early postoperative period and continued to improve through the late postoperative period. Bone conduction hearing thresholds were stable even in the early postoperative follow-up and the improvement in bone conduction hearing thresholds at 1 and 2 kHz and worsening at 4 kHz were seen. CONCLUSION: After CO2 laser stapedotomy, the stability of cochlear function begins in the early postoperative period and remains stable through the late postoperative period. The conductive component of hearing thresholds continues to improve through the late postoperative period. Thus, the early postoperative hearing outcomes reflect a side effect of postsurgical sensorineural hearing loss and the long-term postoperative hearing outcomes determine the efficacy of this procedure.