Boonchoo Ronayooth, Puapermpoonsiri Pichai
Department of Otolaryngology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2007 Oct;90(10):2097-103.
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.
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.
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.
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.
研究采用聚四氟乙烯活塞假体及自体血封闭行二氧化碳（CO₂）激光镫骨切除术的耳硬化症患者的听力结果及并发症。
回顾了1997年至2005年期间在曼谷都市管理医学院和瓦吉拉医院进行的所有原发性CO₂激光镫骨切除术的病历。选择使用聚四氟乙烯活塞假体及自体血封闭且有一年以上随访数据的患者纳入研究。排除任何因耳硬化症以外的疾病接受CO₂激光镫骨切除术的患者或术后数据不充分的患者。使用气骨导间距的闭合情况以及纯音平均听阈（PTA）和不同频率下的术后感音神经性听力损失（SNHL）分析术前和术后（最近一次随访）的听力结果。记录主要并发症。
本综述得出1997年至2005年期间进行了73例原发性CO₂激光镫骨切除术，36例患者接受了40次CO₂激光镫骨切除术符合分析标准。平均随访听力结果22个月。术前和术后PTA气骨导间距平均分别为32.7 dB和7.5 dB。术后PTA气骨导间距在10 dB以内的患者比例为77.5%，在15 dB以内的为95%。PTA及所有频率（0.5至4 kHz频率）下气骨导间距均有显著闭合，且0.5、1和2 kHz频率下气骨导间距的闭合在统计学上优于4 kHz频率。术后高频率纯音骨导平均听阈下SNHL的总体发生率为7.5%。术后无主要并发症。
采用聚四氟乙烯活塞假体及自体血封闭的CO₂激光镫骨切除术是治疗耳硬化症的一种安全有效的方法。该手术提供了可接受的听力结果，在低频和中频范围内气骨导间距闭合更佳，且术后无明显SNHL及其他严重并发症。
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