Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Laryngoscope. 2013 Jun;123(6):1519-26. doi: 10.1002/lary.23864. Epub 2013 Jan 31.
OBJECTIVES/HYPOTHESIS: To evaluate the safety and efficacy of the one-shot noncontact technique in stapedotomy for revision stapes surgery with a CO₂ laser combined with a scanning system.
Prospective study.
Intraoperative findings and hearing results of 106 patients who underwent revision CO₂ laser stapedotomy because of conductive or sensorineural hearing loss or vertigo were analyzed.
Leading pathologies were displacement of the prosthesis, incus erosion, fibrous adhesions, and bony reobliteration or a too long or too short prosthesis. Surgery was successfully performed in all cases with a noncontact technique resulting in significantly improved postoperative air and bone conduction. The rate of permanent complications was 0.9%. A comparison of the effect of higher laser energies used for the perforation of bony stapes footplates and lower energies for neomembranes revealed no significant difference in hearing results, underscoring the safety of the technique.
To avoid any manipulation of the conductive hearing chain that may cause sensorineural hearing loss, we adapted the noncontact technique previously introduced by us for use in revision stapedotomy. This technique was successfully applied to improve conductive and sensorineural hearing loss as well as vertigo in first and second revision stapedotomy cases. Because the rate of postoperative complications was comparable to what is achieved with other laser systems, we conclude that the method has at least an equal level of safety. In conclusion, we advocate the use of a noncontact technique as suitable for an early revision of failed stapedotomy.
目的/假设：评估 CO₂ 激光联合扫描系统的一次性非接触技术在镫骨切除术翻修中的安全性和疗效。
前瞻性研究。
分析了 106 例因传导性或感音神经性听力损失或眩晕而行 CO₂ 激光镫骨切除术翻修的患者的术中发现和听力结果。
主要病变为假体移位、砧骨侵蚀、纤维粘连、骨质再闭塞或假体过长或过短。所有病例均采用非接触技术成功完成手术，术后气导和骨导明显改善。永久性并发症发生率为 0.9%。对于较高激光能量用于穿孔骨镫骨底板和较低能量用于新膜的效果比较，听力结果无显著差异，突出了该技术的安全性。
为避免任何可能导致感音神经性听力损失的传导性听力链的操作，我们采用了我们之前为镫骨切除术翻修引入的非接触技术。该技术成功应用于改善初次和二次镫骨切除术翻修病例的传导性和感音神经性听力损失以及眩晕。由于术后并发症发生率与其他激光系统相当，我们得出结论，该方法至少具有同等的安全性。总之，我们主张使用非接触技术作为早期翻修失败的镫骨切除术的合适方法。
