Schönfeld Uwe, Weiming Hu, Hofmann Veit M, Jovanovic Sergije, Albers Andreas E
Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, 12200, Berlin, Germany.
Krankenhaus Bethel Berlin and Private Practice, Promenadenstr. 3-5, 12207, Berlin, Germany.
Eur Arch Otorhinolaryngol. 2017 Dec;274(12):4131-4139. doi: 10.1007/s00405-017-4769-3. Epub 2017 Oct 11.
Total laser energy in CO stapedotomy depends on the laser settings and the amount of applications. It is unclear if the amount of total laser energy affects bone-conduction hearing thresholds and if possible effects are temporary or permanent. Alterations of bone-conduction hearing thresholds after single or multiple-shot CO laser stapedotomy were analyzed between 1 and 3 weeks and 1.5-6 months after primary (n = 501) or revision surgeries (n = 153) and correlated to time, laser energy, frequency, surgical technique, and pathology encountered in revision stapedotomy. In both time periods, most patients showed a lower bone-conduction threshold in the four-tone puretone average (PTA) at frequencies of 0.5, 1, 2, and 3 kHz that further improved over time. Between 1 and 3 weeks, the improvement was significant in subgroups with cumulative energies lower 1 J and successful one-shot technique or in revisions without laser application. The remaining subgroups with higher total energies showed significant improvements between 1.5 and 6 months. At 4 and 8 kHz, significant improvements were found during 1.5-6 months after primary and revision surgery independent of the used energy. Repeated CO laser applications showed no impairment in bone-conduction thresholds and can thus be considered as safe. In most patients, significant, yet unexplained, improvements in bone-conduction hearing thresholds were noticed in a time- and energy-related pattern.
CO2 镫骨切除术的总激光能量取决于激光设置和应用次数。目前尚不清楚总激光能量是否会影响骨传导听力阈值，以及可能产生的影响是暂时的还是永久的。在初次手术（n = 501）或翻修手术（n = 153）后的 1 至 3 周以及 1.5 至 6 个月之间，分析了单次或多次 CO2 激光镫骨切除术后骨传导听力阈值的变化，并将其与时间、激光能量、频率、手术技术以及翻修镫骨切除术中遇到的病理情况相关联。在这两个时间段内，大多数患者在 0.5、1、2 和 3 kHz 频率的四音纯音平均（PTA）中显示出较低的骨传导阈值，并且随着时间的推移进一步改善。在 1 至 3 周之间，累积能量低于 1 J 且采用成功的单次技术的亚组或未应用激光的翻修手术中，改善情况显著。其余总能量较高的亚组在 1.5 至 6 个月之间显示出显著改善。在 4 和 8 kHz 时，初次手术和翻修手术后 1.5 至 6 个月期间发现了显著改善，与所使用的能量无关。重复应用 CO2 激光未显示骨传导阈值受损，因此可认为是安全的。在大多数患者中，骨传导听力阈值出现了显著但无法解释的改善，呈现出与时间和能量相关的模式。
