Nair Lakshmi, Gildener-Leapman Neil, Parnes Steven
1Albany Medical College, 47 New Scotland Ave, Albany, NY 12208 USA.
2Division of Otolaryngology, Albany Medical College, Albany, NY USA.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 2):1364-1368. doi: 10.1007/s12070-018-1430-4. Epub 2018 Jun 21.
Tympanoplasty repairs tympanic membrane perforations but also covers an umbrella of procedures characterized by surgery of the mastoid bone. Tympanoplasty is widely regarded as a beneficial procedure with an over 90% graft closure success rate and an over 80% return to normal hearing range. Though surgical technique and graft type are important in determining surgical outcomes of the procedure, results are most greatly correlated with location of the perforation. Marginal perforations are associated with the most complications in reconstruction of the tympanic membrane, lack of vascularization and limited membrane area delaying the healing process (4). Lasers have been used in medical procedures dating back to the 1960s. The advantage of infrared lasers such as CO are the precision of cutting and the smooth interaction with tissues (5). The CO laser is absorbed by the tympanic membrane and does not damage the middle ear while visible lasers penetrate and can damage the ear drum (6). This retrospective study of 150 patients from 2013-2016 assesses and demonstrates the viability of using carbon dioxide laser as an alternative to the traditional method for de-epithelialization of tympanic perforation margins during tympanoplasty. By comparing closure rates and audiogram data, this study reveals parameters of use, benefits and adverse outcomes on healing and hearing restoration with the CO laser-assisted method. Perforation closure rate of 91% and hearing improvement in 66% of patients was observed. Fourteen patients did not undergo closure of the tympanic membrane with an overwhelming majority of the 14 having large and marginal perforations.
鼓室成形术不仅可修复鼓膜穿孔，还涵盖了一系列以乳突骨手术为特征的手术。鼓室成形术被广泛认为是一种有益的手术，移植物闭合成功率超过90%，听力恢复到正常范围的比例超过80%。虽然手术技术和移植物类型对该手术的手术结果很重要，但结果与穿孔的位置相关性最大。边缘性穿孔在鼓膜重建中并发症最多，血管化不足和膜面积有限会延迟愈合过程（4）。激光自20世纪60年代起就已用于医疗手术。诸如CO等红外激光的优点是切割精确且与组织相互作用平稳（5）。CO激光被鼓膜吸收，不会损伤中耳，而可见激光会穿透并可能损伤鼓膜（6）。这项对2013年至2016年150例患者的回顾性研究评估并证明了在鼓室成形术期间使用二氧化碳激光替代传统方法对鼓膜穿孔边缘进行上皮化剥脱的可行性。通过比较闭合率和听力图数据，本研究揭示了CO激光辅助方法在愈合和听力恢复方面的使用参数、益处和不良后果。观察到穿孔闭合率为91%，66%的患者听力得到改善。14例患者鼓膜未闭合，其中绝大多数有大的边缘性穿孔。
