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.


METHODS
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.


CONCLUSIONS
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.
Department of Otolaryngology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand. ronayooth@vajira.ac.th
Ronayooth
R
Boonchoo
Pichai
P
Puapermpoonsiri
D000328:Adult; D001299:Audiometry; D001777:Blood Coagulation; D005260:Female; D006309:Hearing; D006319:Hearing Loss, Sensorineural; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D010040:Otosclerosis / Q000601:surgery* / Q000628:therapy; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D011184:Postoperative Period; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000295:instrumentation* / Q000379:methods; D013785:Thailand; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene