A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations
Keywords:Tympanic membrane perforation, Myringoplasty, CO2 laser, Silastic
Background: The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO2)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.
Methods: This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO2 (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO2 laser myringoplasty was compared with conventional type 1 tympanoplasty.
Results: Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.
Conclusions: A closure rate of 80% (24/30) was achieved with a CO2-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size <3 mm, where the CO2 facility is available before they undergo formal conventional microscopic surgery.
Wani A, Rehman A, Lateef S, Malik R, Ahmed A, Ahmad W, Kirmani M. Traumatic tympanic membrane perforation: An overview. Indian J Otol. 2016;22:100-4.
Marchisio P, Esposito S, Picca M, Baggi E, Terranova L, Orenti A, et al. Prospective evaluation of the aetiology of acute otitis media with spontaneous tympanic membrane perforation. Clin Microbiol Infect. 2017;23(7):486.
Chow LC, Hui Y, Wei WI. Permeatal temporalis fascia graft harvesting for minimally invasive myringoplasty. Laryngoscope. 2004;114:386-8 .
Patil K, Baisakhiya N, Deshmukh PT. Evaluation of different graft material in Type 1 Tympanoplasty. Indian J Otol. 2014;20:106-14.
Dhanapala N, Hussain SM, Reddy LS, Bandadka R. Comparative study of clinical and audiological outcome between anterior tucking and circumferential flap methods of Type 1 Tympanoplasty in large central perforation. Indian J Otol. 2018;24:190-3.
Jyothi AC, Shrikrishna BH, Kulkarni NH, Kumar A. Endoscopic Myringoplasty Versus Microscopic Myringoplasty in Tubotympanic CSOM: A Comparative Study of 120 Cases. Indian J Otolaryngol Head Neck Surg. 2017;69(3):357-62.
Golz A, Goldenberg D, Netzer A, Fradis M, Westerman ST, et al. Paper patching for chronic tympanic membrane perforations. Otolarygol Head Neck Surg. 2003;128(4):565-70.
Santhi T, Rajan KV. A study of closure of tympanic membrane perforations by chemical cauterisation. Indian J Otolaryngol Head Neck Surg. 2012;64(4):389-92.
Gross CW, Bassila M, Lazar RH. Adipose plug myringoplasty: an alternative to formal myringoplasty technique in children. Otolaryngol Head Neck Surg. 1989;101:617-20.
Szymański M. Effect of CO2 laser on prostheses used in middle ear surgery. Otolaryngol Pol. 2005;59(3):333-6.
Omi T, Numano K. The Role of the CO2 Laser and Fractional CO2 Laser in Dermatology. Laser Ther. 2014;23(1):49-60.
Singh BJ, Sengupta A, Das SK, Ghosh D, Basak B. A comparative study of different graft materials used in myringoplasty. Indian J Otolaryngol Head Neck Surg. 2009;61:131 4.
Spandow O, Hellstrom S, Dahlstrom M. Comparison of the repair of permanent tympanic membrane perforations by hydrocolloidal dressing and paper patch. J Laryngol Otol. 1995;109:1041-7.
Laidlaw DW, Costantino PD, Govindaraj S. Tympanic membrane repair with dermal allograft. Laryngoscope. 2001;111:702-7.
Gaur K, Kasliwal N, Gupta R. Association of smoking or tobacco use with ear diseases among men: a retrospective study. Tob Induc Dis. 2012;10(1):4.
Kartush JM. Tympanic membrane patcher: a new device to close tympanic membrane perforations in an office setting. Am J Otol. 2000;21:615-20.
Golz A, Goldenberg D, Netzer A, Fradis M, Westerman ST, Westerman LM, Joachims HZ. Paper patching for chronic tympanic membrane perforations. Otolaryngol Head Neck Surg. 2003;128(4):565-70.
Ozgursoy OB, Yorulmaz I. Fat graft myringoplasty: a costeffective but underused procedure. J Laryngol Otol. 2005;119(4):277-9.
Kotecha B, Fowler S, Topam J. Myringoplasty: a prospective audit study. Clin Otolaryngol. 1999;24:126-9.
Bühler A, Berger S, Bengsch F, Martin G, Han H, Vierkotten S, et al. Cathepsin proteases promote angiogenic sprouting and laser-induced choroidal neovascularisation in mice. Exp Eye Res. 2013;115:73-8.