A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations


  • Inderdeep Singh Department of ENT, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
  • Basavaraj S. Patil Department of ENT, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
  • Mohammad Z. Akhtar Department of ENT, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India




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.



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