Results of CO2 Laser Stapedotomy with Teflon Piston Prosthesis and Autologous Blood Seal
Ronayooth Boonchoo MD*, Pichai Puapermpoonsiri MD*
Affiliation : * Department of Otolaryngology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok
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.
Materials and 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.
Conclusion : 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.
Keywords : Laser, Stapedotomy, Hearing, Otosclerosis, Polytetrafluoroethylene
