LASER ASSISTED SMALL FENESTRA STAPEOTOMY …激光辅助足板小孔开窗….pptVIP

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2018-06-19 发布于福建
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LASER ASSISTED SMALL FENESTRA STAPEOTOMY …激光辅助足板小孔开窗….ppt

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LASER ASSISTED SMALL FENESTRA STAPEOTOMY …激光辅助足板小孔开窗…

LASER ASSISTED SMALL FENESTRA STAPEDOTOMYTECHNIQUE ANALYSIS Dr V.V.Raut, Dr J.Halik Dept. of Otolaryngology Toronto N= 135 (Primary cases) Markham Stouffville Hospital M:F = 54: 81(1: 1.5) Age Range: 20-78 yrs Second Ear surgery: 35 Follow-up: 4 months –24 months(avg 10 months) Technique Local anaesthesia with IV sedation Argon Laser 2.5 watt (coherent) Otoprobe –20 deg. Angled, 0.2 mm tip diameter Halik footplate perforators:0.3,0.4,0.5, 0.6mm diameter (Richards) Cawthorne piston: 0.3 x 5mm Teflon prosthesis with notch at 3 o’clock(Modified Halik) Laser Settings Stapedial Tendon and Crurae 0.2 sec at 2.0 watts Footplate 0.1 sec at 1.0 watts COST Laser - $ 45,000(cdn) Otoprobe-$190(cdn)-Single use- offset against cost of prosthesis which is cheap ResultsN=135Avg A-B gap closure(Post op air minus pre-op bone) Over Closure of Air-Bone GapN=135 40/135(29.6%) Range 5-40dB Average over closure = 13dB Improvement in High Frequency Hearing(post-op air minus pre-op air) Post-op SRT 30dB=111 Pre-op possible SRT30db=107 %Improvement=111/107 (103%) ComplicationsN=135Minor Taste:29 cases(21%)-resolved in 3 months Tinnitus:9cases(6%)- 2 persisted beyond 3 months Vertigo: 6 cases(4%)-1 persisted beyomd 3 months Major Immediate SNHL-nil Delayed SNHL-nil Perilymph fistula- 1 case(young female perilymph gusher-reexplored, prosthesis removed,OW sealed with fat,ME sealed with tisseal, no SNHL, persistent cond loss) Persistent conductive loss-4 cases Advantages of Small Fenestra Stapedotomy Lower incidence of perilymph fistula Lower incidence of immediate SNHL Long term hearing loss progresses more slowly* 4kHz Speech Discrimination scores show less significant deterioration* * Smyth,Hassard El Kordy, 1980 Advantages of Laser Precision Least traumatic Better control of bleeding Technically easier Floating footplate Results-Over closure Decreased post-operative morbidity- Day surgery Conclusion Safe Minimal Vestibular upset Acceptable A-B gap closu