Carbon Dioxide (CO2) Laser Glomus Tympanicum Resection: Hearing Outcomes and Recurrence Rates.

Abstract

Introduction: Paragangliomas of the middle ear (glomus tympanicum, GT) are commonly encountered neoplasms of the temporal bone. GT is a benign tumor of vascular origin, arising from the neural crest cells and located on the promontory. The treatment of choice is surgical excision of the lesion.

Objective: Our aim was to describe the surgical and hearing outcomes in a cohort of patients with middle ear paragangliomas following resection.

Methods: We retrospectively reviewed the data of patients with GT who were treated with a CO2 laser from 2014 to 2021. Preoperative and postoperative audiometric outcomes, symptom evaluations, and otomicroscopic examinations were performed. The surgical approach was individualized for each patient based on tumor characteristics demonstrated on computed tomography. Three different approaches were used: (1) canal wall down, canal wall reconstruction, and mastoid obliteration (CWD, CWR, and MO) mastoidectomy; (2) canal wall up (CWU) mastoidectomy; and (3) endaural/transcanal.

Results: Three males and 12 females aged between 33 and 76 years (mean, 56 yr) were included. Complete removal was accomplished in all cases using a CO2 laser with no recurrence or complications during the postoperative follow-up period.CWU mastoidectomy, CWD mastoidectomy with CWR/MO, and endaural/transcanal approaches were used in 5, 3, and 7 patients, respectively. A flexible 500-micron CO2 laser fiber was employed at 3-4 watts on the continuous mode setting.Three patients underwent concurrent ossicular chain reconstruction along with CWD/CWR mastoidectomy owing to preoperative conductive hearing loss with an air-bone gap (ABG) of wider than 30 dB, resulting in postoperative ABG closure. In relation to the remaining patients, no statistically significant postoperative worsening of audiometric outcomes in Word Recognition Score, pure tone average, and speech recognition threshold were observed. The mean follow-up period was 12 months.

Conclusions: We found that using a flexible CO2 laser fiber and CWD mastoidectomy with canal wall reconstruction and mastoid obliteration are beneficial for managing these tumors.CO2 lasers are safe and reliable for GT resection. The advantages of this modality include complete removal, low complication and recurrence rates, and minimum morbidity.