Hearing Outcome Following Laser-Assisted Stapes Surgery

Garin, Pierre; Prooyen-Keyser, Sandrine Van; Jamart, Jacques

doi:10.2310/7070.2002.19196

Cited by 19 publications

(23 citation statements)

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“…Auch unter Verwendung der Mehrfachapplikationstechnik in Rosettenform zur Fußplattenperforation wird der CO 2 -Laser weit verbreitet mit guten Ergebnissen eingesetzt [1,6,10,29,30,36,45].…”

Section: Diskussionunclassified

Laserstapedotomie

Albers

Wagner

Stölzel

et al. 2011

HNO

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In addition to hearing aids, stapesplasty represents the standard treatment of otosclerosis-induced hearing loss. In this procedure, the stapes superstructure is replaced by a prosthesis that is attached to the long process of the incus and communicates through a perforation in the footplate with the perilymphatic space of the inner ear. The removal of the stapes superstructure and perforation of the footplate are the critical steps of this surgical procedure. With the introduction of laser-assisted perforation techniques, the surgical safety of this method has been improved compared to conventional techniques. KTP, argon, as well as diode, Er:YAG and CO(2) lasers are used for stapedotomy. By using the CO(2) laser in conjunction with a scanner system, the number of laser applications required for the perforation of the footplate has been markedly reduced. In contrast to other systems, a more reproducible perforation diameter of the stapes footplate is achieved with a CO(2) laser equipped with a scanner. Complications such as uncontrolled leakage of perilymph, irradiation of inner ear structures or the occurrence of pressure waves with subsequent damage to the inner ear can be reduced by using a CO(2) laser. In this review, the surgical technique of CO(2) laser stapedotomy, including clinically established variants and paying particular attention to the one-shot technique, are described and discussed in comparison to other laser systems.

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Section: Diskussionunclassified

Laserstapedotomie

Albers

Wagner

Stölzel

et al. 2011

HNO

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“…The wavelength of a CO 2 laser is 10.6 μm, which prevents a CO 2 laser from penetrating the perilymph in the inner ear [2]. CO 2 lasers have become one of the most commonly used devices in stapes surgery, because they can perforate the stapes footplate efficiently with minimal complications to the inner ear [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of Free-Beam- and Fiber-Type CO2 Laser Delivery Systems in Stapes Surgery

et al. 2017

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Background and ObjectivesA free-beam-type CO2 laser, which use a micromanipulator mounted on a microscope as the delivery system, has the merit of not being affected by hand tremor at the time of shooting. However, this delivery system has several disadvantages, including a restricted operation range and a risk of incorrect focusing. A fiber-type CO2 laser uses a hand-held delivery system and has the opposite merits and demerits. We compared the results of stapes surgery with free-beam and fiber type delivery systems.Subjects and MethodsThe study enrolled 36 patients who underwent stapedotomy with free-beam- (n=26) or fiber- (n=10) type CO2 lasers. The air-bone (AB) gap closure, bone conduction (BC) change, and operating time were evaluated. The AB gap closure was calculated by subtracting the preoperative BC thresholds from the postoperative air conduction thresholds. The BC change was calculated by subtracting the postoperative BC thresholds from the preoperative BC thresholds.ResultsThe mean operating time was significantly (p=0.035) shorter in the fiber-type group (72.5±8.2 min) than in the free-beam-type group (80.5±11.4 min). The mean AB gap closure did not differ significantly (p=0.297) between the free-beamand fiber-type groups (5.8±10.1 and 1.4±6.8 dB, respectively). The mean BC change did not differ significantly (p=0.873) between the free-beam- and fiber-type groups (2.4±6.9 and 2.8±5.3 dB, respectively). The hearing outcomes did not differ significantly between the two groups.ConclusionsOperating times were significantly shorter using the fiber-type CO2 laser, while hearing outcomes did not differ significantly between the two groups.

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“…1 The first clinical use of an Argon laser for stapedotomy was published by Palva 2 and by Perkins. [30][31][32] Photoablative systems such as the Er:YAG laser cause little thermal effects and are able to ablate bone in a precise and bloodless manner, but create pressure transients which could result in acoustic trauma. 7-12͒, the KTP ͑Refs.…”

Section: Introductionmentioning

confidence: 99%

“…3 Since then, various lasers, such as the Argon, 4-7 the CO 2 ͑Refs. 19,20,31 However, even with a great number of pitfalls, laser surgery of the stapes footplate has been proven to be beneficial in terms of hearing outcome compared to mechanical drilling 11,32 in primary surgery and even more in revision surgery, as the diseased ear is even more vulnerable to mechanical stress induced by conventional surgery. 7 and 13-18͒, and the Erbium:YAG ͑Refs.…”

Section: Introductionmentioning

confidence: 99%

Morphological effects of nanosecond- and femtosecond-pulsed laser ablation on human middle ear ossicles

et al. 2006

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We evaluate the feasibility of nanosecond-pulsed and femtosecond-pulsed lasers for otologic surgery. The outcome parameters are cutting precision (in micrometers), ablation rate (in micrometers per second), scanning speed (in millimeters per second), and morphological effects on human middle ear ossicles. We examine single-spot ablations by a nanosecond-pulsed, frequency-tripled Nd:YAG laser (355 nm, beam diameter 10 microm, pulse rate 2 kHz, power 250 mW) on isolated human mallei. A similar system (355 nm, beam diameter 20 microm, pulse rate 10 kHz, power 160-1500 mW) and a femtosecond-pulsed CrLi:SAF-Laser (850 nm, pulse duration 100 fs, pulse energy 40 microJ, beam diameter 36 microm, pulse rate 1 kHz) are coupled to a scanner to perform bone surface ablation over a defined area. In our setups 1 and 2, marginal carbonization is visible in all single-spot ablations of 1-s exposures and longer: With an exposure time of 0.5 s, precise cutting margins without carbonization are observed. Cooling with saline solution result is in no carbonization at 1500 mW and a scan speed of 500 mms. Our third setup shows no carbonization but greater cutting precision, although the ablation volume is lower. Nanosecond- and femtosecond-pulsed laser systems bear the potential to increase cutting precision in otologic surgery.

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Hearing Outcome Following Laser-Assisted Stapes Surgery

Cited by 19 publications

References 0 publications

Laserstapedotomie

Laserstapedotomie

Comparison of Free-Beam- and Fiber-Type CO2 Laser Delivery Systems in Stapes Surgery

Morphological effects of nanosecond- and femtosecond-pulsed laser ablation on human middle ear ossicles

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