Laser‐Assisted Endoscopic Stapedectomy: A Prospective Study

Abstract

Objective: To improve the techniques required to perform a stapedotomy without prosthesis (stapedioplasty). Study Design: New infrared lasers were evaluated for potential use in otological surgery in guinea pigs. A prospective human trial of 34 primary stapes operations using the Argon ion laser was performed, with 11 stapedioplasties and 23 conventional stapedotomies as controls. Methods: Laser-tissue interactions were evaluated for temporal bone and live guinea pig tissues, measuring crater histology and labyrinthine temperature elevations. Patients undergoing stapedioplasty had Argon ion laser cuts with endoscopic assistance made in the anterior crus and footplate to mobilize the posterior segment of the stapes while the anterior portion remained fixed. Results: Diode laser (808-nm) vaporization craters and temperature elevations in the vestibule were suitable for clinical use. Overall, stapedioplasty patients' hearing was improved with air-bone gap closure to a mean of 8.3 dB (SD ؎ 9.8 dB). Conclusions: Patients with anterior footplate otosclerosis are candidates for stapedioplasty preserving the annular ring and stapes tendon and eliminating prosthesis complications. High-resolution small endoscopes, coupled with Argon ion or diode lasers promise to improve stapes visualization, enhancing the ability to perform minimally invasive surgery on the stapes footplate.

Comparative study between microscopic and endoscopic stapes surgery

“…However, endoscopes have been used for observation and treatment of conditions in the areas that may be hard to visualize completely under the microscope. [6][7][8] In treatment of cholesteatoma, we have employed an endoscope combined with a microscope to minimize drilling, thereby preserving hearing and facial nerve called as "endoscopy assisted surgery". 10 Few reports have been published concerning stapes surgery that is entirely performed by endoscopy.…”

Study of 50 Cases of Otosclerosis by Stapedotomy: Our Experience

“…Endoscope-assisted stapedotomy was first described by Poe in 2000., 7 there is only one publication fully on endoscopic stapedotomy (ES). 8 …”

Experimental study on thermic effects, morphology and function of guinea pig cochlea: A comparison between the erbium:yttrium–aluminum–garnet laser and carbon dioxide laser

“…Opening of the inner ear in stapedotomy can be performed with handheld perforators, or, in cases of thickened otosclerotic plate, with a microdrill. Alternatively, the application of different lasers has been described in experimental and clinical studies recently [4][5][6][7][8][9][10].…”

“…The application of all of these laser systems for stapedotomy has been reported by different authors [1,2,[4][5][6][7][8][9][10].The CO 2 laser is well absorbed in water with a wavelength of 10.6 mm. It can be applied in either a continuous or a pulsed mode.…”