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.

https://onlinelibrary.wiley.com/doi/pdf/10.1097/00005537-200005001-00001

Laser-assisted endoscopic stapedectomy: a prospective study.

Objectives/Hypothesis To assess hearing results and complications following primary stapedotomy in otosclerosis patients comparing the use of laser and conventional techniques for fenestration. Study Design Systematic literature review. Methods A systematic bibliographic search was conducted in PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Studies reporting original data on the effect of laser fenestration, compared to conventional techniques, on closure of air-bone gap in patients undergoing primary stapedotomy were included. Directness of evidence and risk of bias of the selected articles were assessed. Studies with low directness of evidence, high risk of bias, or both were not further analyzed. The absolute risks, risk differences, and 95% confidence intervals were extracted only for studies with moderate to high directness of evidence and moderate to low risk of bias. Results In total, 383 unique studies were retrieved. Eight of these (including 999 procedures) provided high or moderate directness of evidence and carried a moderate risk of bias, and were considered eligible for data extraction. The included studies show no consistent difference in postoperative air-bone gap closure or immediate postoperative vertigo. Conclusions Both footplate fractures and sensorineural hearing loss appear to occur more frequently in the conventional group than in the laser group. Therefore, we prefer laser above conventional methods for footplate fenestration in primary stapedotomy.

Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review

Among different types of lasers, the erbium laser exhibits particularly favourable characteristics for ear surgery. Experiments with application of erbium laser pulses to the isolated stapes connec...

Advantages and dangers of erbium laser application in stapedotomy.

Objective To further optimize the surgical technique with the CO2 laser in stapes surgery a scanner system was used to obtain a footplate perforation of 0.5 to 0.6 mm with only 1 laser application (“one-shot” stapedotomy). Study design 188 patients with otosclerosis were submitted to a primary CO2 laser stapedotomy with the SurgiTouch™ scanner. This study surveys the surgical technique and clinical results. Results An adequately large perforation diameter could be achieved with a single shot in 68% of the patients treated with the SurgiTouch™ scanner. In 11% of the patients, a second laser application at the same site was necessary. In 21% of the patients, the perforation had to be enlarged by several slightly overlapping laser applications without scanner. The clinical data of this study clearly documents that there is no evidence of laser depending inner ear affections. Conclusion The CO2 laser combined with modern scanner systems is well suited for application in stapes surgery.

CO2 laser stapedotomy with the "one-shot" technique--clinical results.

Background and Objective: The purpose of this study was to evaluate the ablation of ossicular tissue using a 1,053 nm Ti:Sapphire chirped pulse amplifier laser system configured to deliver ultrashort pulses of 350 femtoseconds (fs) (3.5 x 10 -13 seconds) in cadaver temporal bone. Study Design/Materials and Methods: Ablation of the formalin-fixed incus and stapes was performed using an ultrashort pulse laser (USPL) (0.4 mm beam diameter, pulse fluence of 2.0 J/cm 2 , and pulse repetition rate of 10 Hz). The ablation rate was measured using optical micrometry, and crater surface morphology examined using scanning electron microscopy. Results: The laser produced precise bone ablation at a rate of 1.26 μm/pulse, with almost no evidence of thermal damage, and very little evidence of photomechanical injury. Conclusions: Ultrashort pulse lasers may provide a useful clinical tool for otologic and skull base surgery, where precise hard tissue ablation is required adjacent to critical structures.

Ultrashort pulse laser ossicular ablation and stapedotomy in cadaveric bone.

Hypothesis: Experiments in guinea pigs were performed to clarify which, if any, of the CO 2 lasers in different modes (continuous wave [cw] and superpulse) can damage the inner ear on application of the laser parameters required for stapedotomy and to determine their application safety. Methods: The laser effect connected with perforating the basal convolution of the guinea-pig cochlea (cochleostomy) was examined. Acoustic evoked potentials (compound action potentials [CAPs]) yielded information on inner-ear function. Results: In cw mode, even single applications of an approximately four times higher power density (60.000 W/cm 2 ) than necessary for stapedotomy at a pulse duration of 50 msec (energies up to I J) and 20-fold applications of effective parameters for a footplate perforation (power density 16,000 W/cm 2 ; energy 0.2 J) did not cause CAP changes. Experimental studies with the CO 2 superpulse laser used (peak pulse powers: ca. 300 W) have demonstrated that irreversible CAP alterations already occur in the effective laser range in > 40% of the animals. Conclusions: Because damage is expected only at much higher energies (> 2 J) than those used clinically, the CO 2 laser in cw mode has a high application safety for laser stapedotomy. The application of the CO 2 laser in superpulse mode with peak pulse powers of approximately 300 W in stapedotomy appears to be more unreliable and dangerous for the inner ear.

Influence of CO2 laser application to the guinea-pig cochlea on compound action potentials.

Animal experiments in mature guinea pigs were devised to determine whether and to what extent inner ear damage can be caused by in vivo use of the erbium laser for stapedotomy. The present study examined the laser effect in connection with perforation of the basal convolution of the cochlea and subsequent application in the opened cochlea. Acoustic evoked potentials as compound action potentials (CAP) were recorded for changes in inner ear function. Findings demonstrated that five applications of the erbium:YSGG (yttrium-scandium-gallium-garnet) laser (energy, 85 mJ/pulse; energy density, 36 J/cm2) were needed to create a footplate perforation of 500–600 μm and did not lead to CAP alteration in any animal (n = 20). An increase of the repetition rate from 1 to 5 Hz likewise caused no CAP alteration (n = 17). Application of high total energies in the open cochlea (n = 5) to determine the safety of the laser system for stapedotomy revealed that a 10-fold increase in the total energy required for adequate perforation led to irreversible CAP alterations and no CAP could be recorded at a 15-fold increase in total energy. In contrast, a 5-fold maximum increase in total energy caused no CAP alterations. These results demonstrate the safety of the Er:YSGG laser comparable to that of the CO2 laser for stapedotomy, supporting its utility as an alternative method for surgery.

Experimental studies on the suitability of the erbium laser for stapedotomy in an animal model.

Experiments were performed in guinea pigs to clarify which, if any, of the CO2 lasers used can damage the inner ear on application of the laser parameters required for stapedotomy. A further aim was to determine their application safety. The basal convolution of the guinea-pig cochlea was chosen as the application site, since its thickness is similar to that of the human stapes base. We examined the laser effect in connection with perforation of the basal convolution and subsequent application in the open cochlea. Acoustic evoked potentials (compound action potentials [CAP]) yielded information on inner-ear function. Animals without laser treatment were used as controls. Perforation of the basal convolution and laser applications in the open cochlea with the same parameters did not lead to a measurable CAP alteration with the CO2 cw laser (power: 8 W, pulse duration: 50 ms, power density: 3200 W/cm2). An increase of the laser power to 15 W (power density: 6000 W/cm2) and of the pulse duration to 200 and 500 ms (energy: 3 J and 7.5 J) caused partly irreversible CAP alterations; finally, no potential could be recorded any more at a maximal laser power and pulse duration (15 W and 500 ms). Examination of high power densities (40,000 and 60,000 W/cm2) through reduction of the laser beam diameter to 180 microns yielded comparable results.(ABSTRACT TRUNCATED AT 250 WORDS)

Tierexperimentelle Untersuchungen zur CO2-Laser-Stapedotomie*, **

Tierexperimentelle Untersuchungen zur CO 2 -Laser-Stapedotomie*, **

BACKGROUND Recent experimental studies have demonstrated that, apart from the continuous wave lasers, several pulsed laser systems are also suitable for stapedotomy. The aim of this study was to clarify whether irradiation of the basal convolution of the guinea pig cochlea could cause morphological inner-ear changes using the Er:YSGG and Ho:YAG laser with laser parameters required for stapedotomy. METHODS After opening the bulla, the basal convolution of the guinea pig cochlea, whose thickness is similar to that of the human stapes footplate, was irradiated with the Er:YSGG and Ho:YAG laser. The laser parameters used were those necessary for an adequate perforation of a human stapes footplate (500-600 microns). The cochleae were removed 90 minutes, 1 day, 2 weeks, or 4 weeks after laser application. The organ of Corti was examined by scanning electron microscopy in all convolutions. RESULTS Application of Er:YSGG laser parameters effective for stapedotomy (5 pulses, energy: 85 J/pulse, energy density: 36 J/cm2, total energy: 0.425 J) had no adverse effects on the organ of Corti in the guinea pig cochlea. On the other hand, effective Ho:YAG laser parameters (10 pulses, energy: 210 J/pulse, energy density: 90 J/cm2, total energy: 2.1 J) caused damage to the outer hair cells with fusion of stereocilia and formation of giant cilia leading to partial or total cell loss. The inner hair cells and supporting cells were usually normal. CONCLUSION Our results clearly demonstrate that the Er:YSGG laser has high application safety. It could prove to be a viable alternative to the thermically acting CO2 laser for stapedotomy. The Ho:YAG laser is not well tolerated in animals and has low application safety. Its use in stapedotomy would be unreliable and dangerous for the inner ear.

Wirkung des gepulsten Er:YSGG-und Ho:YAG-Lasers auf das Corti-Organ der Meerschweinchen-Cochlea : eine rasterelektronenmikroskopische Studie

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