Small fenestra stapedotomy using a fiberoptic hand‐held argon laser in obliterative otosclerosis

Abstract

Obliterative otosclerosis has been a challenge since the advent of stapes surgery. "Drill-out" procedures have had a generally poorer prognosis than conventional stapes surgery because of excessive bleeding, acoustic trauma from the burr, and reclosure of the oval window by otosclerosis. In this report, we describe our early experience using a hand-held fiberoptic argon laser for small fenestra stapedotomy in 10 cases of obliterative otosclerosis. Closure of the air-bone gap to within 10 dB was seen in 100% of the patients. There was no significant sensorineural hearing loss, vertigo, or facial weakness. Argon-laser stapedotomy using a hand-held fiberoptic system is a safe and effective alternative to drill-out stapedotomy in cases of obliterative otosclerosis.

Thermal Effects of Laser Stapedectomy in an Animal Model: CO2 Versus KTP

“…The results of stapedectomy performed with the visible‐light lasers in the clinical setting have been excellent and seem to contradict the laboratory findings 1‐5 . Hodgson and Wilson 4 and Horn et al 11 both reported good results with the argon laser.…”

“…The energy parameters for all procedures were set at 2 watts with 0.1‐second duration in the singlepulse mode. These parameters mirror those reported and used in the clinical setting 2,3 . Following measurement of a stable baseline temperature in the vestibule, the anterior and posterior crura of the stapes were vaporized.…”

“…In further response to the issue of mechanical injury during creation of the oval window fenestra, Perkins 1 in 1980 was the first to explore the possible benefits of laser stapedotomy. Since this original report, multiple centers have published successful results with various lasers (argon, KTP and CO 2 ) and various delivery systems (micromanipulator and handheld probe) 1‐5 . For otologic purposes, lasers are divided into two basic types: the visible‐wavelength(argon and KTP) and the invisible‐wavelength (CO 2 ) lasers.…”

Chapter 11 Obliterative Otosclerosis

“…Wiet et al (1993) recommended a high-resolution CT scan when a reclosure of an obliterated footplate is suspected following primary stapes surgery. Gherini et al (1990) reported excellent results with the use of a fiberoptic, handheld argon laser when dealing with an obliterated footplate. They reported 10 cases where the fiberoptic argon laser was used and small fenestra stapedectomy was performed.…”

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

“…7 and 13-18͒, and the Erbium:YAG ͑Refs. 17 As the dilemma between thermal load and mechanical stress remains unsolved, the safety of laser surgery for the middle ear has been accomplished by ͑1͒ meticulous choice of laser parameters, 32,34 ͑2͒ surgical techniques which aim to spare structures at risk ͑e.g., avoiding irradiation of the open vestibule, 18,34 and ͑3͒ development of purposebuilt instruments that help surgeons to handle the laser beam more precisely 5,32,35,36 ͑Endo-Otoprobe TM , scanning devices, etc.͒. 24 and 25͒, Holmium:YAG ͑Refs.…”