<title>Laser applications in middle ear surgery: advantages and possible side-effects</title>

Abstract

The use of lasers in otolaryngology has become well established over the last decades. Especially in the treatment of otosclerosis, where precise no-touch fenestration of the stapes footplate is required, lasers provide an attractive alternative to mechanical drilling method. Today, Argon, KTP, CO2 and Er:YAG lasers are clinically used in middle ear surgery. Each laser has its characteristic interaction process with bone gaining specific advantages and disadvantages. Therefore, the conflicting and controversially discussed experimental and clinical reports are not surprising The visible laser radiation has a high optical penetration depth in water and therefore a limited energy absorption in the unpigmented bone. In contrast, infrared radiation by virtue of its strong absorption in water results in an explosive ablation process of high efficiency. The greatest potential risks for the inner ear during laser stapedotomy are the conversion of laser energy into heat in the vestibule, due to direct absorption of laser radiation or heat diffusion, and pressure fluctuations inside the cochlea caused by the explosive ablation process inherent in pulsed laser systems. The purpose of this study is to comprehensively compare the tissue effects of the different laser systems in view of safety and efficacy.