Laser-assisted endoscopic stapedectomy: a prospective study.
OBJECTIVE
To improve the techniques required to perform a stapedotomy without prosthesis (stapedioplasty).


METHODS
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.
Poe
D S
DS
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA.
D000328:Adult; D000818:Animals; D004867:Equipment Design; D005260:Female; D006168:Guinea Pigs; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D019933:Ossicular Replacement / Q000295:instrumentation; D010040:Otosclerosis / Q000601:surgery*; D019720:Otoscopes; D011446:Prospective Studies; D013201:Stapes Surgery / Q000295:instrumentation*; D016896:Treatment Outcome