title: Photoacoustic effects of carbon dioxide lasers in stapes surgery: quantification in a temporal bone model.
abstract: OBJECTIVE
  The use of the CO2 laser in stapes surgery creates sound waves that could damage hearing. BACKGROUND The application of a laser to any medium has absorption, reflection, and thermal effects. To date, the majority of research on the safety of CO2 laser stapedotomy has focused on the thermal effects of the laser alone. Because of the properties of the CO2 laser, its absorption also presents some risk to the inner ear. This absorbed energy can be converted to photoacoustic or photochemical effects. The goal of this paper is to measure these photoacoustic effects (sounds) produced by the CO2 laser.
  
  
  METHODS
  Using a variety of settings, a Sharplan 150 XJ Laser and a Contour model Erbium:YAG laser were applied to the oval window of human temporal bones. Perilymph was simulated by fixing the temporal bone in a normal saline bath. Photoacoustic waves were measured by a hydrophone 2 mm beneath the oval window. Measurements were made with and without a simulated tissue seal over the window.
  
  
  RESULTS
  No detectable sounds were created below 4 watts (continuous mode) or 60 mJ (superpulse mode). Above those settings, intensities of 90 dB sound pressure level and higher were detected when the laser was applied directly to the perilymph. With the tissue seal in place, no detectable sounds were identified. The accuracy of this model was confirmed by comparing these results with previously published results using the Erbium:YAG laser.
  
  
  CONCLUSIONS
  Below 4 watts in continuous wave mode and below 60 mJ in superpulse mode, any sound generated by the laser is small. Above these thresholds, however, impact sounds are produced that could result in threshold shifts with repeated applications.
authors.affiliation: Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, 72205, USA.
authors.forename: Edward K
authors.initials: EK
authors.lastname: Gardner
authors.forename: John
authors.initials: J
authors.lastname: Dornhoffer
authors.forename: Scott
authors.initials: S
authors.lastname: Ferguson
mesh_terms: D006801:Humans; D066298:In Vitro Techniques; D053685:Laser Therapy / Q000009:adverse effects*; D008953:Models, Anatomic; D009622:Noise / Q000009:adverse effects*; D010046:Oval Window, Ear / Q000503:physiopathology; D010498:Perilymph / Q000502:physiology; D013018:Sound Spectrography; D013201:Stapes Surgery / Q000009:adverse effects*