Lasers in Otology

Stahle and Hogberg first proposed the use of surgical lasers for otologic surgery in 1965.2 Unfortunately, this study and others using powerful pulsed lasers had distinctly chilling effects on early enthusiasm for otologic and neurologic laser surgery.3-5

These studies demonstrated the devastating damage of pulsed lasers on the ear and brain. Unlike the "studies in biologic overkill" using pulsed lasers, an early study by Sataloff6 demonstrated the clinical potential of lasers in otosclerosis surgery. In

1967, using a neodymium-glass laser, Sataloff6 discretely fen estrated a cadaver stapes footplate. In 1979, Escudero et al.7

excited the otologic world by reporting the use of an argon laser in seven patients undergoing tympanoplasty. Perkins8 and DiBartolomeo and Ellis9 first reported the application of a surgical laser to clinical stapes surgery in 1980. Both DiBar-tolomeo and Perkins used the argon laser to create a small fenestra in the stapes footplate. Numerous reports have since outlined the use of argon, KTP-532, and CO2 lasers for otosclerosis and other middle ear disorders.10-31

While discussing the use of an argon laser in acoustic tumor surgery, Glasscock et al.,32 in 1981, pointed out the practical problems associated with microscope-mounted micromanipulator delivery systems, including increased working distance, decreased available light, the need to "bounce the laser off of small mirrors to reach inaccessible areas," and the necessity of keeping one hand out of the operative field on the joystick of the micromanipulator. In 1986, we began to experiment with hand-held fiberoptic systems for the argon laser. The initial system consisted of a 200-^m fiber taped to a Rosen needle. In 1987, we developed several fiberoptic hand pieces for the argon laser. The hand pieces consist of a 200-^m fiber housed in a 24-gauge graduated needle hand piece designed to be held and used in a manner similar to a traditional otologic instrument. Fiberoptic hand pieces have eliminated the practical problems described by Glasscock. Fiberoptic hand pieces for both argon and KTP-532 lasers have since been used in otosclerosis, middle ear, and acoustic tumor surgery.

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