Experimental and clinical results of Er : YAG laser stapedotomy

Background and Objective: At the beginning of the 1980s, different laser ty pes were used for stapes surgery to reduce potential harm to inner ear stru ctures through manipulation with conventional instruments during stapedotom y. Most clinical studies were carried out with the CO2 or the argon laser. The Er:YAG laser has been used rarely in patients with otosclerosis. Study Design/Materials and Methods: In an experimental study on 54 human pe trous bones, the optimal laser energy parameter for dissection of the poste rior stapes crus and the footplate perforation were determined. With these parameters, stapedotomy was carried out with the Er:YAG laser in 29 patient s with otosclerosis with a conventional dissection of the incudostapedial j oint and the stapedius muscle tendon. The Er:YAG laser was used (60 or 100 mJ, 3-6 pulses) for dissection of the posterior stapes crus and footplate p erforation. Results: No intra- or postoperative complications were observed in all 29 p atients. Vertigo and hearing loss were not observed intra- or postoperative ly. The postoperative hearing results (improvement of the air-bone gap) was in all cases satisfactory (median remaining air bone gap, 8.1 dB). The med ian operation time was 29 minutes (15-42 minutes) and did not show a signif icant prolongation in comparison to the conventional technique. In 1 of the 29 patients, the footplate perforation needed to be carried out convention ally. Conclusion: For the first time, Er:YAG laser parameters have been optimized and refined in a human petrous bone model and were then used in a clinical setting. According to the presented results, the Er:YAG laser seemed to be a very suitable instrument for stapedotomy. Lasers Surg. Med. 28:11-17, 20 01. (C) 2001 Wiley-Liss, Inc.