Comparison of lasers used in stapedotomy using specialized visualization techniques for mechanical and thermal effects in an inner ear model

The outcome of stapedotomy depends on several surgical steps. Using laser light, the ossicular chain can be handled and the oval window can be punctured with a non-touch method. Various lasers are being used or considered, however, it is not clear which settings and characteristics will contribute to optimal or adverse effects (vestibule damage and loss hearing frequencies). Using a unique high speed thermal imaging setup based on Schlieren techniques, the mechanical and thermal effects during laser stapedotomy were studied in an inner ear model consisting of human, fresh frozen stapes positioned on a liquid filled cavity in a gel cast. The cw KTP (532 nm), cw CO2 (10.6 μm), cw Thulium (2.0 μm), pulsed Er,Cr;YSGG (2.78 μm) coupled to special fiber delivery systems were applied at typical clinical settings for comparison. The imaging techniques provided a good insight in the extent of heat conduction beneath the footplate and (explosive) vapour formation on both sides. For the pulsed laser modes, explosive vapour expansion can to be controlled with optimized pulse energies while for continuous wave lasers the thermal effects can be controlled with the pulse length and repetition rate. The fluence at the tip of the delivery system and the distance to the footplate has a major impact on the ablation effect. The pulsed IR lasers with fiber delivery show to be promising for a controlled stapedotomy.