CO2 laser in stapes surgery

Stapedotomy is not only one of the most successful interventions in otology but also one of the most dangerous for the inner ear. To reduce the risk of damaging middle and inner ear structures through manipulations with conventional instruments, the CO2 laser beam is used for perforating the footplate and removing the suprastructures. This non-contact technique aims at precise and controlled management of middle ear structures. Consideration is given to the impact of experimental data on the clinical application of the CO2 laser in stapes surgery. The discussion covers the advantages and disadvantages with regard to optical and tissue-related properties and points out possible dangers to the inner ear. Our experimental and clinical experience is taken as a basis for examining the surgical technique and the varying demands made on the laser beam in treating the stapedial tendon, crura and footplate. Attention is called to the need for additional instruments. Effective energy parameters for CO2 laser stapedeotomy are evaluated for different lasers. Application of the CO2 laser contributes towards optimization of this high-precision intervention and promises to reduce the incidence of inner ear damages in large numbers of cases. This technique appears useful particularly in difficult anatomic situations and, above all, for revisional operations.