E-Book, Englisch, 192 Seiten, ePub
Hüttenbrink Lasers in Otorhinolaryngology
1. Auflage 2004
ISBN: 978-3-13-258078-7
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Current Topics in Otorhinolaryngology-Head and Neck Surgery
E-Book, Englisch, 192 Seiten, ePub
ISBN: 978-3-13-258078-7
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Karl-Bernd Hüttenbrink
Zielgruppe
Ärzte
Fachgebiete
Weitere Infos & Material
1 Basic Principles of Medical Laser Technology
2 Lasers in Otology
3 Lasers in Rhinology
4 Laser Use in the Oral Cavity and Oropharynx
5 Lasers for Benign Diseases of the Larynx, Hypopharynx, and Trachea
6 Lasers for Malignant Lesions in the Upper Aerodigestive Tract
7 Laseres in Dermatology (Including Interstitial Therapy)
8 Lasers in Otologic Research
2 Lasers in Otology
S. Jovanovic
Contents
Role of Various Lasers in Otology
Suitability of Different Wavelengths
Thermal and Acoustic Effects of Laser Radiation
Laser Use in the External Auditory Canal
Laser Use on the Tympanic Membrane
Acute Otitis Media with Vestibulocochlear Complications
Acute Eustachian Tube Dysfunction
Tympanic Membrane Perforations and Atrophic Scars
Graft Fixation for Tympanic Membrane Defects
Epidermoid Cysts of the Tympanic Membrane
Ossicular and Prosthetic Dislocation after Tympanoplasty
Safe and Effective Energy Parameters for CO2 Laser Stapedotomy
Surgical Technique of CO2 Laser Stapedotomy
Problems in Revision Procedures
Technique of CO2 Laser Revision Stapedotomy
Author’s Results with CO2 Laser Stapedotomy
Complications in Primary Operations
Results of Revision Operations
Complications of Revision Operations
Laser Versus Conventional Surgery
Peripheral Vestibular Disorders: Benign Paroxysmal Positional Vertigo and Endolymphatic Hydrops
Tinnitus and Sensorineural Hearing Loss
Laser Use in the Internal Auditory Canal
Abstract
Ongoing efforts to refine surgical techniques in otology are based on the desire to minimize the critical aspects of these procedures, especially the hazards to the inner ear. One approach is to optimize conventional operative techniques through the precise and controlled use of lasers. This chapter deals with the various indications for noncontact laser use in the external auditory canal, on the tympanic membrane, and in the middle and inner ear and reviews the surgical techniques involved in the use of various laser wavelengths, placing special emphasis on the techniques that are best for specific indications. For example, today it is hard to conceive of stapes surgery without lasers, both in primary operations and revision surgery. Other indications for laser use are chronic hyperplastic mucosal suppuration, cholesteatoma, tympanosclerosis, malleus fixation, adhesive processes, external auditory canal exostoses near the tympanic membrane, and vascular lesions of the middle ear. Particularly in revision surgery, the laser often provides a surgical treatment option that would not be available with conventional instruments. Lasers applied to the tympanic membrane in the operative treatment of middle ear ventilation problems, transtympanic endoscopy, and the treatment of perforations are additional procedures that can be carried out on an ambulatory basis. With regard to the inner ear, the use of lasers in the treatment of peripheral vestibular disorders as well as tinnitus and sensorineural hearing loss is discussed. The chapter concludes with a description of laser use in the surgical treatment of acoustic neuroma.
Introduction
In otology, surgical techniques using conventional instruments are widely practiced and have been established for many years. All manual instrument techniques involve the manipulation of tissues (external auditory canal, tympanic membrane, middle ear mucosa, ossicular chain, etc.) to produce and transmit mechanical energy. Some of the instruments, such as drills, cause additional energy transmission through vibrations. In the past, various types of energy have been used to eliminate these unwanted effects during the surgical alteration of tissues. For a review see the article “The Argon Laser in Otology” by DiBartolomeo and Ellis [1]. Clarke, for example, used electrocautery needles in 1973 to remove exostoses from the external auditory canal [2]. Mülwert and Voss used ultrasound in 1928 for the treatment of otosclerosis [3]. Krejci, in 1952, was the first to surgically expose the mastoid and selectively ablate the vestibular apparatus with ultrasound as a treatment for Ménière’s disease [4]. Sjöberg and Stahle optimized the ultrasound therapy for Ménière’s disease in 1965, but this treatment was not widely accepted due to lack of precision in selective ablation [5]. Similarly, the selective cryosurgical destruction of anatomic structures has failed to offer significant advantages [6].
In the continuing search for a precise and “noncontact” form of tissue alteration, the application of laser beams appeared to be the ideal approach. Stahle and Högberg [7], in 1965, were among the first to investigate the potential of lasers in otologic surgery, initially using a ruby laser to carry out inner ear surgery in pigeons. Later the same group of authors used the argon laser on the organ of Corti in guinea pigs to produce surface changes in the stria vascularis without damaging the bony cochlea [8]. Sataloff [9], in 1967, was the first to experimentally vaporize isolated human footplates with a neodymium:glass laser. Kelemen et al. [10] were able to induce bleeding in the inner ear of mice with pulsed ruby and neodymium:yttrium aluminum garnet (Nd:YAG) lasers. Wilpizeski et al. [11] produced selective vestibular ablation in monkeys by irradiating the semicircular canals with an argon laser. However, the conflicting experimental data prevented clinical application. Escudero et al. [12] used an argon laser in human tympanoplasties to spot-weld a temporalis fascia graft to the margin of the perforated eardrum. DiBartolomeo and Ellis [1] reported on the clinical application of argon laser surgery of the external auditory canal and middle ear for the treatment of various soft-tissue abnormalities (adhesions, granulations, persistent stapedial artery, etc.), the ossicular chain, and bony lesions of the external auditory canal (exostoses, osteomas). Finally, Perkins [13] introduced the argon laser in clinical stapes surgery in 1980. Silverstein et al. [14] first used the potassium-titanyl-phosphate (KTP)-532 laser in stapes surgery in 1989 and Lesinski [15] the carbon dioxide (CO2) laser also in 1989. Among the pulsed laser systems, the erbium (Er):YAG laser was first used clinically for otologic surgery in 1992 [16]. Recently, an experimental study was published on the use of fiberoptically transmitted near-infrared diode lasers in otologic surgery [17]. To date, their clinical use has been limited to a few cases. More recently, otosurgical applications of the argon, KTP-532, CO2 and Er:YAG lasers have been described in various publications, with some degree of controversy [1, 13–15, 19–71, 73–94].
Many otosurgical procedures involve removing large amounts of bone and soft tissue with conventional instruments. In contrast, the application of laser energy using a noncontact technique allows for vibration-free tissue removal and enables surgeons to carry out some procedures with greater precision, leading to better results and fewer complications. The transmission of potentially harmful energy to the surrounding tissues can be limited in a very precise way by selecting the optimal laser parameters for removing particular types of tissue.
For the present, lasers are still not widely used in otologic surgery. Using a laser means leaving behind traditional, established surgical techniques with conventional instruments. The safe and effective use of lasers in otology requires knowledge of the basic principles of laser–tissue interactions and the possible applications of laser use in otologic surgery. However, theoretical knowledge is no guarantee for achieving good surgical results, which depend more upon clinical experience acquired in a supervised setting.
In this chapter first the general principles of laser use in otologic surgery are reviewed. Then the following sections deal with clinical laser application in selected otologic disorders.
Role of Various Lasers in Otology
Laser–tissue interactions have already been dealt with in some detail in Chapter 1. Here we consider...
