The carbon dioxide laser has been used for more than two decades in otologic surgery. The high specificity for water absorption makes it an ideal tool for precisely controlled incision, excision, vaporization and ablation with simultaneous hemostasis in small vessels. The same properties of water absorption and the non-contact nature of the instrument enhance its safety and effectiveness when used on and around very tiny and sensitive auditory structures.
Lumenis has a variety of CO2 laser product solutions for otologic surgery, ranging from Free-Beam with the Digital AcuBlade™ scanning micromanipulator to the new FiberLase™ flexible CO2 laser fiber. All are safe and effective for otologic applications. After more than 20 years, the otologic surgeon now has a choice - CO2 laser energy delivery via free-beam or a flexible fiber!
Eustachian tube dysfunction
Common causes of eustachian tube dysfunction are chronic otitis media (fluid in the middle ear) and damage from chronic pharyngeal reflux. Fluid build-up in the middle ear can lead to dulled hearing, a feeling of fullness, ear pain and sometimes tinnitus. In selected patients who are refractory to conservative medical therapy, the CO2 laser can be used to ablate hypertropic mucosal and submucosal tissue on the intraluminal surface of the posterior cushion of the posteriomedial wall.
Eustachian tuboplasty is a simple operating room procedure performed under general anesthesia. The AcuPulse 40WG CO2 laser and FiberLase flexible CO2 laser fiber can be used with a malleable FiberLase handpiece, which can be shaped for the patient’s nasal anatomy. A small rigid endoscope provides visualization.
Polyps and granulation tissue in external ear canal
When the CO2 laser is used for excision of polyps and granulation tissue in the external ear canal, the procedure is nearly bloodless. Laser energy is easily directed at the tissue target using a micromanipulator or the new FiberLase flexible CO2 laser fiber.
The Lumenis OtoScan Ear Aeration system is designed specifically for Laser-Assisted Myrin - gotomy procedures in children and adults. The procedure is performed under local anesthesia in the surgery center or office setting. Within milliseconds, the OtoScan scanner creates the desired size fenestration in the tympanic membrane, usually 1.0 - 1.6 mm in infants and children. Larger opening sizes may be needed in adults. The treatment goal is to provide immediate pain relief by relieving pressure from fluid build-up and give the underlying infection an opportunity to resolve — while the hole remains open, generally a few days to a week. At the discretion of the treating physician, aeration tubes may or may not be inserted at the time of procedure. Chronic
Chronic tympanic membrane perforation
The rim of chronic tympanic membrane perforations can be “refreshed” using a CO2 laser, leaving healthy epithelial cells to fill in the defect. The OtoScan works well for this. The AcuSpot microma - nipulator with SurgiTouch scanner and the new FiberLase flexible fiber can all be used for this procedure.
Tympanic membrane atelectasis
Chronic fluid accumulation depletes the air in the middle ear cavity and can cause the tympanic membrane to contract down onto the middle ear ossicles. Thermal energy from the CO 2 laser can be used along with a hand-held pick to dissect the tympanic membrane from the middle ear structures. The benefits associated with the CO2 laser are reduced manipulation of the ossicles which can be harmful, a bloodless surgical field and rapid treatment speed. The FiberLase flexible CO2 fiber is ideal for this procedure.
Congenital aural atresia
The CO2 laser, combined with an AcuSpot Series micromanipulator enables control and non - contact precision for dissection of soft tissue and separation of the ossicles from surrounding bone.
Depending on the extent and location, the CO2 laser can be used alone or in combination with a pick to remove cholesteatoma. The laser speeds the procedure and keeps the surgical field bloodless. The non-contact nature of the device makes it especially useful for removing residual skin cells from the ossicular chain and other delicate areas.
Stapedotomy is performed to enable insertion of a stapes prosthesis. The surgical objectives include protection of nearby nerves and the inner ear structures associated with hearing and balance. Because of its non-contact nature and precision, CO2 laser-assisted stapedotomy has been performed for nearly four decades. Lumenis has many product solutions for performing various stapedotomy techniques.
- The AcuSpot micromanipulator with SurgiTouch scanner on the AcuPulse 40ST laser auto - mates the creation of the desired size stapedotomy.
- The AcuSpot micromanipulator on the UltraPulse CO2 laser can be defocused to create a single precisely sized hole, or focused for multiple-hole rosette technique.
- The new FiberLase flexible CO2 laser fiber with the AcuPulse 40WG provides the greatest degree of convenience for the procedure.
During revision stapedotomy, removal of scar tissue around the prosthesis can be tedious and time consuming and frustrated by bleeding. The CO2 laser speeds the procedure by enabling non-contact dissection of scar tissue with concurrent hemostasis. The new FiberLase flexible CO2 laser fiber provides the surgeon an easy and convenient way to perform this procedure.
Cochlear implant revision
The CO2 laser is useful for lysis of fibrous tissue that is adherent to the implanted array while maintaining a bloodless field. In addition, using the laser to char the rim of the fibrous tract from which the old array is removed, keeps the opening to the channel open – making it easier to insert the new wire.
The CO2 laser is another tool that can be added to the surgical armamentarium for removal of acoustic neuroma. The non-contact nature, precision and small vessel hemostasis capabilities of the laser make it useful for capsular and intracapsular dissection of tumor tissue. Laser powers for this procedure tend to be greater than for other otological applications. The new FiberLase flexible CO2 laser fiber adds ease of use in a handheld instrument – combined with high energy transmission and fiber durability.