Abstract
Laser stapedotomy has now become an established method in the surgical treatment of otosclerosis. Recent experimental studies have demonstrated that, apart from the continuous wave lasers, several pulsed laser systems are also suitable for stapes management. Experiments were performed in guinea pigs to clarify which, if any, of the pulsed lasers used can damage the inner ear on application of the laser parameters required for the stapedotomy. The basal convolution of the guinea-pig cochlea was chosen as the application site. Acoustic evoked potentials (compound action potentials) yielded information on inner-ear function. With the Er:YSGG laser (energy: 85 J/pulse, energy density: 36 J/cm2, total energy: 0.425 J), five applications to the cochlea are necessary for a foot plate perforation of 500 - 600 micrometers . With the Ho:YAG laser, an adequately large perforation can be achieved with at least 10 applications of an energy of 210 mJ per pulse (energy density: 90 J/cm2, total energy: 2.1 J). The aim of this study was: (1) to clarify whether the Er:YSGG and Ho:YAG laser could cause morphological changes in the organ of Corti of the guinea pig on application of the laser parameters required for stapedotomy, and (2) to verify our experimental electrophysiological results and correlate them with the morphological changes detected in the organ of Corti in the guinea pig cochlea by scanning-electron-microscopic examination. It shows that the effective laser parameters (5 X 85 mJ) of the Er:YSGG-laser cause no changes of the guinea pig cochlea. Even with the application of 25 pulses with the same energy the guinea pig cochlea shows normal appearance. The effective laser parameters of the Ho:YAG laser (10 X 210 mJ) show changes in the outer hair cells in the form of stereocilie fusion and giant hair cell formation while the inner hair cells and supporting cells are showing normal appearance. Our results clearly demonstrate a high application safety for the Er:YSGG laser, while the Ho:YAG-laser is not well tolerated in the animal experiment and has only a low application safety. Its application in stapedotomy would be unreliable and dangerous for the inner ear. Our results also clearly show that the electrophysiological data correlate well with the scanning- electron-microscopic data.
