However, with the handpiece delivery system, the laser light begins to diverge after it leaves the micropick handpiece. The energy dissipates over a wider area and the neuroepithelium is safe. In a combined series of over 500 microlaser stapedectomies which was collected by the authors, an argon laser beam delivered by micropick-mounted fiberoptic laser fibers was found to be quite successful. It originates from congenital rests of squamous epithelium which become trapped behind the tympanic membrane or it can occur as a consequence of chronic ear infections and tympanic membrane retractions. Middle ear and mastoid cholesteatoma is usually managed surgically.
Successful treatment requires the complete extirpation of all keratinizing squamous epithelium.
Unfortunately, a recurrence can arise from even a few cells which remain hidden under mucosal remnants, granulation tissue, or in mastoid air cells. Following removal of the cholesteatoma, it has become increasingly common to use a laser to vaporize the cholesteatoma bed or to remove potential cholesteatoma remnants adjacent to the oval window, round window or ossicles in order to reduce the recurrence rate. While the evidence is only anecdotal, this technique has appeared to be quite helpful in selected cases. The authors have found laser therapy to be particularly useful in cases where cholesteatoma remnants are attached to a mobile stapes footplate, oval window, or round window. A statistical evaluation of the long term outcome of using this technique will require following these patients for five to ten years.