Lasers are an excellent surgical tool for the restoration of hearing in conductive hearing loss, the prevention of recurrence of cholesteatoma in chronic otitis media, and the positioning of implantable hearing devices. The physiology of hearing involves the transmission of sound vibrations through the ear canal to the tympanic membrane and then across the ossicular chain to the oval window. This causes conductive hearing loss because vibrations cannotbe transmitted easily Figure 2A Steps in stapectomy. Arrow indicates otosclerosis fixation.
Stapedectomy is the best management for the conductive hearing loss caused by otosclerosis.
Because there is less surgical manipulation of the inner ear, superior patient outcomes are achieved and there are fewer postoperative complications such as balance difficulties, nausea, or other problems which are severe enough to require hospitalization. Bone is curetted from the margins of the ear canal in order to allow visualization of the oval window, and the fixation of the stapes is confirmed. At this point, a laser is used to vaporize both the joint between the incus and the stapes and the stapedius tendon. The posterior crus of the stapes is vaporized with the laser and the remainder of the superstructure, or the arch, of the stapes is removed. Once the char is removed, a small piston prosthesis is crimped onto the incus and fit into the tiny opening in the footplate of the stapes.