To determine the safety and efficacy of new handheld optical fibers for CO2 laser stapedotomy and stapedectomy revision. Advantages of the new CO2 optic fibers are: convenience, reliability and precision. Disadvantages are: special adaptor required for laser console, limited spot size and cost. Omniguides' handheld optic fibers introduce a safe, effective, and precise delivery system for CO2 laser otosclerosis surgery.
Methods
Prospective study of 25 consecutive otosclerosis patients. Researchers at Massachusetts Institute of Technology have developed a flexible optical fiber (photonic bandgap reflector) which can deliver CO2 laser energy through a handheld probe with minimal loss of laser energy. Omniguide introduced a 0.9 mm (O.D.) fiber in 2007 specifically for otologic surgery. This clinical study analyzes the safety and effectiveness of this new technology for CO2 laser otosclerosis surgery. To determine appropriate energy parameters, stapedotomy was performed in the laboratory on human temporal bones. Subsequently, 25 consecutive otosclerosis patients underwent CO2 laser stapedotomy (21) or stapedectomy revision (4) employing these handheld fibers. 6-month post op audiograms were analyzed for air/bone gaps and nerve loss according to AAO-HNS guidelines.
Results
21/21 primary and 3/4 revision patients closed the air/bone gap to within 15 decibels (mean 0.5, 1, 2, 3 KHz). There was no nerve loss at these frequencies. Three patients demonstrated a slight loss at 4 KHz (2-15 db, 1-20 db) compared with their preop audiograMS These results compare favorably with previous otosclerosis surgery performed by the author with microscope mounted CO2 lasers.
Conclusions
Advantages of the new CO2 optic fibers are: convenience, reliability and precision. Disadvantages are: special adaptor required for laser console, limited spot size and cost. Omniguides' handheld optic fibers introduce a safe, effective and precise delivery system for CO2 laser otosclerosis surgery.
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