Amy Y Yau1, Hossein Mahboubi, Marlon Maducdoc, Yaser Ghavami, Hamid R Djalilian. 1. *Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, and †Department of Biomedical Engineering, University of California, Irvine, California, U.S.A.
Abstract
OBJECTIVE: To determine whether endoscopic cholesteatoma removal can be performed efficiently and safely using a curved fiberoptic-based laser. BACKGROUND: Angled instruments are required in endoscopic ear surgery to access recesses of the middle ear without extra drilling. Lasers are effective at ablating visible and microscopic cholesteatoma matrix and removing granulation tissue. STUDY DESIGN: Retrospective case review from 2006 to 2013. SETTING: Single tertiary care center. PATIENTS: Patients who underwent cholesteatoma surgery with otoendoscopy. INTERVENTION: Residual cholesteatoma that could not be reached by conventional microinstruments was identified using an endoscope. This residual cholesteatoma was ablated in a contactless manner using a fiberoptic-based curved laser carrier with an argon laser. The laser tip through the carrier probe has a 45-degree curve, and the length of the tip is adjustable, allowing it to be used in recesses or around corners, such as in the sinus tympani, around the stapes suprastructure, in the oval window, or in the Eustachian tube orifice. MAIN OUTCOME MEASURES: Presence or absence of residual cholesteatoma after laser ablation and complications. RESULTS: In 7 cases, the fiberoptic curved laser was used to ablate cholesteatoma completely with no injury to surrounding structures and with no evidence of recidivism with a mean follow-up period of 19 months. There were no cases of sensorineural hearing loss or perilymphatic fistula. CONCLUSION: The curved laser probe allows for precise removal of cholesteatoma endoscopically.
OBJECTIVE: To determine whether endoscopic cholesteatoma removal can be performed efficiently and safely using a curved fiberoptic-based laser. BACKGROUND: Angled instruments are required in endoscopic ear surgery to access recesses of the middle ear without extra drilling. Lasers are effective at ablating visible and microscopic cholesteatoma matrix and removing granulation tissue. STUDY DESIGN: Retrospective case review from 2006 to 2013. SETTING: Single tertiary care center. PATIENTS: Patients who underwent cholesteatoma surgery with otoendoscopy. INTERVENTION: Residual cholesteatoma that could not be reached by conventional microinstruments was identified using an endoscope. This residual cholesteatoma was ablated in a contactless manner using a fiberoptic-based curved laser carrier with an argon laser. The laser tip through the carrier probe has a 45-degree curve, and the length of the tip is adjustable, allowing it to be used in recesses or around corners, such as in the sinus tympani, around the stapes suprastructure, in the oval window, or in the Eustachian tube orifice. MAIN OUTCOME MEASURES: Presence or absence of residual cholesteatoma after laser ablation and complications. RESULTS: In 7 cases, the fiberoptic curved laser was used to ablate cholesteatoma completely with no injury to surrounding structures and with no evidence of recidivism with a mean follow-up period of 19 months. There were no cases of sensorineural hearing loss or perilymphatic fistula. CONCLUSION: The curved laser probe allows for precise removal of cholesteatoma endoscopically.