Kamalski Digna M A, Verdaasdonk Rudolf M, de Boorder Tjeerd, Vincent Robert, Versnel Huib, Grolman Wilko
*Department of Otorhinolaryngology and Head & Neck Surgery, †Brain Center Rudolf Magnus, University Medical Center Utrecht; ‡Department of Physics and Medical Technology, VU University Medical Center Amsterdam; §Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, The Netherlands; and ∥Jean Causse Ear Clinic, Transverse de Béziers, Colombiers, France.
Otol Neurotol. 2014 Aug;35(7):1156-62. doi: 10.1097/MAO.0000000000000465.
The mechanical and acoustic effects that occur during laser-assisted stapedotomy differ among KTP, CO2, and thulium lasers.
Making a fenestration in stapedotomy with a laser minimizes the risk of a floating footplate caused by mechanical forces. Theoretically, the lasers used in stapedotomy could inflict mechanical trauma because of absorption in the perilymph, causing vaporization bubbles. These bubbles can generate a shock wave, when imploding.
In an inner ear model, we made a fenestration in a fresh human stapes with KTP, CO2, and thulium laser. During the fenestration, we performed high-speed imaging from different angles to capture mechanical effects. The sounds produced by the fenestration were recorded simultaneously with a hydrophone; these recordings were compared with acoustics produced by a conventional microburr fenestration.
KTP laser fenestration showed little mechanical effects, with minimal sound production. With CO2 laser, miniscule bubbles arose in the vestibule; imploding of these bubbles corresponded to the acoustics. Thulium laser fenestration showed large bubbles in the vestibule, with a larger sound production than the other two lasers. Each type of laser generated significantly less noise than the microburr. The microburr maximally reached 95 ± 7 dB(A), compared with 49 ± 8 dB(A) for KTP, 68 ± 4 dB(A) for CO2, and 83 ± 6 dB(A) for thulium.
Mechanical and acoustic effects differ among lasers used for stapedotomy. Based on their relatively small effects, KTP and CO2 lasers are preferable to thulium laser.
在激光镫骨手术过程中，KTP激光、二氧化碳激光和铥激光产生的机械和声学效应有所不同。
在镫骨手术中使用激光制造开窗可将机械力导致镫骨足板浮动的风险降至最低。从理论上讲，镫骨手术中使用的激光可能会因外淋巴中的吸收而造成机械性创伤，从而产生汽化气泡。这些气泡在破裂时会产生冲击波。
在一个内耳模型中，我们使用KTP激光、二氧化碳激光和铥激光在新鲜的人镫骨上制造开窗。在开窗过程中，我们从不同角度进行高速成像以捕捉机械效应。用一个水听器同时记录开窗产生的声音；将这些记录与传统微型钻头开窗产生的声音进行比较。
KTP激光开窗显示出很小的机械效应，产生的声音也最小。使用二氧化碳激光时，前庭中出现了微小的气泡；这些气泡的破裂与声学情况相对应。铥激光开窗在前庭中显示出较大的气泡，产生的声音比其他两种激光更大。每种激光产生的噪音都明显低于微型钻头。微型钻头产生的噪音最大达到95±7dB(A)，而KTP激光为49±8dB(A)，二氧化碳激光为68±4dB(A)，铥激光为83±6dB(A)。
用于镫骨手术的激光产生的机械和声学效应有所不同。基于其相对较小的效应，KTP激光和二氧化碳激光比铥激光更可取。
