DeRowe A, Ophir D, Katzir A
Applied Physics Group, Raymond and Beverly Sackler School of Physics and Astronomy, Tel-Aviv University, Israel.
Lasers Surg Med. 1994;15(3):249-53. doi: 10.1002/lsm.1900150303.
CO2 laser myringotomy has previously been proven effective in patients with serous otitis media for short-term aeration of the middle ear. However, the system based on a microscope and a coaxially aligned laser is cumbersome and expensive. The advantage of CO2 laser energy is the high absorption coefficient in biological tissue, meaning minimal damage surrounding the desired lesion. The disadvantage is that conventional optical fibers do not transmit CO2 laser energy (lambda = 10.6 microns). We have developed a silver halide optical fiber of diameter 0.9 mm and lengths of several meters, with high transmission at 10.6 microns. Using a hand-held otoscope coupled to a fiberoptic delivery system, CO2 laser myringotomies were performed in guinea pigs. In the animal model the feasibility of the procedure was proven. Different irradiation parameters were studied and a "dose-dependent" relationship was found between the total energy used and the duration of a patent myringotomy. However, conventional histological studies failed to show a difference in circumferential damage with different energy parameters. CO2 laser myringotomy utilizing a hand-held otoscope coupled to an optical fiber capable of transmitting CO2 laser energy may prove simple and effective. The relationship between energy parameters and myringotomy patency may be instrumental in deciding on the optimal duration of aeration of the middle ear in secretory otitis media.
二氧化碳激光鼓膜切开术先前已被证明对浆液性中耳炎患者有效，可实现中耳的短期通气。然而，基于显微镜和同轴对准激光的系统既笨重又昂贵。二氧化碳激光能量的优点是在生物组织中的吸收系数高，这意味着在所需病变周围的损伤最小。缺点是传统光纤不传输二氧化碳激光能量（波长 = 10.6微米）。我们已经开发出一种直径为0.9毫米、长度为几米的卤化银光纤，在10.6微米处具有高传输率。使用与光纤传输系统相连的手持式耳镜，在豚鼠身上进行了二氧化碳激光鼓膜切开术。在动物模型中证明了该手术的可行性。研究了不同的照射参数，发现所用总能量与鼓膜切开术通畅持续时间之间存在“剂量依赖性”关系。然而，传统的组织学研究未能显示不同能量参数下周边损伤的差异。利用与能够传输二氧化碳激光能量的光纤相连的手持式耳镜进行二氧化碳激光鼓膜切开术可能被证明既简单又有效。能量参数与鼓膜切开术通畅性之间的关系可能有助于确定分泌性中耳炎中耳通气的最佳持续时间。
