Doctor Interview: Atelectatic Ear Drum with Adhesions using CO2 Laser Fiber

Dr. Michaelides: Today I performed a Tympanoplasty
on an ear drum that was severely atelectatic or
collapsed into the middle ear. Because of that there was a fair bit of adhesions between the ear drum and
structures in the middle ear, such as the cochlea, the promontory of the cochlea, and the stapes and incus. I also elevated the drum off of the
malleus so that I could put a graft underneath the ear drum. The particular
device I used today which was the BeamPath S, has a very thin narrowed tip
which is very useful in otologic applications. It allows us to deliver a very small spot size to the
area that we want without having a lot of bulk to it so that we can see around the device
through our microscope. The use of the CO2 fiber, in this case, was used
to remove some of the scar tissue and free
up the adhesions without causing any vibrational trauma to those delicate middle ear structures. In elevating a drum off of, say the stapes, where there are adhesions you may end up moving the stapes a fair
bit if you’re using manual dissection with instruments. However, with the laser fiber we were
able to change the approach to this in use the laser energy that just will cut through the adhesions without touching the stapes at all. So we’re able to remove some of the scar
tissue without touching those delicate parts of the inner ear. I
think it’s a very good tool for doing all sorts of dissections of
soft tissue within the middle ear. It is very accurate because you can put the
tip of the instrument exactly where you want, change the angles and deliver precise amounts of cutting energy or coagulation throughout the middle ear. It will be very helpful in general ear surgery for these situations where you want to remove scar tissue without
causing any damage to the surrounding structures.

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