[Laser stapedotomy]

In addition to hearing aids, stapesplasty represents the standard treatment of otosclerosis-induced hearing loss. In this procedure, the stapes superstructure is replaced by a prosthesis that is attached to the long process of the incus and communicates through a perforation in the footplate with the perilymphatic space of the inner ear. The removal of the stapes superstructure and perforation of the footplate are the critical steps of this surgical procedure. With the introduction of laser-assisted perforation techniques, the surgical safety of this method has been improved compared to conventional techniques. KTP, argon, as well as diode, Er:YAG and CO(2) lasers are used for stapedotomy. By using the CO(2) laser in conjunction with a scanner system, the number of laser applications required for the perforation of the footplate has been markedly reduced. In contrast to other systems, a more reproducible perforation diameter of the stapes footplate is achieved with a CO(2) laser equipped with a scanner. Complications such as uncontrolled leakage of perilymph, irradiation of inner ear structures or the occurrence of pressure waves with subsequent damage to the inner ear can be reduced by using a CO(2) laser. In this review, the surgical technique of CO(2) laser stapedotomy, including clinically established variants and paying particular attention to the one-shot technique, are described and discussed in comparison to other laser systems.