[Thermal stress of the inner ear during laser stapedotomy. I: Continuous-wave laser]

As a consequence of perforating the footplate during laser stapedotomy, direct radiation to the inner ear will warm perilymph and adjacent structures. To determine the possible thermal dangers to cochlear structures from different laser parameters, heat transport mechanisms, temperature increases and temperature fields were investigated in a model system approximating caloric and physiologic changes in the inner ear. The temperature-time course of local cochlear warming showed a rapid convection-dependent increase that reached a peak at about the end of the laser impulse. An increase in power density caused an elevation of the temperature in all laser systems used. Maximum temperatures varied widely for CO2 lasers at the same wave-length, but a different beam-time behavior was found at a distance of 2 mm behind the perforation by using low-power densities. Heat values were lowest at a pulse duration of 50 ms in the superpulse (< 5 degrees C) and continuous wave (cw) modes (< 9 degrees C), while the highest value was found in the pulser mode (to 21 degrees C). After argon laser irradiation at high-power densities, temperatures were nearly independent of location (5.5-13 degrees C). When considering risks of possible inner ear damage from thermal stress during laser stapedotomy, application of the CO2 superpulse and cw laser appears to be safe over a large power-density range. Low energies using a small-beam diameter and short pulse durations (50-100 ms) are recommended. In contrast, use of the CO2 laser in a pulser mode may result in inner-ear damage because of the high temperatures produced. Structures located at a greater distance can be endangered by direct irradiation with the argon laser.