Laser-based stapes surgery

Otosclerosis is a common disease which entails fixation of the stapes footplate at the border between middle ear and vestibule of the inner ear. It can be treated with perforation, partial or total removal of the stapes footplate and its suprastructure including replacement by prosthesis. As structures are very delicate and prone to damage by direct manipulation, the use of lasers has been proven advantageous in comparison to mechanical tools. Yet there has been extensive debate about unwanted effects on the inner ear by pressure transients, temperature rise, and temporary impairment of inner ear function. However, with growing experience in this field, various lasers have been shown not only to be effective but also safe in preserving labyrinthine and cochlear function while restoring sound transmission. This chapter deals with the history of laser use, laser systems, and instrumentation, while providing a perspective for future developments in microscale bone ablation.