Lasers in endoscopic middle ear surgery: where do we stand today?

Objective: To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery.

Methods: Comprehensive Pubmed search from 1975 to 2020 including clinical articles, of any type, reporting the combined use of a laser and an endoscope. Purely experimental and non-human studies were excluded.

Results: Reports on the application of the laser in pediatric and adult endoscopic middle ear surgery (EES) are increasing since 2013. Laser-assisted EES is performed for cholesteatoma, non-squamous chronic otitis media, ossicular fixation, otosclerosis and tympanic paraganglioma. The improved haemostasis and the non-contact ablation of tissue around the ossicles and inaccessible areas, represent unique advantages. In stapes surgery, the resection of stapes superstructure with minimal force and the non-contact footplate fenestration are potential advantages. Proper use of the laser, i.e. direction away from the facial nerve and the open labyrinth and safe energy settings have resulted in minimal complications.

Conclusion: Based on the increasing number of publications, endoscopic ear surgeons show an interest in using a laser for specific operative tasks. The configuration of a hand-held laser probe does not differ significantly from other otological instruments and therefore is easy to use alongside the endoscope, even in children. The 'handicap' of single-handed surgery can be partially offset by the bloodless and non-contact laser ablation of tissue.