In der vorliegenden Arbeit wird am Beispiel des Erbium:YAG-Lasers und des CO2-Lasers die Wirkung von Laserstrahlung am menschlichen Trommelfell dargestellt. Für beide Lasersysteme wurden anhand eines neuentwickelten Trommelfellmodells verschiedene Applikationssysteme getestet und hinsichtlich ihrer Praktikabilität für die Laserparazentese bewertet. Es wurden laserspezifische Parameter ermittelt, die Grundlage einer klinischen Erprobung des Erbium:YAG-Lasers und des CO2-Lasers sowie ihrer Applikationssysteme zur Laserparazentese sind.
Myrigotomy with and without adenoidectomy is the therapy of choice in patients with chronic secretory otitis media (SOM). In order to determine wether or not lasers are suitable instruments for myringotomy, we investigated two different IR-laser systems (CO2-laser and Er:YAG-laser) in combination with different laser application-systems. The ablation properties and thermic effects of the CO2-laser and Er:YAG-laser were examined histologicaly and with electron microscope in a newly developed tympanic membrane model. Since duration of middle-ear ventilation depends on the size of the myringotomy, the relationship between energy parameters and myringotomy patency may be instrumental in deciding on the optimal duration of aeration of the middle ear in secretory otitis media. Myrigotomy perforations should have a diameter greater than 2 mm to ventilate the middle ear for approximately 3 weeks, thus avoiding tympanic ventilation tubes. Therefore we investigated the relationship between energy parameters and myringotomy perforation size with different applications systems (laserotoscope, micromanipulator in combination with microscope and scanner systems, laser fibers). Currently, an effective, easy and practical performance of laser myringotomy for SOM therapy is possible with the CO2-laser whereas the Er:YAG-laser seems to be not suitable.