New flexible laser scalpel gives ear surgeons greater precision

Dr. David Foyt of the Capital Region Ear Institute in Slingerlands, an ear, nose and throat surgeon,
Dr. David Foyt of the Capital Region Ear Institute shows the new flexible laser device to patient Michael Breen of Halfmoon.
Dr. David Foyt of the Capital Region Ear Institute shows the new flexible laser device to patient Michael Breen of Halfmoon.

Following delicate middle ear surgery on Feb. 19, the first thing Michael Breen did was smile.

That’s because the 54-year-old construction worker from Halfmoon could have easily lost that ability as the result of a benign tumor made up of dead skin cells in his right ear called a cholesteatoma.

Breen underwent two surgeries to remove the cells last year, but in both cases the tumor grew back.

Then he was referred to Dr. David Foyt, of the Capital Region Ear Institute in Slingerlands.

Foyt, an ear, nose and throat surgeon, uses a new flexible C02 laser that allows light to bend, thus allowing him to navigate around delicate tissue in the ear and help minimize the possibility of causing permanent hearing loss or facial nerve injury.

“I was so worried about losing my facial nerve during the surgery,” recalled Breen. “When I woke up, the first thing I did was ask my girlfriend if I could move my face. I was so happy when she said, ‘yes.’ ”

New ability

The new flexible C02 laser allows surgeons to manipulate delicate structures precisely in ways they couldn’t before.

“It makes surgery dramatically more predictable and safer,” said Foyt. “I actually manipulate these tiny hearing bones and remove [the] tumor without having to disturb other structures.”

The procedure is done in the hospital on an outpatient procedure. The surgeon makes an incision behind the ear and removes some of the bone in the back of the ear called the mastoid bone. Then the tumor is lasered out through the ear drum. A second surgery several months later follows to restore any hearing loss.

“Basically, when you open up the ear, you’ve got this tumor sitting there, and you’ve got these tiny little delicate bones,” Foyt explained. “What the laser allows you to do on a microscopic level is burn out the tumor without having to touch these little hearing bones.”

Before the flexible fiber laser became available about a year ago, surgeons used rigid C02 lasers that operated in a straight line and required moving the patient’s body to meet up with the position of the laser.

In some cases, a more serious surgery called a radical mastoidectomy, in which bone had to be removed, would be used. That surgery carries risks like persistent ear drainage and other infections, including meningitis or brain abscesses, permanent hearing loss and facial nerve injury.

“Up until last year, the lasers were mounted to a microscope and they were very difficult to manipulate,” said Foyt. “The new flexible C02 laser really allows ear surgeons to manipulate very small structures very precisely in ways we couldn’t do before. Hearing results are much better, and tumor control results are much better, making surgery dramatically more predictable and safer.”

When Breen first developed symptoms, he said he felt like his eardrum was clogged and popping.

“At first, the doctors thought maybe I had water behind my ear— so they treated me with antibiotics,” Breen recalled.

When that didn’t work, doctors punctured Breen’s ear drum and discovered there was no water. A CT scan showed the presence of the cholesteatoma.

Foyt said cholesteatomas are fairly common.

“They’re caused by skin that gets trapped behind the ear drum,” Foyt explained. “The skin starts acting like a little, aggressive tumor and can actually erode into the brain and kill you.”

Breen had the cholesteatoma removed twice by a different doctor, who tried to scrape the cells clean with a metal scalpel, but each time they grew back.

Foyt, one of the first surgeons in the country to use the new flexible C02 laser scalpel, said he has used it on about 50 patients since last January.

Foyt said the flexible C02 laser scalpel can be used for any type of hearing-restoration surgery.

“It’s much safer in terms of the risk to hearing, but with any of these operations, there is a risk of hearing loss,” said Foyt.

Breen will have a second surgery with the flexible C02 laser in December to restore some hearing that was lost.

“It will involve putting in a titanium prosthesis, which is basically like a prosthetic ear bone,” said Foyt. “And Michael should hear normally again.”

Breen said he will be happy if he regains 90 percent of his hearing. “Right now if I’m in a big room, it’s hard to hear, and if someone comes up behind me, I have to turn around to hear them. So I’m definitely looking forward to getting my hearing back again. Actually, I can’t wait.”

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