Lasers, radiofrequency, coblation, cryosurgery, hyperbaric oxygen and narrow-band imaging in ENT
- Procedure
Tools that cut, coagulate or freeze tissue, or that help healing and better viewing; each has its own uses and risks.
See it in 3D: Vocal folds · Trachea · Inferior nasal conchae · Stapes
What it is
A laser produces light of a single wavelength, coherent and parallel; each type acts on a chromophore (water, haemoglobin, pigment), so it is chosen according to the tissue. Radiofrequency and electrosurgery heat tissue with electric current. Coblation uses radiofrequency in saline to create a plasma that dissolves tissue at a lower temperature than cautery. Cryosurgery destroys tissue by freezing. Hyperbaric oxygen delivers pure oxygen at higher than atmospheric pressure to help heal irradiated bone and difficult wounds. Narrow-band imaging filters the endoscope light to highlight mucosal vessels and detect early cancer. This page is an educational overview.
Indications and contraindications
- CO2 laser: recurrent respiratory papillomatosis, early glottic cancer (cordectomy), laryngeal stenosis, leukoplakia; coupled to the microscope.
- KTP or argon laser: stapedotomy, nasal telangiectasias, papillomas through a fibre in clinic. Diode and Nd:YAG lasers: deep coagulation and bronchial tumours.
- Coblation and radiofrequency: tonsillectomy and adenoidectomy, inferior turbinate reduction, palate surgery for snoring.
- Cryosurgery: superficial vascular lesions, some small tumours and palliation; little used in the airway today.
- Hyperbaric oxygen: untreated pneumothorax is an absolute contraindication; relative ones are eustachian tube dysfunction, upper respiratory infection and epilepsy.
- Narrow-band imaging: blue and green light absorbed by haemoglobin; shows the mucosal vessel pattern in leukoplakia, dysplasia and early cancer.
How it is done
- Choose the device by tissue: water to cut and vaporise (CO2), haemoglobin to coagulate (KTP, argon, Nd:YAG).
- Laser safety: wavelength-specific eye protection for the whole team, and the patient's eyes covered.
- Against fire: laser-resistant endotracheal tube with a saline-filled cuff, wet swabs and the lowest possible oxygen concentration.
- Short pulses are used with smoke evacuation, as the plume can carry viral particles (papilloma).
- Coblation: the tip works in saline and removes tissue with less heat than classic cautery.
- Hyperbaric oxygen: scheduled as repeated chamber sessions; ears and the ability to equalise pressure are checked first.
- Narrow-band imaging: during endoscopy the light filter is switched and abnormal vessels are sought to guide biopsy.
Lasers in ENT by use
| Laser | Absorbed by | Delivery | Typical uses |
|---|---|---|---|
| CO2 | Water | Articulated arm and microscope | Laryngeal microsurgery, papillomas, early glottic cancer, stenosis |
| KTP | Haemoglobin | Optical fibre | Stapedotomy, papillomas and vascular lesions, nasal surgery |
| Argon | Haemoglobin and pigment | Optical fibre | Middle ear surgery, vascular lesions |
| Nd:YAG | Deep penetration (not very selective) | Optical fibre | Tumours obstructing the trachea and bronchi, vascular malformations |
| Diode | Haemoglobin and melanin | Optical fibre | Turbinates, vascular lesions, coagulation |
Complications
- Airway fire: stop the laser, stop oxygen, remove the tube and extinguish with saline; then inspect the airway.
- Retinal or corneal injury from a laser without proper eye protection; burns of skin and neighbouring mucosa.
- Scarring and webs (synechiae) at the anterior commissure of the larynx after laser on both vocal folds.
- Coblation and radiofrequency: secondary bleeding and pain, as with other tonsillectomy techniques.
- Hyperbaric oxygen: middle ear and sinus barotrauma, transient myopia, seizures from oxygen toxicity, confinement anxiety.
- Cryosurgery: marked swelling after freezing, dangerous in the airway.
Next step / Initial management
- Before referral: describe the lesion (leukoplakia, papilloma, vascular lesion) and request endoscopic assessment; do not plan laser without a histological diagnosis of a suspicious lesion.
- After laryngeal laser surgery: voice rest as the surgeon advises, hydration and reflux control with proton pump inhibitors if the specialist indicates it.
- Before hyperbaric oxygen: check ears and sinuses; if there is tubal dysfunction, the specialist may place ventilation tubes to prevent barotrauma.
- Refer urgently, the same day, if after airway surgery there is stridor, breathing difficulty or bleeding.
- Refer with priority to ENT hoarseness lasting more than 3 weeks, leukoplakia of the larynx or mouth and respiratory papillomatosis.
Test yourself
Think of the answer, then tap the question to see it.
Which laser is most often used in vocal fold microsurgery, and why?
The CO2 laser: it is absorbed by tissue water, cuts and vaporises very precisely with little deep damage, and couples to the microscope.
Which three elements make up the fire triangle in laser airway surgery?
Fuel (endotracheal tube, swabs, drapes), oxidiser (oxygen, nitrous oxide) and ignition source (laser or electrocautery).
What is the most common complication of hyperbaric oxygen?
Middle ear barotrauma, from failure to equalise pressure through the eustachian tube during compression.
What advantage does narrow-band imaging offer in laryngeal endoscopy?
It highlights mucosal vessels with blue and green light absorbed by haemoglobin, helping to detect dysplasia and early cancer and to guide biopsy.
Elsewhere in DurgiPedia
Connections
See it in 3D4
The structures of Durgical's 3D anatomy where it is found.
Microorganisms1
In Pharmacology2
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Laser Complications (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026); Surgical Fire Safety (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2023); Electrosurgery (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2023); Hyperbaric Complications (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2025); Hyperbaric Oxygen Therapy Contraindications (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2025).
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Representative model, for educational purposes only.