[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [ENT](https://durgical.com/en/ent/) › [Procedures and technology](https://durgical.com/en/ent/areas/procedures/) › Lasers, radiofrequency, coblation, cryosurgery, hyperbaric oxygen and narrow-band imaging in ENT

# 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.

Updated Nov 12, 2026

**See it in 3D:** [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/) · [Trachea](https://durgical.com/en/anatomy/trachea/) · [Inferior nasal conchae](https://durgical.com/en/anatomy/inferior-nasal-concha-bone/) · [Stapes](https://durgical.com/en/anatomy/stapes/)

## Key points

- CO2: absorbed by water; cuts and vaporises precisely with little deep damage; it is the laser of laryngeal microsurgery (papillomas, early glottic cancer).
- KTP and argon: absorbed by haemoglobin; pass through optical fibre; useful for vascular lesions, papillomas and stapes surgery.
- Nd:YAG: penetrates deeply and coagulates; used through a fibre for tumours obstructing the trachea and bronchi and for vascular malformations.
- The greatest risk of laser in the airway is fire: fuel (tube, swabs), oxidiser (oxygen, nitrous oxide) and an ignition source.
- Hyperbaric oxygen in ENT: osteoradionecrosis of the mandible, malignant otitis externa and sudden hearing loss (adjunct); its most common complication is ear barotrauma.

On this page

- The basics Key points
- What it is
- How it is done
- Lasers in ENT by use
- Memory aid
- Elsewhere in DurgiPedia

- Clinical Complications

- Treatment Next step / Initial management

- Safety Indications and contraindications

- Study Test yourself

- Connections Connections

## 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.

## Memory aid

CO2 cuts with water; KTP and argon seek blood; Nd:YAG goes deep.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ent/lasers-radiofrequency-coblation-cryosurgery-hyperbaric-oxygen-and-narrow-band-im/)

## Elsewhere in DurgiPedia

- [The WHO surgical safety checklist](https://durgical.com/en/nursing/the-who-surgical-safety-checklist/)

## Connections

## See it in 3D 4

The structures of Durgical's 3D anatomy where it is found.

- [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/)
- [Trachea](https://durgical.com/en/anatomy/trachea/)
- [Inferior nasal conchae](https://durgical.com/en/anatomy/inferior-nasal-concha-bone/)
- [Stapes](https://durgical.com/en/anatomy/stapes/)

## Related 3

- [Direct laryngoscopy, bronchoscopy and oesophagoscopy](https://durgical.com/en/ent/direct-laryngoscopy-bronchoscopy-and-oesophagoscopy/)
- [Tonsillectomy and adenoidectomy: indications, technique and complications](https://durgical.com/en/ent/tonsillectomy-and-adenoidectomy-indications-technique-and-complications/)
- [Septal surgery: septoplasty and submucous resection](https://durgical.com/en/ent/septal-surgery-septoplasty-and-submucous-resection/)

## Related conditions 2

- [Recurrent respiratory papillomatosis](https://durgical.com/en/conditions/recurrent-respiratory-papillomatosis/)
- [Laryngeal cancer](https://durgical.com/en/conditions/laryngeal-cancer/)

## Microorganisms 1

- [Human papillomavirus](https://durgical.com/en/microbiology/human-papillomavirus/)

## In Pharmacology 2

- [Cidofovir](https://durgical.com/en/pharmacology/cidofovir/)
- [Proton pump inhibitors (PPIs)](https://durgical.com/en/pharmacology/classes/proton-pump-inhibitors/)

[← All of ENT](https://durgical.com/en/ent/)

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)](https://www.ncbi.nlm.nih.gov/books/NBK532248/) (StatPearls Publishing, NCBI Bookshelf, 2026); [Surgical Fire Safety (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK544303/) (StatPearls Publishing, NCBI Bookshelf, 2023); [Electrosurgery (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK482380/) (StatPearls Publishing, NCBI Bookshelf, 2023); [Hyperbaric Complications (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK459191/) (StatPearls Publishing, NCBI Bookshelf, 2025); [Hyperbaric Oxygen Therapy Contraindications (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK557661/) (StatPearls Publishing, NCBI Bookshelf, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ent/lasers-radiofrequency-coblation-cryosurgery-hyperbaric-oxygen-and-narrow-band-im/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/lasers-radiofrequency-coblation-cryosurgery-hyperbaric-oxygen-and-narrow-band-im/