Comparison of argon and CO2 laser stapedotomy in primary otosclerosis surgery

The primary use for the laser in otosclerosis surgery is to create a stapes footplate fenestration that obviates the need for mechanical footplate removal. Experimental studies that evaluate the potential safety of visible (argon and potassium-titanyl-phosphate [KTP]) and invisible (CO2) light laser systems in stapes surgery report conflicting results. The purpose of this study is to compare the clinical safety and efficacy of the CO2 and argon laser systems when used for primary laser stapedotomy.

A retrospective case review of 124 primary laser stapedotomies using either the argon (n = 59) or CO2 (n = 65) laser was performed. Data consisted of pre- and postoperative air and bone conduction audiometry, speech discrimination scores (SDS), intraoperative findings, and postoperative complications. Between group differences (argon v CO2) were sought using standard statistical methodology.

The argon and CO2 laser groups were comparable with regards to age, sex, preoperative air-bone gap, and laterality. Mean preoperative air and bone conduction pure-tone average (PTA) and SDS were somewhat higher in the CO2 laser group (P < .05). Postoperatively, both groups showed similar results in mean change in air conduction PTA, air-bone gap, and SDS, as well as in the frequency of complications. There were no anacoustic ears in either group.

The results suggest that the argon and CO2 laser systems are comparable with regards to safety and efficacy when used by experienced surgeons for stapedotomy.