The Use of Lasers in Stapes Surgery

Otosclerosis is a disease process that usually starts around the oval window, causing fixation of the stapes, resulting in conductive hearing loss. Treatment of the conductive hearing loss caused by otosclerosis consists of either rehabilitation with hearing aids or performing surgery. Given the risks of hearing impairment and vertigo associated with the surgery, there has been a desire to advance the practice to minimize the complications. The so-called "non-contact" or "no touch" techniques with the use of various lasers are in current practice. This review article will cover the surgical aspects, the theory behind laser and the various types used in stapes surgery. It will also review the evidence of laser versus conventional stapes surgery and the comparison of different laser types.

A literature search up to December 2019 was performed using Pubmed and a nonsystematic review of appropriate articles was undertaken. Keywords used were stapes, surgery, laser, stapedectomy, and stapedotomy.

Overall, there is no evidence to say laser fenestration is better than conventional fenestration techniques; however, with the micro drill, there is an increased risk of footplate fracture and sensorineural hearing loss. There is an increased risk of tinnitus with the laser compared to conventional techniques. Studies have favored the CO₂ laser over potassium titanyl phosphate (KTP) and erbium-doped yttrium aluminium garnet (Erbium-YAG) lasers for postoperative closure of the air-bone gap; and KTP laser has less thermal, mechanical, and sound effects compared with the thulium and carbon dioxide (CO₂) lasers. There is an increased risk if inner ear complications with the thulium laser.

It can be deduced that theoretically and practically, the thulium laser is less safe compared to the KTP and CO₂ lasers. The choice of laser used depends on the surgeon's preference, as well as availability, cost, side effects profile, as well as ease of use.