Safety and Effectiveness of Diode Laser Used in Stapes Surgery

We comprehensively assessed the safety and effectiveness of a 980-nm diode laser with fiberoptic delivery in stapes surgery by laser energy use, complications, and audiometric outcomes. We retrospectively reviewed 116 primary stapes surgery cases. A high-power (30-40 W), short-pulse (60 msec), 980-nm diode laser was used for superstructure removal and footplate fenestration in the diode laser group (DLG) and, the hook and drill method in the conventional technique group (CTG). Data on complications and surgical diode laser use were collected; audiometric results within 6 months postoperatively were included in the analysis. In DLG, the median fenestration and superstructure resection energy were 4.80 and 18.23 J, respectively. Footplate floating occurred in two ears (2/128, 1.56%) with manual fenestration, although none in the DLG (p = 0.07). Six CTG patients (6/26, 23.08%) underwent inevitable stapedectomy owing to footplate dislocation, which was higher than that in the DLG (2.11%, p < 0.01). No patients in the DLG experienced sensorineural hearing loss, and bone conduction (BC) improved at 1 (preoperative and postoperative means: 23.69 and 20.93 dB, respectively; p = 0.003) and 2 kHz (preoperative and postoperative means: 35.28 and 31.40 dB, respectively; p < 0.001), whereas changes in BC at 0.5 and 3 kHz were stable (p > 0.05). Four DLG patients (4/107, 3.74%) experienced transient facial nerve palsy postoperatively. Laser energy analysis showed shorter superstructure vaporization intervals in patients with transient facial nerve palsy (mean, 11.65 sec; median of control, 24.57 sec; p = 0.037). High-power, short-pulse, 980-nm diode laser is safe and effective in stapes surgery.