CO ₂ Laser Technique versus Cold Steel: Is CO ₂ Laser Required as a Surgical Tool for Flawless Stapes Surgery?

Introduction  Stapedotomy is the standard of care in the surgical management of clinical otosclerosis. It is a precise and technically demanding craft requiring impeccable surgical skills. Both conventional and laser-assisted procedures aim to achieve closure of the air-bone gap (ABG) with minimum collateral damage. Objective  To compare the postoperative outcomes of conventional stapes surgery and CO ₂ laser-assisted surgery. Methods  We conducted a retrospective analysis of the medical records of 74 adult patients who underwent stapedotomy at our center. The patients were divided into two groups for comparison: the "cold steel method" (CSM) group, which was composed of patients who had undergone conventional stapedotomy (manual microperforators/hand-held microdrill); and the "CO ₂ laser-assisted" (LA) group. The postoperative outcomes assessed at 3 and 6 months in both groups were analyzed and compared. The average operative time and complications of both groups were also compared. Results  The hearing outcomes presented statistically significant postoperative improvement in both groups. The LA group presented statistically significant better air conduction thresholds at 3 and 6 months ( p  < 0.05). The ABG and its degree of closure were statistically better at 3 months in the LA group; however, the difference became insignificant at 6 months. Transient vertigo was more common in the LA group ( p  < 0.01). There was no new sensorineural hearing loss in either group. The operative time was longer in the LA group. Conclusion  In experienced hands, both conventional and laser techniques can be used with equal ease and expectation of better outcomes. The CO ₂ laser is not an indispensable tool to achieve good surgical results on a routine basis.