Comparing CO₂ Laser and Microdrill in Primary Stapedotomy: A Systematic Review and Meta-Analysis of Post-Operative...

Introduction: The gold-standard treatment of otosclerosis is stapedectomy. Recent surgical advancements have led to the use of two approaches for stapedectomy: CO₂ laser and microdrill-assisted stapedotomy. There is limited data on the comparison of both interventions. This study aims to provide an update on evidence-based medicine on the use of CO₂ laser and microdrill in stapedotomy.

A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search was conducted to identify studies comparing CO₂ laser versus microdrill for stapedectomy. Post-operative hearing outcomes and the rates of sensorineural hearing loss (SNHL) were identified as primary outcomes. Secondary outcomes included post-operative complications such as vertigo and abnormal taste sensation. The analysis was based on fixed or random-effects modelling.

Four studies enrolling 1,540 patients were identified. Post-operative hearing outcomes (odds ratio [OR] = 1.23, p = 0.1), SNHL (OR = 0.8, p = 0.74), and abnormal taste sensation post-operatively (OR = 0.84, p = 0.58) were not significantly different between both interventions. However, a significant difference was found between both groups for post-operative vertigo, showing a higher rate for the microdrill group (OR = 2.54, p = 0.02).

In conclusion, CO₂ laser and microdrill are both effective procedures for stapedectomy, as they both produced comparable outcomes in post-operative hearing outcomes and SNHL. However, microdrill had higher rates of post-operative vertigo, possibly indicating that the CO₂ laser is a slightly more preferable option.