Short-Term Audiological Results of Diode Laser in Comparison with Manual Perforation in Stapes Surgery

Hamerschmidt, Rogério; Saab, Stephanie Sbizera; Carvalho, Bettina; Carmo, Carolina do

doi:10.1055/s-0037-1602703

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…The laser-assisted stapes surgery is an increasingly widespread procedure 10 with excellent audiological results. According to current knowledge, the use of potassium titanyl phosphate (KTP) and CO 2 laser could be superior to other techniques, 11 while promising results with new solutions such as diode laser could be found 12 as well. In our practice, the use of CO 2 laser is preferred during otologic surgery, due to its wide versatility and atraumatic properties.…”

Section: Discussionmentioning

confidence: 99%

Revision Stapedotomies: The Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Polony

Gáborján

Tamás

et al. 2021

Int Arch Otorhinolaryngol

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Introduction Revision stapes surgeries are difficult to perform, and their audiological results are inferior to primary surgeries. Objective Our goal was to identify the most common and most influential postoperative reasons that cause persistent air-bone gap (ABG) after the primary surgery. Our focus was concentrated on the mechanical dysfunctions in the middle ear, with special regard to postoperative adhesion formation. Methods We performed a retrospective case series study with 23 cases that underwent revision stapedotomies. Results A significant improvement was seen in ABG and air conduction levels after surgery. The periprosthetic adhesion formation was seen in 65% of the cases, and it was the primary cause behind the unsatisfactory hearing result in 30% of cases. There was no significant difference in the level of persistent ABGs after the primary surgery, in case of the intratympanic adhesion presence, compared with the presence of other surgical failures. Concerning hearing and ABG gain after revision surgery, the non-inferiority of the negative effect associated with adhesion was shown compared with the other reasons. Conclusion The revision stapedotomy is an efficient treatment option in case of persistent ABG. Periprosthetic adhesions are the most common intratympanic reasons for compromised audiological outcomes after stapedotomy.Adhesion formations have the same negative effect on ABG development as any other surgical failure, and the revision could be more challenging in these cases. These findings highlight the use of the most atraumatic surgical technique and preservation of intact intratympanic mucosa during middle ear surgery.

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Section: Discussionmentioning

confidence: 99%

Revision Stapedotomies: The Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Polony

Gáborján

Tamás

et al. 2021

Int Arch Otorhinolaryngol

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“…Research investigating poststapedectomy sensorineural hearing loss and mitigating contributing factors influencing poor hearing outcomes has been ongoing. Much of this research is on the mechanical and thermal effects of laser vs conventional fenestration, [19][20][21] as well as on hearing outcomes between the surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Effects of Varying Laser Parameters During Laser Stapedotomy on Intracochlear Pressures

Boscoe

Hartl

Gubbels

et al. 2022

Otolaryngol.--head neck surg.

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Objective Sensorineural hearing loss is a known complication of stapes surgery. We previously showed that laser stapedotomy can result in intracochlear pressures that are comparable to high sound pressure levels. Optimizing laser settings to those that correspond with the lowest pressure changes may mitigate risk for postoperative hearing loss. Here we quantify the effects of various laser parameters on intracochlear pressures and test the hypothesis that intracochlear pressure changes are proportional to the laser energy delivered. Study Design Basic and translational science. Setting Cadaveric dissection and basic science laboratory. Methods Cadaveric human heads underwent mastoidectomies. Intracochlear pressures were measured via fiber-optic pressure probes placed in scala vestibuli and tympani. Pulses of varied stimulus power and duration from a 980-nm diode laser were applied to the stapes footplate. Results Sustained high-intensity pressures were observed in the cochlea during all laser applications. Observed pressure magnitudes increased monotonically with laser energy and rose linearly for lower stimulus durations and powers, but there was increased variability for laser applications of longer duration (200-300 ms) and/or higher power (8 W). Conclusions Results confirm that significant pressure changes occur during laser stapedotomy, which we hypothesize may cause injury. Overall energy delivered depends predictably on duration and power, but surgeons should use caution at the highest stimulus levels and longest pulse durations due to the increasing variability in intracochlear pressure under these stimulus conditions. While the risk to hearing from increased intracochlear pressures from laser stapedotomy remains unclear, these results affirm the need to optimize laser settings to avoid unintended injury.

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“…This could contribute to firmer fixation of the prosthesis and better short-term as well as long-term results. Favorable outcomes of laser stapes surgery when compared to manual perforation were already published [ 25 , 26 ]. In the current study, the use of laser for footplate perforation was independently associated with better audiological outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of surgeons’ experience and the single-shot perioperative antibiotic prophylaxis on outcome in stapedotomy

Brkic

Erović²,

Onoprienko

et al. 2021

PLoS ONE

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Background The aim of this study was to evaluate whether surgeons´ experience and perioperative single-shot antibiotic prophylaxis affect outcome of patients undergoing stapes surgery. Patients and methods We retrospectively evaluated audiological outcomes and postoperative complications of 538 consecutive patients who underwent stapes surgery at a single tertiary referral center between 1990 and 2017. Effects of different clinical variables, including single-shot antibiotic prophylaxis and surgeons’ experience on outcome were assessed. Results 538 patients underwent 667 stapedotomies and postoperative complication rate was 7.5% (n = 50). Air conduction and air-bone gap closure improved significantly after surgery (14.2 ± 14.8 dB, p = 0.001; 14.5 ± 12.8 dB, p = 0.001). Multivariate analysis revealed that 6 years or less of surgical experience was independently associated with a higher incidence of persisting or recurrent conductive hearing loss (p = 0.033, OR 5.13) but perioperative application of antibiotics had no significant effect on outcome. Conclusion First, clinical outcome regarding persisting or recurrent conductive hearing loss caused by incus necrosis and prosthesis luxation is linked to surgical performance. This underlines the need for a meticulous training and supervision of less experienced surgeons performing stapes surgery. Second, our results do not support the need for perioperative antibiotic prophylaxis in stapes surgery. Potential standard limitations of retrospective cohort studies (selection bias, confusion bias etc.) could play a role in interpreting our results. However, the probability for these limitations is minimized due to the large patient sample.

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Short-Term Audiological Results of Diode Laser in Comparison with Manual Perforation in Stapes Surgery

Cited by 8 publications

References 15 publications

Revision Stapedotomies: The Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Revision Stapedotomies: The Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Effects of Varying Laser Parameters During Laser Stapedotomy on Intracochlear Pressures

Impact of surgeons’ experience and the single-shot perioperative antibiotic prophylaxis on outcome in stapedotomy

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