Lasers in stapes surgery: a review

Young, Eric D.; Mitchell‐Innes, Alistair; Jindal, Mudit

doi:10.1017/s0022215115001280

Cited by 16 publications

(22 citation statements)

References 39 publications

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“…Stapedotomy as treatment for otosclerosis can be performed using a variety of different surgical techniques, including several laser modalities in combination with a microdrill in the different steps of surgery. CO 2 , diode, potassium‐titanyl‐phosphate (KTP), and thulium lasers are the lasers most frequently used …”

Section: Introductionmentioning

confidence: 99%

“…CO 2 , diode, potassium-titanyl-phosphate (KTP), and thulium lasers are the lasers most frequently used. 1 Stapedotomy is a safe procedure with good results and few complications. In some cases, however, stapedotomy can result in sensorineural hearing loss, worsening of tinnitus, dizziness, taste disturbance, and in exceptional cases, facial nerve palsy and deafness.…”

Section: Introductionmentioning

confidence: 99%

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Surgical technique in stapedotomy hearing outcome and complications

et al. 2019

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Objectives/Hypothesis The aim of this study was to investigate different stapes surgery techniques in relation to hearing outcome and risk for complications such as tinnitus, hearing deterioration, dizziness, and taste disturbance. Study Design Retrospective database review. Methods The study was based on data from the Swedish Quality Register for Otosclerosis Surgery (SQOS). Two study protocols were completed by the surgeon, and a questionnaire was distributed to each patient 1 year after surgery. A total of 832 patients operated on during 2013 to 2016 were included. Pure‐tone audiometry was performed preoperatively and 1 year after surgery. Results There was no significant difference in postoperative high‐frequency hearing thresholds among the subgroups at the 1‐year follow‐up. The CO2 + drill laser group had the best hearing outcome according to the following criteria: air‐bone gap closure ≤10 dB, air‐conduction improvement >20 dB, and bone conduction not worsened >5 dB. The overall complication rate was low in all analyzed groups. The most commonly reported symptom after surgery was newly developed or worsened tinnitus (6%). Subjective hearing 1 year after surgery was reported to be better or much better in 91% of the patients. Conclusions The combination of a drill and CO2 laser or a drill and potassium‐titanyl‐phosphate laser resulted in the best hearing outcome in this study from the SQOS. There were no major differences in high‐frequency hearing outcome when comparing the different surgical techniques. Complications from surgery were rare, and patient satisfaction was very high 1 year after the operation. Level of Evidence NA Laryngoscope, 130:790–796, 2020

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical technique in stapedotomy hearing outcome and complications

et al. 2019

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“…25 In contrast, the CO 2 laser utilizes a longer wavelength (10,600 nm; within the infrared spectrum), which is strongly absorbed by bone with minimal penetration into surrounding tissues. A major disadvantage of the CO 2 laser is the invisible beam, which necessitates an aiming beam 18 ; the duel beams could be theoretically misaligned, resulting in inadvertent damage to surrounding structures. Furthermore, because the CO 2 laser utilizes a helium stream, there is a small risk of inner ear insufflation when the stapedotomy is performed.…”

Section: Discussionmentioning

confidence: 99%

Variations in Stapes Surgery Cost within a Multihospital Network

Casazza

Thomas

Dewey

et al. 2019

Otolaryngol.--head neck surg.

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Objective To identify costs and operative times for stapedotomy and evaluate factors influencing cost variation. Study Design Case series with cost analysis. Setting Multihospital network. Subjects and Methods A multihospital network’s standardized activity-based accounting system was used to determine costs and operative times of all patients undergoing stapedotomy from 2013 to 2017. Subjects with additional procedures were excluded. Correlations between variable factors and cost were calculated by Spearman correlation coefficients. Audiometric and cost data were compared with a Mann-Whitney U test. Results The study cohort included 176 stapedotomies performed by 23 surgeons at 10 hospitals. Mean ± SD patient age was 44.3 ± 17.4 years. Mean cut-to-close time was 61.1 ± 23.55 minutes. Mean total encounter cost was $3542.14 ± $1258.78 (US dollars). Significant factors correlating with increased total encounter cost were surgical supply cost ( r = 0.74, P < .0001) and cut-to-close time ( r = 0.66, P < .0001). Laser utilization ($563.37 ± $407.41) was the highest-cost surgical supply, with the carbon dioxide laser being significantly more costly than the potassium titanyl phosphate (KTP; $852.60 vs $230.55, P < .001). Additionally, the carbon dioxide laser was associated with a significantly higher mean total encounter cost than the KTP laser ($4645.43 vs $2903.00, P < .001) and cases where no laser was used ($4645.43 vs $2932.47, P < .001). There was no difference in mean total encounter cost between the KTP laser and cases of no laser use ($2903.00 vs $2932.47, P = .75). Conclusions Significant cost variation exists in stapes surgery. Surgical supply cost, specifically laser use, may be associated with significantly increased costs. Reducing variation in costs while maintaining outcomes may improve health care value.

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“…In the past, multiple shots were performed to allow the prosthesis to fit; however, currently the CO 2 laser can be utilized using the one shot laser technique. 7 Diode. It has a wavelength of 805 to 980 nm and is portable.…”

Section: Carbon Dioxide Laser (Co 2 )mentioning

confidence: 99%

The Use of Lasers in Stapes Surgery

2020

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Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.

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Lasers in stapes surgery: a review

Abstract: This review discusses the various different lasers used in stapes surgery with regard to their properties and suitability for this type of surgery. In particular, the laser parameters used are discussed to facilitate their clinical use.

Cited by 16 publications

References 39 publications

Surgical technique in stapedotomy hearing outcome and complications

Surgical technique in stapedotomy hearing outcome and complications

Variations in Stapes Surgery Cost within a Multihospital Network

The Use of Lasers in Stapes Surgery

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