"Hot" vs "Cold" endoscopic stapes surgery: a matched case-control study

Abstract

Purpose: To compare hearing results and complication rates between two groups of patients operated on by endoscopic stapes surgery (ESS) for otosclerosis, either with CO₂ fiber laser or microdrill.

Methods: A case-control study was performed. All consecutive cases of CO₂ fiber laser ESS operated at a single center during the period 2017-2020 (case group) were matched to a control group of patients operated by traditional technique, according to year of surgery, preoperative mean air-bone gap, sex and age. Audiological data from preoperative and postoperative examinations and complication rates were compared.

Results: 46 cases were included. Mean operative time was significantly longer in the laser cohort (65 min) than in the drill one (45 min) (p = 0.003). Similar results were found in the two groups regarding the mean postoperative BC-PTA. The high-frequency bone conduction resulted significantly higher in the laser group (p = 0.002), suggesting an overclosure effect in the laser group. Consistently, a significant improvement of the BC-PTA threshold at 2000 Hz postoperatively was found in the laser group (p = 0.034). The postoperative AC-PTA significantly improved in both groups at all frequencies (p < 0.05), except for the AC threshold at 8 kHz. Similar rates of complications were found in the two groups.

Conclusion: This study is the first to compare hearing results and complications between CO₂ fiber laser and microdrill in ESS. Our results demonstrated similar functional outcomes between the two groups, confirming ESS as safe and effective, regardless of the technique used.

Keywords: Air conduction; Air–bone gap; Bone conduction; CO2 laser; Endoscopic stapes surgery; Microdrill; Microscopic stapes surgery; Stapedotomy; Stapes.