KTP and CO2 Laser Fiber Stapedotomy Compared

What is the safety and efficacy of the OmniGuide handheld fiber for CO2 laser stapedotomy as compared to the handheld potassium titanyl phosphate (KTP) laser in patients undergoing stapedotomy for otosclerosis?

Background: While both argon and KTP lasers can potentially have thermal effects on deep inner ear structures, CO2 lasers have been considered safer. However, the CO2 delivery system has been associated with damage resulting from missing the target. The new OmniGuide handheld CO2 laser may replace the micromanipulator system.

Study Design: Prospective, nonrandomized clinical study

Setting: Jean Causse Ear Clinic, Colombiers, France

Synopsis: Surgery for otosclerosis with stapes fixation was performed in 214 patients between January 2008 and January 2009. Patients were divided into two equal groups: KTP laser fiber and flexible CO2 laser fiber, with all procedures performed by the same surgeon. In the KTP laser group, the postoperative air-bone gap (ABG) was 4.3 dB compared to three dB in the CO2 group. Of the patients in the KTP group, 92 percent (76 cases) had a postoperative ABG of 10 dB or less, compared to 97 percent (89 cases) in the CO2 group. The postoperative ABG at 4 kHz was 4.9 dB in the KTP and 2.2 dB in the CO2 group. The authors suggest that further study should look at outcomes such as tinnitus or dizziness and quality of life. Additionally, future studies might look at six and eight kHz frequencies, and a larger, randomized trial was recommended, including longer follow-up to show possible sensorineural hearing loss.

Bottom Line: The clinical safety and efficacy of both KTP and CO2 laser for primary stapedotomy was reaffirmed, with the use of the new handheld CO2 laser shown to be associated with slightly better hearing results, especially when assessed at the four kHz frequency.

Citation: Vincent R, Grolman W, Oates J, et al. A nonrandomized comparison of potassium titanyl phosphate and CO2 laser fiber stapedotomy for primary otosclerosis with the otology-neurotology database. Laryngoscope. 2010;120(3):571-576.