The Use of KTP Laser in Revision Stapedectomy

Abstract

Revision stapes operations have lower success rates than primary surgeries. Success rates have increased since the introduction of the laser. Visible (KTP, argon) and infrared (CO2) spectrum lasers have been used in stapes surgery. A concern has been raised regarding the use of visible lasers in revision stapedectomy because of their properties of tissue penetrance. The objective of our study is to evaluate a series of patients who underwent revision stapedectomy with the use of KTP laser to determine whether there is an increased risk of sensorineural hearing loss associated with the use of this laser. Patients with otosclerosis requiring revision stapedectomy. Revision stapedectomy or stapedotomy were performed using the KTP laser. The primary outcome evaluated was the incidence of postoperative sensorineural hearing loss. Improvement in air-bone gap was evaluated as a secondary outcome. There were no cases of postoperative sensorineural hearing loss or deafness. Approximately 56.5% of patients achieved closure of the postoperative ABG to within 10 dB; 91.3% of patients achieved a postoperative ABG within 20 dB. The KTP laser was used most commonly to lyse fibrous adhesions. Although there is a theoretical risk of penetrance of the KTP laser through the oval window and underlying perilymph with resultant damage to the sense organ-containing endolymph, this theoretical risk did not translate into an increased rate of sensorineural hearing loss in our series. The KTP laser allowed for less traumatic clearing of middle ear adhesions and good hearing results.