Thulium laser in stapedotomy surgery

Background: Revolix JR (Thulium) laser use in stapedotomy surgery has previously raised issues regarding its thermal effects on the vestibular area with production of acoustic shock waves which may result in permanent complications. Objectives: To evaluate the efficacy and safety of the Thulium laser use in stapedotomy and its long-term effect on the clinical and audiological results. Study design: Retrospective case series study. Settings: All surgeries were performed at a single Otologic Center of a tertiary University Hospital. Subjects: 148 otosclerosis patients, with ages ranging from 18 to 78 years, were divided into two groups; group A included 62 patients, and group B included 86 patients. Intervention: In all patients, the reversal-stapedotomy technique was used. In group A, multiple overlapped 4 W Thulium shots, with a 15-seconds interval between them, were used. In group B, one shot followed by regularization with a manual perforator was used. The main outcome measures: The preoperative and the postoperative threshold as pure tone average (PTA4) were evaluated along with eventual intraoperative (footplate cracking and stapedectomy) and the postoperative complications (SNHL, vertigo, and tinnitus). Results: a statistically significant improvement of the ABG in both groups was achieved. ABG closure (< 10 dB) was 87.1% of patients in group A and 89.5% of patients in group B. Intraoperative complications were more observed in group B (p-value=0.038), while the postoperative complications occurred more in group A (p-value=0.017). Conclusions: According to our experience on a relatively large number of cases, the Thulium laser is a safe tool to be used in stapedectomy either by multiple shots or by single shot plus manual perforator. The use of this tool showed to be effective in improving functional hearing with minimum, nonsignificant rate of complications that were not affecting the inner ear function.