TruBlue LASER in Cholesteatoma surgery

Purpose: The retrospective cohort study aims to determine the efficacy and safety of TruBlue laser application in cholesteatoma surgeries.

Methods: All cholesteatoma surgeries conducted from January 2018 to January 2022 by NTEC ENT, with and without use of TruBlue laser, were included. Pure tone audiogram was done pre- and post-operatively to assess hearing. Disease extent was graded with ChOLE score and ChOLE staging. Recurrence of disease was determined clinically, radiologically, or surgically with second look operation.

Results: 120 cholesteatoma cases were identified. 39.2% (n=47) of the cholesteatoma surgeries utilized TruBlue laser, while 60.8% (n=73) did not. Overall follow-up duration was 21 ± 12.4 months, ranging from 2-47 months. When comparing the two groups of cholesteatoma surgeries with and without TruBlue laser usage, there are no significant differences in terms of length of stay (2 ± 2 days in non-laser, 1 ± 1 day in laser, p=0.31) and complications (1.4% in non-laser, 1.3% in laser, p=0.97, all prelated to mild perilymphatic leak, no facial nerve palsy reported). Bone conduction hearing threshold in the laser group after operation is preserved (pre-operative BC 26.8 ± 24.9dB, post-operative 25.6 ± 23.9 dB, p=0.59). Recurrence of cholesteatoma occurred in 17.8% (n=13) in non-laser group, and 21.3% (n=10) in laser group, which is not statistically significant (p=0.64). Location of recurrence was found in the mastoid attic and middle ear in the non-laser group, where recurrence are around the facial nerve and stapes footplate in the laser group.

Conclusion: In this study we observed no BlueLASER related complications. Unfortunately we did not show statistically significant numer of reduction in recurrence. Probably due to the location of recurrence in the laser group were the area that laser cannot be applied.