Efficacy of a 445 nm wavelength laser in the surgical treatment of chronic otitis media.

HYPOTHESIS: Laser-assisted middle ear surgery using a blue wavelength laser is a sufficient treatment option for chronic otitis media. INTRODUCTION: Definitive treatment of chronic otitis media necessitates complete removal of all sites of inflammation. Laser-based surgical techniques have demonstrated promise for achieving thorough resection while preserving auditory function. This study examines the clinical outcomes associated with the use of a 445 nm diode laser, specifically regarding recurrence rates and postoperative hearing restoration in patients with chronic otitis media. METHODS: A cohort of 53 patients (21 Laser respectively 32 microsurgical) undergoing microscopic middle ear surgery for chronic otitis media at the Department of Ear, Nose and Throat Medicine, University of Lübeck, was included based on guideline-driven indications. The surgical intervention employed a fiber-guided approach using a commercial 445 nm wavelength diode laser for tissue ablation, operated in pulse mode with a laser peak power of up to 4 Watt, compared to conventional microsurgical techniques. Retrospective analysis was performed to evaluate recurrence and audiometric outcomes, assessed via pure-tone averages for air and bone conduction thresholds. RESULTS: Six months postoperatively, patients in the diode laser cohort exhibited a significant improvement in hearing outcomes compared to those treated with conventional microsurgical techniques (median AC-PTA improved from 45.36 dB to 30.67 dB in the laser group versus 43.48 dB to 44.45 dB in the microsurgical group; p = 0.0163). All documented recurrences occurred exclusively within the microsurgical treatment group. CONCLUSION: Blue laser-assisted middle ear surgery represents a safe and efficacious modality for the management of chronic otitis media.