Effect of the stapedotomy technique on early post-operative hearing results—Preliminary results
Introduction
One-shot CO2 laser application is a widely accepted technique in stapedotomy. It is described as a safe procedure [1], [2], [3] used to create a perforation in the stapes footplate with a diameter of about 0.5–0.6 mm depending on the laser parameters used for laser application. The main advantage of a laser assisted stapedotomy over conventional stapes surgery (perforator) or stapedotomy techniques using a microdrill or piezoelectric devices [4] is to avoid a mechanical trauma of the inner ear. The laser assisted stapedotomy technique has been described as well suited for primary stapes surgery [2] and has also been recommended as a standard procedure in revision stapes surgery [5]. Several authors have reported good audiological results after CO2 assisted laser stapedotomy and did not find a significant sensorineural hearing loss in the speech range [6].
High frequency sensorineural hearing losses (SNHL) following stapes surgery were described by Robinson and Kasden in 1977 [7]. Since then, several authors have reported a distinct sensorineural hearing loss after stapes surgery in the high frequency range from 2 to 8 kHz. The main factors were considered to be: aspiration of the perilymph during surgery, mechanical trauma during preparation, and bleeding into the vestibule. SNHL was also observed after laser stapedotomy [8]. Deterioration of bone conduction was found after potassium titanyl phosphate (KTP) and CO2 laser stapedectomy, being 7.1 dB and 6.7 dB at 4 kHz 1 and 2 weeks post-operatively, respectively. At 8 kHz, a persistent drop in air conduction (AC) was reported. Neither the laser system used (KTP versus CO2) nor the surgery status (primary versus revision surgery) showed significant differences in audiological results post-operatively. Recently, a retrospective chart study has revealed a deterioration in bone conduction (BC) of approximately 6 dB at 4 kHz and 8 dB at 8 kHz 4–6 weeks after stapes surgery [9]. The authors performed CO2 laser assisted stapes surgery in 53 patients. The fenestration of the footplate was carried out with a CO2 laser. Whenever possible, a partial stapedectomy was performed removing the central fragments and the posterior half of the footplate.
The specific aim of this study is to compare two stapedotomy techniques in the surgical treatment of otosclerosis. The early audiological data of patients who were treated with CO2 laser stapedotomy (one shot versus repeated shots) were compared with those in whom the perforator was used. The effects of high-dose cortisone therapy, pre-operative hearing level, and patient age were also considered.
Section snippets
Materials and methods
This unblinded and non-randomized study included 48 patients who underwent stapes surgery for primary otosclerosis between May 2008 and April 2009 at the Department of Otorhinolaryngology, Head and Neck Surgery in Rostock, Germany. A stapedotomy was performed in all patients, using either a CO2 laser or a perforator.
The study group consisted of 48 patients with otosclerosis (30 women, 18 men) with a mean age of 41 ± 13 years, ranging from 14 to 70 years. The study was conducted in strict
Results and analysis
The early post-operative audiograms of all patients included in this study are presented in Table 1. The pre-operative and post-operative ABG measurements were 33.2 ± 9.0 and 12.8 ± 4.4, respectively. There are significant differences between the pre-operative and post-operative bone-conductive thresholds at 1, 4, 6, and 8 kHz, between the pre-operative and post-operative air-conductive thresholds at 0.25–6 kHz and between the air bone gaps (all p-values <0.05). There were no significant group
Discussion
In this non-randomized and unblinded study, we demonstrated a slight, but non-significant increase in the BC threshold in the frequency range between 4 and 8 kHz, 2–3 weeks after stapedotomy. These slight increases in the BC thresholds in the high frequency range had no influence on the early post-laser stapedotomy air–bone gap. Jovanovic et al. presented excellent clinical results for CO2 laser stapedotomy in 188 patients at 1.5–6 months after surgery [2]. It is conceivable that a slight
Financial support
There are no financial interests.
Conflict of interest
None.
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2014, Auris Nasus LarynxCitation Excerpt :From then on, all different types of laser systems, such as KTP, argon, erbium, YAG and CO2 lasers, were assessed for their suitability for stapes footplate perforation [6–11]. But none of them were believed to have any overwhelming advantage over the others in audiological results post-operatively [12–14], although the main advantages of the laser included the high precision of its application, the high ablation efficiency, and the low risk of floating footplate due to the noncontact manipulation of these systems [6]. Several studies showed the negative impact of the laser used in otologic surgery, causing heat or pressure trauma, consequently impairing hearing [6,15–17].
Lasers in stapes surgery: A review
2015, Journal of Laryngology and OtologyFrequency -Specific Air- Conduction and Bone - Conduction Outcomes after Stapedotomy
2023, Iranian Journal of OtorhinolaryngologyLaser vs drill for footplate fenestration during stapedotomy: a systematic review and meta-analysis of hearing results
2021, European Archives of Oto-Rhino-Laryngology