To determine what percentage of patients with otosclerosis
could successfully undergo a laser stapedotomy minus prosthesis
over a 5-year period, and to determine the percentage of patients in whom refixation
develops during follow-up.
Retrospective case review of 136 patients (137 ears) who underwent primary surgery for otosclerosis
An otology/neurotology tertiary referral center.
Patients were chosen if they had clinical evidence of otosclerosis
without a history of otologic surgery.
A standard stapes approach was used for all patients. For the laser stapedotomy minus prosthesis
, a hand-held laser probe was used to vaporize the anterior crus of the stapes and perform a linear stapedotomy across the anterior one third of the footplate. If otosclerosis
was confined to the fissula ante fenestram, the stapes became completely mobile. The stapedotomy opening was sealed with an adipose tissue graft from the ear lobe.
Main Outcome Measures
Pure-tone audiometry with appropriate masking and auditory discrimination testing was performed before surgery, 6 weeks after surgery, and every year thereafter.
Of the 137 cases, favorable anatomy and minimal otosclerosis
allowed 46 (33.6%) of these patients to undergo laser stapedotomy minus prosthesis
. Fifty-seven patients (41.6%) could not undergo the procedure because of extensive otosclerosis
. The remaining 34 patients (24.8%) did not receive laser stapedotomy minus prosthesis
because of other anatomic or technical difficulties. Of the 34 patients in the laser stapedotomy minus prosthesis
group with more than 4 months follow-up, the average air-bone gap was closed from a mean of 22 dB (SD 10 dB) to 6 dB (SD 4 dB) 6 weeks postoperatively. Follow-up periods ranged from 5 months to 53 months (mean 767 days, SD 437 days). The long-term air-bone gap improved slightly to an average of 5 dB (SD 6 dB) in comparison with the sixth postoperative week value.
Conclusion Laser stapedotomy minus prosthesis
is a minimally invasive procedure, which over the follow-up period has a very low incidence of refixation
, as evidenced by a lack of progressive conductive hearing loss. The success of this procedure depends on the correct selection of cases. This procedure has been successfully performed on 33.6% of patients undergoing primary stapes surgery. Laser stapedotomy minus prosthesis
seems to be a viable alternative to conventional stapedotomy that yields good results without evidence of refixation
over an extended time.