STAPEDECTOMY VS STAPEDOTOMY - DO YOU REALLY NEED A LASER

Objective: To compare the effectiveness of different techniques of sta pes surgery in improving the hearing of individuals with otosclerosis. Methods and Design: large and small fenestra techniques, as well as t he instrument used to make the fenestra (drill or laser), were compare d with regard to effectiveness and rate of side effects. The charts of 875 patients who underwent primary stapedectomies performed by member s of the House Ear Clinic, Los Angeles, Calif, were reviewed. Patients who underwent stapedectomy for reasons other than otosclerosis and th ose with inadequate postoperative bone conduction threshold data were excluded. A group of 550 patients met the criteria. This group was bro ken into categories depending on the technique of stapedectomy and the instrument used to create the fenestra. The techniques were then comp ared using air-bone gap closure at different frequencies, pure tone av erage, and the rate of significant side effects. Results: The study in dicated that small fenestra stapedotomy and large fenestra techniques have similar rates of closure of the air-bone gap. Small fenestra stap edotomy has a slightly lower rate of postoperative sensorineural heari ng loss, especially at higher frequencies. With regard to the small fe nestra technique, there was no significant difference in either postop erative air-bone gap closure or postoperative sensorineural hearing lo ss, regardless of whether the fenestra was created by laser or microdr ill. Conclusions: While we did find a statistically significant differ ence between the large and small fenestra techniques in postoperative sensorineural hearing loss at higher frequency, the difference is smal l and is probably not clinically significant. Therefore, we find that similar good results can be obtained by the experienced surgeon using either the large or small fenestra technique. Similarly, we found the laser and microdrill to be equally safe and effective in the creation of the fenestra.