Laser stapedotomy minus prosthesis (laser STAMP): A minimally invasive procedure

Objective: To determine whether hearing can be restored using a laser witho ut a prosthesis in patients with minimal otosclerosis. Study Design: Retrospective case review of 12 patients with minimal otoscle rosis who underwent a laser stapedotomy without prosthesis (laser STAMP) pr ocedure. Setting: An otology/neurotology tertiary referral center. Patients: Patients were chosen for the procedure if there was a blue footpl ate with minimal otosclerosis confined to the fissula antefenestram. Interventions: Using a hand-held probe (CeramOptic), and the HGM argon lase r, the anterior crus of the stapes was vaporized. Next, a linear stapedotom y was made across the anterior one third of the footplate. If otosclerosis is confined to the fissula antefenestram, the stapes becomes completely mob ile. The stapedotomy opening is sealed with an adipose tissue graft from th e ear lobe. Main Outcome Measures: Pure-tone audiometry with appropriate masking and au ditory discrimination testing were performed before surgery, 6 weeks after surgery, and 1 year after surgery. Results: The average air-bone gap was closed to a mean (SD) of 2.6 dB (3.3 dB). The average improvement in air-bone gap was 17.4 dB (7.6 dB). The disc rimination scores remained unchanged. Audiometric testing of five cases wit h 1 year follow-up demonstrates that excellent hearing results are maintain ed. Conclusions: In selected cases of minimal otosclerosis confined to the fiss ula antefenestram, normal mobility of the ossicular chain can be obtained w ithout a prosthesis by vaporizing the anterior crus and making a linear sta pedotomy across the anterior one third of the footplate. The advantages of the procedure are that the stapedius tendon and most of the normal stapes r emain intact, eliminating hyperacusis. The procedure is less invasive so it reduces inner ear trauma, possible prosthesis problems are avoided, and po stoperative barotrauma risk is minimized. Minimal surgery is done for minim al disease. If the stapes refixes at some time in the future, a conventiona l stapedotomy can still be performed.