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CO 2 laser revision stapedotomy
Author(s) -
Albers Andreas E.,
Schönfeld Uwe,
Kandilakis Kostas,
Jovanovic Sergije
Publication year - 2013
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23864
Subject(s) - medicine , incus , stapes , conductive hearing loss , sensorineural hearing loss , vertigo , surgery , prosthesis , otosclerosis , stapes surgery , laser , hearing loss , audiology , middle ear , physics , optics
Objectives/Hypothesis To evaluate the safety and efficacy of the one‐shot noncontact technique in stapedotomy for revision stapes surgery with a CO 2 laser combined with a scanning system. Study Design Prospective study. Methods Intraoperative findings and hearing results of 106 patients who underwent revision CO 2 laser stapedotomy because of conductive or sensorineural hearing loss or vertigo were analyzed. Results Leading pathologies were displacement of the prosthesis, incus erosion, fibrous adhesions, and bony reobliteration or a too long or too short prosthesis. Surgery was successfully performed in all cases with a noncontact technique resulting in significantly improved postoperative air and bone conduction. The rate of permanent complications was 0.9%. A comparison of the effect of higher laser energies used for the perforation of bony stapes footplates and lower energies for neomembranes revealed no significant difference in hearing results, underscoring the safety of the technique. Conclusions To avoid any manipulation of the conductive hearing chain that may cause sensorineural hearing loss, we adapted the noncontact technique previously introduced by us for use in revision stapedotomy. This technique was successfully applied to improve conductive and sensorineural hearing loss as well as vertigo in first and second revision stapedotomy cases. Because the rate of postoperative complications was comparable to what is achieved with other laser systems, we conclude that the method has at least an equal level of safety. In conclusion, we advocate the use of a noncontact technique as suitable for an early revision of failed stapedotomy. Level of Evidence 2b