title: Clinical results after stapedotomy: a comparison between the erbium: yttrium-aluminum-garnet laser and the conventional technique.
abstract: OBJECTIVE
  The objective of this study was to assess whether the use of the erbium: yttrium-aluminum-garnet (Er:YAG) laser has negative effects on inner ear function and to compare the short- and long-term hearing outcome of patients undergoing conventional stapedotomy versus laser stapedotomy.
  
  
  METHODS
  Retrospective review of prospectively collected audiometric data of patients with otosclerosis operated on by one experienced surgeon.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  A total of 266 stapes surgeries were evaluated for intraoperative findings, of which 209 patients were evaluated for preoperative and postoperative hearing thresholds after a 6- to 452-week (mean, 22 wk) audiological follow-up.
  
  
  METHODS
  One hundred fifteen (43%) of the operations were performed conventionally, using manual perforators for stapedotomy (Group A); in 115 (43%) surgeries, the perforators were used in combination with the Er:YAG laser (Group B), and in 36 (14%) operations, the Er:YAG was used exclusively for footplate perforation (Group C).
  
  
  METHODS
  Pure-tone audiometry was performed before surgery, 2 days postoperatively (bone conduction only) and at 5, 26, and 57 weeks postoperatively.
  
  
  RESULTS
  A postoperative temporary threshold shift of the bone conduction could be found in all groups. In Group C, where the laser was used exclusively for footplate perforation, this threshold shift was not only the most significant, but also-in contrast to the other groups-not totally reversible. In all techniques, a satisfactory air-bone gap closure could be achieved. The best long-term results (96% of the patients had <or=20 dB air-bone gap after 57 wk) could be found in Group B.
  
  
  CONCLUSIONS
  If certain rules to minimize inner ear trauma are followed, the Er:YAG laser is a safe tool in middle ear surgery. Combining both the laser and the conventional technique, instead of the separate use of either technique, leads to superior postoperative hearing results.
authors.affiliation: Department of Otolaryngology, Medical University of Hannover, Hannover, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Arnoldner
authors.forename: Burkard
authors.initials: B
authors.lastname: Schwab
authors.forename: Thomas
authors.initials: T
authors.lastname: Lenarz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001309:Auditory Threshold; D001844:Bone Conduction; D002648:Child; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000601:surgery*; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome