title: Bone conduction after stapes surgery: comparison of CO2 laser and manual perforation.
abstract: OBJECTIVE
  To compare bone conduction after 2 different ways of perforating the stapes footplate during stapedotomy in patients with otosclerosis.
  
  
  METHODS
  Retrospective clinical study.
  
  
  METHODS
  Tertiary reference center.
  
  
  METHODS
  This study evaluated data from 302 patients (61.2% women) who had undergone primary surgery for stapedial ankylosis between 2000 and 2010. Bone conduction thresholds at 0.5, 1, 2, and 4 kHz were determined on the first and fourth postoperative days in all patients; 280 patients were followed up after 1 month and 125 after 1 year. Audiograms were compared with preoperative bone conduction.A laser was used to open the stapes footplate in 180 patients; manual perforation was performed in 122.
  
  
  RESULTS
  Immediately postoperatively the bone conduction threshold was significantly worse at almost all frequencies. At lower frequencies (0.5 and 1 kHz), it improved to baseline within the first 4 days. At 2 kHz, the threshold on Day 4 remained significantly worse than baseline and improved only after 1 month, then exceeding the preoperative value. Bone conduction at 4 kHz still tended to be worse than baseline 1 month after surgery, but the difference was no longer statistically significant 1 year later. A direct comparison with classic stapedotomy showed a trend in favor of the laser technique, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  Both laser and classic techniques can be used successfully in stapes surgery without causing long-term damage to the inner ear. Direct comparison shows a trend in favor of laser stapedotomy.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Brase
authors.forename: Isabell
authors.initials: I
authors.lastname: Keil
authors.forename: Judith
authors.initials: J
authors.lastname: Schwitulla
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantsopoulos
authors.forename: Matthias
authors.initials: M
authors.lastname: Schmid
authors.forename: Heinrich
authors.initials: H
authors.lastname: Iro
authors.forename: Joachim
authors.initials: J
authors.lastname: Hornung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001844:Bone Conduction / Q000502:physiology*; D002648:Child; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000601:surgery*; D012189:Retrospective Studies; D013199:Stapes / Q000473:pathology*; D013201:Stapes Surgery / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult