title: Laser versus non-laser stapedotomy in otosclerosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare and evaluate the hearing outcome and complications of otosclerosis treated with the laser or non-laser stapedotomy using meta-analysis.
  
  
  METHODS
  A thorough search for publications and "in-process" articles with English abstract dating from January 1978 to July 2013 was conducted using Pubmed, EBSCO and Web of Science databases, as well as all related papers. The included criteria were otosclerosis as diagnosis, clear description of surgical methods, calibrated stapedotomy and regular collection of functional results. Hearing results and other comparable data (age, preoperative hearing status, and mean length of follow-up) were collected from the articles.
  
  
  RESULTS
  Eleven studies with a total of 1614 subjects were identified to meet our criteria. There was a significant difference in the efficacy of stapedotomy with the laser or non-laser technique; current data showed a combined RR of 1.07 (95% CI: 1.02-1.13, p=0.005). But, the postoperative complication showed no advantage for the laser group, with a combined RR of 0.63 (95% CI: 0.30-1.34, p=0.23). Although there was publication bias in this study (p=0.005), the funnel plot would turn out to be symmetrical after six more studies were added by the trim and fill method.
  
  
  CONCLUSIONS
  Our overall results suggest that the laser stapedotomy had significantly better hearing results than non-laser stapedotomy. However, current papers on laser and non-laser stapedotomy did not provide enough subjects to make a subgroup analysis of the hearing outcome between different laser groups. More studies reporting different laser techniques are required to provide us with a better understanding of laser stapedotomy.
authors.affiliation: Department of Otorhinolaryngology, Shanghai Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Lian
authors.initials: L
authors.lastname: Fang
authors.affiliation: Department of Otorhinolaryngology, Shanghai Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Otorhinolaryngology, Shanghai Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: doczhangtianyu@163.com.
authors.forename: Tian-Yu
authors.initials: TY
authors.lastname: Zhang
authors.affiliation: Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tan
mesh_terms: D000328:Adult; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006309:Hearing; D006801:Humans; D053685:Laser Therapy; D016017:Odds Ratio; D010040:Otosclerosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome
keywords: Hearing results; Otosclerosis; Stapedotomy; Stapes surgery