title: Outcomes of different laser types in laser-assisted stapedotomy: a systematic review.
abstract: OBJECTIVE
  To assess hearing results and complications following primary stapedotomy in otosclerosis patients, comparing different laser types.
  
  
  METHODS
  Pubmed, Embase, The Cochrane Library, CINAHL, and Scopus.
  
  
  METHODS
  A systematic bibliographic search was conducted to identify all original articles, comparing hearing outcome between different lasers used for fenestration in stapedotomy.
  
  
  METHODS
  Directness of evidence and risk of bias of the selected articles were assessed. Studies with low or moderate directness of evidence, or high risk of bias, were not further analyzed.
  
  
  RESULTS
  The absolute risks, risk differences, and 95% confidence intervals were extracted only for the studies with high directness of evidence and moderate to low risk of bias.
  
  
  CONCLUSIONS
  A total of 383 unique articles were retrieved. Four studies provided direct evidence, whereas all studies carried moderate to high risk of bias. After exclusion of the studies that did not provide direct evidence and/or carried high risk of bias, 2 studies were considered eligible for data extraction. This best available evidence shows a slightly better air-bone gap closure for CO2 laser compared to potassium titanyl phosphate laser, but the clinical relevance is unclear. The risk difference of 28.1% [95% confidence interval, 22.8, 33.4] between CO2 and erbium yttrium aluminium garnet favors CO2 laser. Unfortunately, this current best available evidence is insufficient to draw any definitive conclusions on which laser to use for fenestration in stapedotomy.
authors.affiliation: *Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht; †Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; ‡Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France; §Department of Epidemiology, Julius Center, University Medical Center Utrecht; and ∥Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.
authors.forename: Digna M A
authors.initials: DM
authors.lastname: Kamalski
authors.forename: Inge
authors.initials: I
authors.lastname: Wegner
authors.forename: Rinze A
authors.initials: RA
authors.lastname: Tange
authors.forename: Robert
authors.initials: R
authors.lastname: Vincent
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
authors.forename: Geert J M
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007834:Lasers; D054020:Lasers, Gas; D053844:Lasers, Solid-State; D013199:Stapes; D013201:Stapes Surgery / Q000379:methods*