title: A comparison of hearing results following stapedotomy under local versus general anesthesia.
abstract: Advances in operative technique, instrumentation, and prosthesis design in otosclerosis surgery continue since Shea performed the first successful surgery. This is the first analysis to specifically compare post-operative hearing outcomes following stapedotomy surgery performed under local versus general anesthesia. Hearing outcomes were further stratified by comparing conventional perforator and Er:YAG laser ablation perforation techniques. Pre- and post-operative audiograms were retrospectively analyzed together with the method of anesthesia and the perforation technique for all patients with otosclerosis who underwent stapedotomy between 1998 and 2007. Pre-operative individual standard audiometry frequency thresholds (IFTs), air (AC) and bone conduction pure tone averages (PTA), and air bone gaps (ABG) were compared against post-operative results. Differences between pre- and post-operative PTAs and ABGs were compared between patients who received stapedotomy under local versus general anesthesia, as well as for patients who underwent conventional versus Er:YAG laser ablation perforations. Eighty-six patients were identified of which 24 % (n = 21) received local and 76 % (n = 65) received general anesthesia. Post-operative audiograms were available for 84 and 48 patients, respectively. Significant improvements were seen across all groups for standard 4-frequency AC-PTA and ABG and for IFTs up to 3 kHz. No significant difference was seen for IFTs between 4 and 6 kHz. A significant decline in post-operative hearing thresholds was seen at 8 kHz. Significant improvements in PTA and ABG were seen for all groups. There was a trend toward general compared to local anesthesia post-operative hearing results furthermore in combination with conventional perforation technique then with laser technique.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany, m.loewenthal@uke.de.
authors.forename: Maureen
authors.initials: M
authors.lastname: Loewenthal
authors.forename: Nathan
authors.initials: N
authors.lastname: Jowett
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Busch
authors.forename: Rainald
authors.initials: R
authors.lastname: Knecht
authors.forename: Carsten V
authors.initials: CV
authors.lastname: Dalchow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001299:Audiometry; D002648:Child; D005260:Female; D006309:Hearing; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
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