title: A nonrandomized comparison of the thulium laser and the CO2 laser in primary stapedotomy for otosclerosis.
abstract: OBJECTIVE
  Comparing hearing results in patients with otosclerosis treated with laser-assisted stapedotomy using the 2-μm thulium laser or the CO2 laser.
  
  
  METHODS
  Prospective nonrandomized clinical study.
  
  
  METHODS
  In a tertiary referral center in France (Jean Causse Ear Clinic, Béziers), 208 primary stapedotomies were performed in 204 patients between March 2008 and November 2009. Sufficient follow-up data were available for 194 procedures.
  
  
  METHODS
  The fenestration in the footplate was made with the thulium laser in 98 procedures and with a flexible CO2 laser in 96 procedures. Preoperative and postoperative audiometric results were compared. Side effects, such as vertigo and tinnitus, were scored.
  
  
  RESULTS
  Patients treated with the CO2 laser had better hearing outcome compared with those treated with the thulium laser at both 3 and 12 months of follow-up. At 3 months, the success of the surgery, defined as closure of the air-bone gap to within 10 dB, was 90.0% in the thulium group compared with 96.8% in the CO2 group. Bone conduction shift showed an overall deterioration of 1.6 dB (standard deviation, 6.9 dB) in the thulium group compared with an improvement of 1.3 dB (standard deviation, 4 dB) in the CO2 group. In the thulium group, there were four patients with sensorineural hearing loss (4.4%) and three with tinnitus (3.1%) compared with none in the CO2 group.
  
  
  CONCLUSIONS
  Stapedotomy surgery performed with a fiber-delivered thulium laser resulted in a higher chance of inner ear damage measured by bone conduction shift compared with the use of a fiber-delivered CO2 laser. We advise not to use the thulium laser for stapedotomy.
authors.affiliation: *Department of Otorhinolaryngology-Head and Neck Surgery, and †Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; and ‡Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France.
authors.forename: Digna M A
authors.initials: DM
authors.lastname: Kamalski
authors.forename: Robert
authors.initials: R
authors.lastname: Vincent
authors.forename: Inge
authors.initials: I
authors.lastname: Wegner
authors.forename: Arnold J N
authors.initials: AJ
authors.lastname: Bittermann
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006309:Hearing / Q000502:physiology*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000601:surgery*; D011446:Prospective Studies; D013201:Stapes Surgery / Q000379:methods*; D013932:Thulium; D016896:Treatment Outcome
chemical_list: D013932:Thulium