Bone conduction after stapes surgery: comparison of CO2 laser and manual perforation.

OBJECTIVE: To compare bone conduction after 2 different ways of perforating the stapes footplate during stapedotomy in patients with otosclerosis. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary reference center. MATERIALS AND 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. CONCLUSION: 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.