Hearing outcome of laser stapedotomy minus prosthesis (STAMP) versus conventional laser stapedotomy.

摘要

OBJECTIVE: The objective of this study was to compare short-and long-term hearing outcomes for patients undergoing primary laser stapedotomy minus prosthesis (STAMP) versus conventional laser stapedotomy. STUDY DESIGN: We conducted a retrospective case review of 167 consecutive patients from 1993 to 2002. SETTING: Otologyeurotology tertiary referral center. PATIENTS: We studied those with clinical otosclerosis without previous otologic surgery. INTERVENTIONS: Patients with otosclerosis confined to the fissula ante fenestram underwent STAMP. Patients with more extensive otosclerosis or anatomic contraindications to STAMP underwent standard laser stapedotomy. MAIN OUTCOME MEASURES: Pure-tone audiometry was performed before surgery, postoperatively, and on routine follow-up examination. RESULTS: Of the 183 ears in 167 patients, 128 (67.1%) underwent laser stapedotomy and 55 (32.98%) underwent STAMP. The STAMP mean air-bone gap (ABG) closed from a preoperative value of 22 dB (standard deviation [SD], 10 dB) to 6 dB (SD, 7 dB) on average follow up of 778 days. In 128 laser stapedotomy patients with an average follow up of 747 days, the preoperative mean ABG closed from 27 dB (SD, 10 dB) to 8 dB (SD, 7 dB). There was a trend toward improvement in high-frequency air conduction thresholds after STAMP versus worsening of high-frequency thresholds in the conventional stapedotomy group. There was a statistically significant improvement in most recent postoperative high-frequency (6000-8000 Hz) air conduction thresholds in the STAMP patients compared with patients who underwent conventional laser stapedotomy. CONCLUSION: Laser STAMP, when used for isolated anterior footplate otosclerosis, provides excellent high-frequency hearing, yields lasting results similar to conventional laser stapedotomy, and has a low incidence of refixation necessitating revision surgery.