CO₂ laser revision stapedotomy

To evaluate the safety and efficacy of the one-shot noncontact technique in stapedotomy for revision stapes surgery with a CO₂ laser combined with a scanning system.

Prospective study.

Intraoperative findings and hearing results of 106 patients who underwent revision CO₂ laser stapedotomy because of conductive or sensorineural hearing loss or vertigo were analyzed.

Leading pathologies were displacement of the prosthesis, incus erosion, fibrous adhesions, and bony reobliteration or a too long or too short prosthesis. Surgery was successfully performed in all cases with a noncontact technique resulting in significantly improved postoperative air and bone conduction. The rate of permanent complications was 0.9%. A comparison of the effect of higher laser energies used for the perforation of bony stapes footplates and lower energies for neomembranes revealed no significant difference in hearing results, underscoring the safety of the technique.

To avoid any manipulation of the conductive hearing chain that may cause sensorineural hearing loss, we adapted the noncontact technique previously introduced by us for use in revision stapedotomy. This technique was successfully applied to improve conductive and sensorineural hearing loss as well as vertigo in first and second revision stapedotomy cases. Because the rate of postoperative complications was comparable to what is achieved with other laser systems, we conclude that the method has at least an equal level of safety. In conclusion, we advocate the use of a noncontact technique as suitable for an early revision of failed stapedotomy.