[Evolution of the operative technique. CO2 laser stapedotomy and stapedoplasty]

In recent years in the literature on stapes surgery several changes have been proposed concerning the adoption either of new technologies (Laser) or of surgical techniques preserving middle ear functional structures (stapedoplasty). The Authors carried out a personal case-report on 30 patients suffering from otospongiotic disease, in order to clarify the real advantages and possible applications of the latest developments in small fenestra stapedectomy. Twenty subjects underwent platinotomy with preservation of the stapedial tendon (stapedoplasty), while a simple stapedotomy was performed in the remaining 10 cases, with or without inversion of surgical times (a "rigid system" technique was adopted in 7 patients). CO2 Laser was used on 10 of these patients (33%) in order to carry out certain surgical steps; in particular it was used on 7 subjects who underwent stapedotomy with stapedoplasty (35%) and in 3 cases of traditional stapedotomy (100%). An audiometric examination was conducted on all subjects 1 and 6 months after the operation, in order to evaluate functional recovery; the post-operative stapedial reflex was also studied in patients who underwent stapedoplasty. This research points out the advantages that CO2 Laser gives in the execution of stapes surgery, whatever the type of technique adopted; in particular, the advantages of using this instrument are: -an easier and bloodless performance of the operation, particularly in the case of the preservation of the stapedial tendon; -a greater regularity and precision of the footplate hole than that obtained by drilling, especially in subjects whose stapes are thin, floating, fractured or even obliterated; -less mechanical traumatism on the labyrinth during either the fracturing of the crura or the footplate fenestration, resulting in the reduction of both perceptive hearing loss an dizziness; -a higher incidence of air-bone gap closure mostly in the case of stapedial tendon preservation. On the other hand, the use of inadequate lasers or the lack of reference to exact parameters (beam power and frequence, time of exposure and defocalization), could cause the heating of labyrinthine liquids and so damage the receptorial structures of the inner ear.