Argon laser in difficult stapedotomy cases

The success and safety of argon lasers in stapedotomy surgery is now well documented. This study reviews results in problematic situations in which the argon laser may be of particular advantage to successful completion of the stapedotomy procedure.

Retrospective chart review.

A retrospective review of the author's most recent 200 stapedotomy cases was performed, identifying 32 patients who at surgery were either found to have a prolapsed dehiscent facial nerve (three cases), developed a floating footplate (eight cases), or were undergoing a revision stapedotomy (21 cases). Four-frequency, pure-tone average air and bone conduction thresholds were computed before and after surgery. Success was defined as closure of the air-bone gap to within 10 dB, while an air-bone gap within 20 dB was considered improvement.

Successful closure of the air-bone gap was achieved in all eight patients with a mobilized footplate, in all three patients with a prolapsed dehiscent facial nerve, and in 43% of the patients undergoing a revision stapedotomy. The rate of improved air-bone gap in the revision cases was 62%. In one revision stapedotomy patient a decrease in speech discrimination occurred. Otherwise, there were no cases of sensorineural hearing loss. Neither intraoperative nor postoperative dizziness was reported by any patient, and all were discharged on an outpatient basis.

The argon laser was found to be safe, effective, and a valuable adjunct for the difficult stapedotomy cases when unexpected obstacles such as a prolapsed dehiscent facial nerve or a mobilized footplate are encountered, as well as for the planned, more difficult revision cases.