Laser versus drill-assisted stapedotomy for the treatment of otosclerosis: A randomized-controlled trial

Objective: To assess whether reversal-steps stapedotomy can always be used in otosclerosis surgery and whether use of laser- or microdrill-assisted technique may enable better outcomes in terms of intra- and post-operative complications as well as of hearing gain as compared with classical stapedotomy technique. Materials and Methods: Eighty-two subjects undergoing primary stapes surgery for otosclerosis were enrolled for this study as having a least pure tone average (PTA) air-bone gap (ABG) of 35 dB. Patients were randomised for four different surgical variants: microdrill-assisted classical stapedotomy; laser-assisted classical stapedotomy; microdrill-assisted reversal-steps stapedotomy; and laser-assisted reversal-steps stapedotomy. Pre- versus post-operative ABG closure has been measured in all the patients, and occurrence of intra- and post-operative complications was rated. Results: Reversal-steps stapedotomy provided significantly less intra-and post-operative complications than classical stapedotomy. Within the reversal-steps group, the laser-assisted technique gave slightly better hearing outcome than the microdrill-assisted one. In only 7% of the patients, the reversal-steps technique was not practicable due to particular anatomical situations involving position of the stapes into the oval fossa. Conclusion: Reversal-steps stapedotomy, either microdrill- or laser-assisted, may be considered a reliable procedure for treatment of otosclerosis. © The Mediterranean Society of Otology and Audiology.