Laser Stapedotomy Minus Prosthesis: Long-term Follow-up

Objective. To evaluate long-term hearing results following laser stapedotomy minus prosthesis (laser STAMP). Study Design. Case series with chart review. Setting. Otologic referral center. Subjects and Methods. From April 1995 to April 2009, 74 adult patients (77 ears; consecutive cases) underwent primary laser STAMP for otosclerosis limited to the fissula ante fenestram. Pure-tone air, bone conduction thresholds, and word discrimination scores were obtained preoperatively, 1 month postoperatively, and yearly thereafter. Results. One-year minimum follow-up data were available for 43 patients (44 ears; nonconsecutive cases). The average air-bone gap (ABG) was closed from a mean of 23 dB to 6 dB at 6 weeks postoperatively. At a median of 33 (lower quartile, 20; upper quartile 46; range, 12-140) months postoperatively, the mean ABG was 7 dB, indicating little evidence of refixation. Seven of 77 patients (9%) underwent revision surgery with stapedotomy and placement of prosthesis with good results. Four patients (5%) were revised within 1 year for other problems unrelated to stapes refixation. Refixation was noted in 3 patients (4%) undergoing revision surgery. Two of these patients (3%) were revised within 1 year, and 1 patient (1%) was revised after 12 years. Conclusions. The laser STAMP is a minimally invasive procedure resulting in stable long-term hearing improvement in those patients available for long-term follow-up. Success depends on proper candidate selection of patients with accessible anatomy and minimal otosclerosis confined to the fissula ante fenestram. Advantages of this procedure include preservation of stapes anatomy and stable long-term, high-frequency hearing improvement.