Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France.
Otol Neurotol. 2012 Aug;33(6):928-33. doi: 10.1097/MAO.0b013e31825f24ff.
To compare the 3-month postoperative hearing results after laser stapedotomy using a flexible potassium titanyl phosphate (KTP) or CO2 laser fiber in patients with primary otosclerosis.
Prospective nonrandomized clinical study.
Tertiary referral center, 862 stapedotomies were performed in 818 study patients between November 2006 and July 2011.
Otosclerotic stapes fixation was treated with flexible KTP laser fiber in 410 patients (431 stapedotomies) and with flexible CO2 laser fiber in 408 patients (431 stapedotomies). Their preoperative and postoperative audiometric results were compared.Logistic regression analyses were performed to evaluate the main effect of laser fiber type and the effect after adjustment for independent predictors of a postoperative air-bone gap (ABG) 10 dB or lower.
In the KTP laser group, the mean postoperative ABG was 4.3 dB compared with 3.1 dB in the CO2 group (difference, 1.1; 95% confidence interval, 0.4-1.9). In 90.4% of the patients in the KTP group, the postoperative ABG was 10 dB or lower, as compared with 96.5% in the CO2 group. The mean postoperative ABG at 4 KHz was 5.4 dB with KTP and 2.2 dB with CO2 (difference, 3.2; 95% confidence interval, 2.2-4.2). Sensorineural hearing loss was reported by 1 patient with KTP laser (0.3%) and by none with CO2 laser. "Type of laser" and "sex" were independent predictors of ABG 10 dB or lower. The chance to achieve a postoperative ABG 10 dB or lower for male subjects is 95%, when treated with CO2 laser and 85% when treated with KTP laser. For female subjects, these chances are 97% and 94%, respectively.
The use of the CO2 laser fiber may be associated with better hearing results than the KTP laser fiber, regarding the ABG closure within 10 dB.
比较原发性耳硬化症患者行激光镫骨足板切除术时使用柔性钾钛磷酸盐（KTP）或二氧化碳（CO2）激光光纤的 3 个月术后听力结果。
前瞻性非随机临床研究。
三级转诊中心，2006 年 11 月至 2011 年 7 月间 818 例研究患者中进行了 862 例镫骨切除术。
采用柔性 KTP 激光光纤治疗 410 例（431 例镫骨切除术）和柔性 CO2 激光光纤治疗 408 例（431 例镫骨切除术）耳硬化症镫骨固定患者。比较其术前和术后的听力结果。采用逻辑回归分析评估激光光纤类型的主要影响以及调整术后气骨导差（ABG）10dB 或更小的独立预测因素后的影响。
KTP 激光组术后平均 ABG 为 4.3dB，CO2 激光组为 3.1dB（差值，1.1；95%置信区间，0.4-1.9）。KTP 激光组 90.4%的患者术后 ABG 为 10dB 或更小，CO2 激光组为 96.5%。KTP 的术后 4kHz 平均 ABG 为 5.4dB，CO2 为 2.2dB（差值，3.2；95%置信区间，2.2-4.2）。KTP 激光组有 1 例（0.3%）患者报告出现感音神经性听力损失，CO2 激光组无患者报告出现感音神经性听力损失。“激光类型”和“性别”是 ABG 10dB 或更小的独立预测因素。对于男性患者，使用 CO2 激光治疗时，术后 ABG 10dB 或更小的几率为 95%，使用 KTP 激光治疗时为 85%。对于女性患者，这些几率分别为 97%和 94%。
与 KTP 激光光纤相比，使用 CO2 激光光纤可能与更好的听力结果相关，表现在 10dB 以内的气骨导差闭合。
