Kumar Vikas, Gupta Anandita, Sethi A
Department of Otorhinolaryngology, Head and Neck Surgery, Army College of Medical Sciences, Brar Square, Delhi Cantonment, New Delhi, India.
Int Arch Otorhinolaryngol. 2025 Jan 22;29(1):1-6. doi: 10.1055/s-0044-1801315. eCollection 2025 Jan.
Stapedotomy is the standard of care in the surgical management of clinical otosclerosis. It is a precise and technically demanding craft requiring impeccable surgical skills. Both conventional and laser-assisted procedures aim to achieve closure of the air-bone gap (ABG) with minimum collateral damage. To compare the postoperative outcomes of conventional stapes surgery and CO laser-assisted surgery. We conducted a retrospective analysis of the medical records of 74 adult patients who underwent stapedotomy at our center. The patients were divided into two groups for comparison: the "cold steel method" (CSM) group, which was composed of patients who had undergone conventional stapedotomy (manual microperforators/hand-held microdrill); and the "CO laser-assisted" (LA) group. The postoperative outcomes assessed at 3 and 6 months in both groups were analyzed and compared. The average operative time and complications of both groups were also compared. The hearing outcomes presented statistically significant postoperative improvement in both groups. The LA group presented statistically significant better air conduction thresholds at 3 and 6 months ( < 0.05). The ABG and its degree of closure were statistically better at 3 months in the LA group; however, the difference became insignificant at 6 months. Transient vertigo was more common in the LA group ( < 0.01). There was no new sensorineural hearing loss in either group. The operative time was longer in the LA group. In experienced hands, both conventional and laser techniques can be used with equal ease and expectation of better outcomes. The CO laser is not an indispensable tool to achieve good surgical results on a routine basis.
镫骨手术是临床耳硬化症外科治疗的标准术式。它是一项精确且技术要求很高的操作，需要精湛的手术技巧。传统手术和激光辅助手术都旨在以最小的附带损伤实现气骨导间距（ABG）的闭合。
为比较传统镫骨手术和CO₂激光辅助手术的术后效果。
我们对在本中心接受镫骨手术的74例成年患者的病历进行了回顾性分析。患者被分为两组进行比较：“冷器械法”（CSM）组，由接受传统镫骨手术（手动微型穿孔器/手持式微型钻头）的患者组成；以及“CO₂激光辅助”（LA）组。分析并比较了两组在术后3个月和6个月时评估的术后效果。还比较了两组的平均手术时间和并发症情况。
两组的听力结果在术后均有统计学意义的改善。LA组在术后3个月和6个月时气导阈值有统计学意义的更好表现（P＜0.05）。LA组在术后3个月时ABG及其闭合程度在统计学上更好；然而，在6个月时差异变得不显著。短暂性眩晕在LA组更常见（P＜0.01）。两组均未出现新的感音神经性听力损失。LA组的手术时间更长。
在经验丰富的医生手中，传统技术和激光技术都可以同样轻松地使用，并预期会有更好的效果。CO₂激光并非常规获得良好手术效果必不可少的工具。
