Silverstein H
The Ear Research Foundation, Sarasota, Florida 34239, USA.
Am J Otol. 1998 May;19(3):277-82.
To determine whether hearing can be restored using a laser without a prosthesis in patients with minimal otosclerosis.
Retrospective case review of 12 patients with minimal otosclerosis who underwent a laser stapedotomy without prosthesis (laser STAMP) procedure.
An otology/neurotology tertiary referral center.
Patients were chosen for the procedure if there was a blue footplate with minimal otosclerosis confined to the fissula antefenestram.
Using a hand-held probe (CeramOptic), and the HGM argon laser, the anterior crus of the stapes was vaporized. Next, a linear stapedotomy was made across the anterior one third of the footplate. If otosclerosis is confined to the fissula antefenestram, the stapes becomes completely mobile. The stapedotomy opening is sealed with an adipose tissue graft from the ear lobe.
Pure-tone audiometry with appropriate masking and auditory discrimination testing were performed before surgery, 6 weeks after surgery, and 1 year after surgery.
The average air-bone gap was closed to a mean (SD) of 2.6 dB (3.3 dB). The average improvement in air-bone gap was 17.4 dB (7.6 dB). The discrimination scores remained unchanged. Audiometric testing of five cases with 1 year follow-up demonstrates that excellent hearing results are maintained.
In selected cases of minimal otosclerosis confined to the fissula antefenestram, normal mobility of the ossicular chain can be obtained without a prosthesis by vaporizing the anterior crus and making a linear stapedotomy across the anterior one third of the footplate. The advantages of the procedure are that the stapedius tendon and most of the normal stapes remain intact, eliminating hyperacusis. The procedure is less invasive so it reduces inner ear trauma, possible prosthesis problems are avoided, and postoperative barotrauma risk is minimized. Minimal surgery is done for minimal disease. If the stapes refixes at some time in the future, a conventional stapedotomy can still be performed.
确定在轻度耳硬化症患者中不使用假体仅通过激光治疗能否恢复听力。
对12例接受了无假体激光镫骨足板开窗术（激光STAMP）的轻度耳硬化症患者进行回顾性病例分析。
一家耳科学/神经耳科学三级转诊中心。
若镫骨足板呈蓝色且耳硬化症较轻，局限于前庭窗前方裂隙，则入选该手术。
使用手持探头（CeramOptic）和HGM氩激光汽化镫骨前足弓。接下来，在足板前三分之一处进行线性镫骨足板开窗术。如果耳硬化症局限于前庭窗前方裂隙，镫骨会完全活动。镫骨足板开窗术开口用耳垂的脂肪组织移植片封闭。
在手术前、术后6周和术后1年进行纯音听力测定并进行适当掩蔽及听觉辨别测试。
平均气骨导差缩小至平均（标准差）2.6 dB（3.3 dB）。气骨导差平均改善17.4 dB（7.6 dB）。辨别分数保持不变。对5例进行了1年随访的听力测试表明，听力结果良好。
在局限于前庭窗前方裂隙的轻度耳硬化症特定病例中，通过汽化镫骨前足弓并在足板前三分之一处进行线性镫骨足板开窗术，无需假体即可使听骨链获得正常活动度。该手术的优点是镫骨肌肌腱和大部分正常镫骨保持完整，可消除听觉过敏；手术侵入性较小，从而减少内耳创伤；避免了可能出现的假体问题，术后气压伤风险降至最低；针对轻度疾病进行最小化手术。如果镫骨在未来某个时间重新固定，仍可进行传统的镫骨足板开窗术。
