Laser stapedotomy minus prosthesis (laser STAMP): a minimally invasive procedure.

OBJECTIVE

To determine whether hearing can be restored using a laser without a prosthesis in patients with minimal otosclerosis.

STUDY

DESIGN

Retrospective case review of 12 patients with minimal otosclerosis who underwent a laser stapedotomy without prosthesis (laser STAMP) procedure.

SETTING

An otology/neurotology tertiary referral center.

PATIENTS: Patients were chosen for the procedure if there was a blue footplate with minimal otosclerosis confined to the fissula antefenestram.

INTERVENTIONS: 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.

MAIN OUTCOME MEASURES: Pure-tone audiometry with appropriate masking and auditory discrimination testing were performed before surgery, 6 weeks after surgery, and 1 year after surgery.

RESULTS

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.

CONCLUSIONS

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.