A meta-analysis review of revision stapes surgery with argon laser: effectiveness and safety.

OBJECTIVE

To determine whether there is an advantage in safety and outcome efficacy with the use of argon laser in revision stapes surgery as compared with conventional instruments.

DATA SOURCES: A search of the published English-language literature, 1970-1995, was conducted using the following key words: revision, surgery, stapes, laser, stapedotomy, and argon laser.

STUDY SELECTION: The following inclusion criteria were used to select articles for the meta-analysis: revision cases only, a comprehensive review of intraoperative pathological findings that led to the failure, and accurate documentation by the author, confirmed by our statisticians using a modified chi 2 test. Eleven studies without the use of the laser (n = 1,147 patients) and four studies with the use of the laser (n = 170 patients) including our own patients (n = 23) were entered into the model.

DATA EXTRACTION: The data had to meet strict audiometric criteria, including preoperative and postoperative audiogram pure tone average air-bone gap; postoperative audiograms had to include five classifications, and these audiograms had to be obtained a minimum of 6 months after revision surgery.

DATA SYNTHESIS: A log-linear model was developed for this meta-analysis study, with each study analyzed individually and collectively.

CONCLUSION

Revision stapes surgery using the laser demonstrated statistically significant (p = 0.002) advantage in both safety and efficacy over revision procedures using conventional instruments.