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Outcomes and predictive factors of success in stapes surgery: a multicentric retrospective analysis

Published online by Cambridge University Press:  01 December 2025

Matteo Di Bari ,
Martina Sebastiani Open the ORCID record for Martina Sebastiani [Opens in a new window] ,
Laurenne Alciato ,
Sean Sheppard ,
Raoul Nucci ,
Roberto Pareschi ,
Stefano Miceli ,
Giovanni Cristalli ,
Olivier Sterkers  and
Daniele Bernardeschi
...Show all authors
Matteo Di Bari
Affiliation:
Otorhinolaryngology, Head and Neck Department, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Legnano, Milan, Italy Service d’Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
Martina Sebastiani*
Affiliation:
Humanitas University, Pieve Emanuele, Milan, Italy Otorhinolaryngology – Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
Laurenne Alciato
Affiliation:
Service d’Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
Sean Sheppard
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Switzerland
Raoul Nucci
Affiliation:
Otorhinolaryngology, Head and Neck Department, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Legnano, Milan, Italy
Roberto Pareschi
Affiliation:
Otorhinolaryngology, Head and Neck Department, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Legnano, Milan, Italy
Stefano Miceli
Affiliation:
Otorhinolaryngology – Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
Giovanni Cristalli
Affiliation:
Department of Otorhinolaryngology, Children’s Hospital “Ospedale Pediatrico Bambino Gesù-IRCCS”, Rome, Italy
Olivier Sterkers
Affiliation:
Service d’Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
Daniele Bernardeschi
Affiliation:
Service d’Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
Arturo Mario Poletti
Affiliation:
ENT Department, American Hospital Dubai, UAE
Giovanni Colombo
Affiliation:
Otorhinolaryngology, Head and Neck Department, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Legnano, Milan, Italy
*
Corresponding author: Martina Sebastiani; Email: martina.sebastiani98@gmail.com
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Abstract

Objective

This study aimed to compare long-term audiological outcomes of diode laser stapedotomy, microdrill stapedotomy and combined potassium titanyl phosphate laser–microdrill stapedotomy, and to identify predictors of surgical success.

Methods

Surgical, audiological and complications data were collected. Surgical success was analysed via the measurement of post-operative air–bone gap, air conduction gain.

Results

A total of 615 patients were included; median follow-up was 16 months (range 1–1319). Overall, the 94.3 per cent achieved surgical success (air–bone gap < 15 dB). Median air–bone gap closure was 5 dB (interquartile range: 2.50–8.12), and median air conduction gain was 27.5dB (interquartile range: 19.37–36.25).

Compared across techniques, success rates were similar; however, post-operative air–bone gap was significantly better with laser techniques than with microdrill alone (p = 0.016). Longer prostheses were associated with improved outcomes.

Conclusion

All the examined techniques showed excellent audiological results. Laser use was associated with better post-operative air–bone gap than stapedotomy with microdrill only.

Keywords

otosclerosislaserstapedotomystapes surgery

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 140 , Issue 2 , February 2026 , pp. 214 - 220
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Martina Sebastiani takes responsibility for the integrity of the content of the paper

References

Vincent, R, Sperling, NM, Oates, J, Jindal, M. Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database. Otol Neurotol 2006;27:S25–47CrossRefGoogle ScholarPubMed
Bittermann, AJN, Rovers, MM, Tange, RA, Vincent, R, Dreschler, WA, Grolman, W. Primary stapes surgery in patients with otosclerosis: prediction of postoperative outcome. Arch Otolaryngol Head Neck Surg 2011;137:780–4CrossRefGoogle ScholarPubMed
Strömbäck, K, Lundman, L, Bjorsne, A, Grendin, J, Stjernquist-Desatnik, A, Dahlin-Redfors, Y. Stapes surgery in Sweden: evaluation of a national-based register. Eur Arch Otorhinolaryngol 2017;274:2421–7CrossRefGoogle ScholarPubMed
Saerens, M, Van Damme, J-P, Bihin, B, Garin, P. Hearing results in 151 primary stapedotomies for otosclerosis: the effects of using different audiologic parameters and criteria on success rates. Otol Neurotol 2021;42:e1436–43CrossRefGoogle ScholarPubMed
Srivastava, R, Cho, W, Fergie, N. The use of lasers in stapes surgery. Ear Nose Throat J 2021;100:73S–6SCrossRefGoogle ScholarPubMed
Perkins, RC. Laser stapedotomy for otosclerosis. Laryngoscope 1980;90:228–40CrossRefGoogle Scholar
Kisilevsky, VE, Dutt, SN, Bailie, NA, Halik, JJ. Hearing results of 1145 stapedotomies evaluated with Amsterdam hearing evaluation plots. J Laryngol Otol 2009;123:730–6CrossRefGoogle ScholarPubMed
Sergi, B, Lucidi, D, De Corso, E, Paludetti, G. Long-term follow-up after “one-shot” CO2 laser stapedotomy: is the functional outcome stable during the years? Eur Arch Otorhinolaryngol 2016;273:3623–9CrossRefGoogle Scholar
Bernardeschi, D, De, Seta D, Canu, G, Russo, FY, Ferrary, E, Lahlou, G, et al. Does the diameter of the stapes prosthesis really matter? A prospective clinical study. Laryngoscope 2018;128:1922–6CrossRefGoogle ScholarPubMed
Poletti, AM, Miceli, S, Rossi, V, Di Pietro, S, Tosi, G, Colombo, G. The “One Shot” diode laser stapedotomy. Photomed Laser Surg 2015;33:598–603CrossRefGoogle Scholar
Poutoglidis, A, Tsetsos, N, Vardaxi, C, Fyrmpas, G, Poutoglidou, F, Kilmpasanis, A, et al. Conventional microscopic stapedotomy: an obsolete technique or still the gold standard for the management of otosclerosis? Cureus 2021;13:e14126Google ScholarPubMed
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–8CrossRefGoogle ScholarPubMed
Gurgel, RK, Jackler, RK, Dobie, RA, Popelka, GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012;147:803–7CrossRefGoogle ScholarPubMed
Bartel, R, Huguet, G, Cruellas, F, Hamdan, M, Gonzalez-Compta, X, Cisa, E. Laser vs drill for footplate fenestration during stapedotomy: a systematic review and meta-analysis of hearing results. Eur Arch Otorhinolaryngol 2021;278:9–14CrossRefGoogle ScholarPubMed
Wegner, I, Kamalski, DM, Tange, RA, Vincent, R, Stegeman, I, van der Heijden, GJ, et al. Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review. Laryngoscope 2014;124:1687–93CrossRefGoogle ScholarPubMed
Fang, L, Lin, H, Zhang, T-Y, Tan, J. Laser versus non-laser stapedotomy in otosclerosis: a systematic review and meta-analysis. Auris Nasus Larynx 2014;41:337–42CrossRefGoogle ScholarPubMed
Feng, X-H, Xie, N-P, Lin, F, Wan, L-C, Yan, X, Guo, M-H, et al. Therapeutic effects of small fenestra stapedotomy with semiconductor diode laser: a comparison with microdrill. Nan Fang Yi Ke Da Xue Xue Bao 2008;28:1391–3Google ScholarPubMed
Nguyen, Y, Grayeli, AB, Belazzougui, R, Rodriguez, M, Bouccara, D, Smail, M, et al. Diode laser in otosclerosis surgery: first clinical results. Otol Neurotol 2008;29:441–6CrossRefGoogle ScholarPubMed
Wang, D, Peng, F, Lin, N, Wang, W. Microdrill versus diode laser in endoscopic stapedotomy: a comparative study. Otol Neurotol 2024;45:489–94CrossRefGoogle ScholarPubMed
Ordóñez Ordóñez, LE, Cerón Perdomo, D, González Saboya, CP, Osorio Mejía, F, Medina-Parra, J, Angulo Martínez, ES. Conventional vs diode laser stapedotomy: audiological outcomes and clinical safety. Eur Arch Otorhinolaryngol 2024;281:3443–52CrossRefGoogle ScholarPubMed
Lesinski, SG. Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol 2002;23:281–8CrossRefGoogle ScholarPubMed
Luryi, AL, Schettino, A, Michaelides, EM, Babu, S, Bojrab, DI, Schutt, CA. Revision stapes surgery: hearing symptoms and associations with intraoperative findings and outcomes. Otolaryngol Head Neck Surg 2022;167:350–5CrossRefGoogle ScholarPubMed
Bernardeschi, D, Canu, G, De, Seta D, Russo, FY, Ferrary, E, Mosnier, I, et al. Revision stapes surgery: a review of 102 cases. Clin Otolaryngol 2018;43:1587–90CrossRefGoogle ScholarPubMed
Mann, WJ, Amedee, RG, Fuerst, G, Tabb, HG. Hearing loss as a complication of stapes surgery. Otolaryngol Head Neck Surg 1996;115:324–8CrossRefGoogle ScholarPubMed
Aarnisalo, AA, Vasama, J-P, Hopsu, E, Ramsay, H. Long-term hearing results after stapes surgery: a 20-year follow-up. Otol Neurotol 2003;24:567–71CrossRefGoogle ScholarPubMed
Salvinelli, F, Casale, M, Vincenzi, A, D’Ascanio, L. Comparison of two stapes prostheses (titanium and fluoroplastic-platinum piston): a theoretical point of view. Acta Otolaryngol 2004;124:986–7CrossRefGoogle ScholarPubMed
Casale, M, De Franco, A, Salvinelli, F, Piazza, F, Vincenzi, A, Zini, C. Hearing results in stapes surgery using two different prosthesis. Rev Laryngol Otol Rhinol (Bord) 2003;124:255–8Google ScholarPubMed
Faramarzi, M, Roosta, S, Daneshian, N. Comparison between fluoroplastic and platinum/titanium piston in stapedotomy: a prospective, randomized clinical study. J Int Adv Otol 2020;16:234–40CrossRefGoogle ScholarPubMed
Bansal, M. Teflon implants versus titanium implants in stapes surgery. Indian J Otolaryngol Head Neck Surg 2016;68:16–19CrossRefGoogle ScholarPubMed
Laske, RD, Röösli, C, Chatzimichalis, MV, Sim, JH, Huber, AM. The influence of prosthesis diameter in stapes surgery: a meta-analysis and systematic review of the literature. Otol Neurotol 2011;32:520–8CrossRefGoogle ScholarPubMed
Odat, H, Kanaan, Y, Alali, M, Al-Qudah, M. Hearing results after stapedotomy for otosclerosis: comparison of prosthesis variables. J Laryngol Otol 2021;135:28–32CrossRefGoogle ScholarPubMed
Husain, Q, Lin, KF, Selesnick, SH. Stapes prosthesis length and hearing outcomes. Laryngoscope 2018;128:722–6CrossRefGoogle ScholarPubMed
Motasaddi Zarandy, M, Amirzargar, B, Golpayegani, G, Motasaddizarandy, M, Emami, H. Fixed vs measured length of stapes prosthesis in stapes surgery. Indian J Otolaryngol Head Neck Surg 2022;74:3883–6CrossRefGoogle ScholarPubMed
Scierski, W, Namysłowski, G, Czerwińska, G, Lisowska, G, Kluczewska, E, Bożek, P. Postoperative vertigo caused by too long stapes prosthesis: radiological diagnostics. Otolaryngol Pol 2012;66:363–7Google ScholarPubMed
Albera, A, Parandero, F, Andriani, R, Albera, R, Riva, G, Canale, A. Prognostic factors influencing postoperative air-bone gap in stapes surgery. Acta Otorhinolaryngol Ital 2022;42:380–7CrossRefGoogle ScholarPubMed
De, Vito A, Mandalà, M, Soprani, F, Iannella, G, Roustan, V, Viberti, F, et al. Conventional approaches versus laser CO2 surgery in stapes surgery: a multicentre retrospective study. Eur Arch Otorhinolaryngol 2022;279:2321–7Google Scholar
Hamerschmidt, R, Saab, SS, Carvalho, B, Carmo, CD. Short-term audiological results of diode laser in comparison with manual perforation in stapes surgery. Int Arch Otorhinolaryngol 2018;22:119–24Google ScholarPubMed
Parida, PK, Kalaiarasi, R, Gopalakrishnan, S. Diode laser stapedotomy vs conventional stapedotomy in otosclerosis: a double-blinded randomized clinical trial. Otolaryngol Head Neck Surg 2016;154:1099–105CrossRefGoogle ScholarPubMed