R J Wiet1, D C Kubek, P Lemberg, A T Byskosh. 1. Clinical Otolaryngology and Neurosurgery, Northwestern University Medical School, Chicago, Illinois, USA.
Abstract
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.
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.