The use of the argon laser in chronic ear disease and otosclerosis surgery is reviewed. Its advantages and limitations are discussed, and safe parameters for use established. The argon laser is an effective tool to remove, cut, and coagulate tissue. It was used in over 500 microsurgical otologic procedures without deleterious effects. One hundred primary laser stapedotomies were performed, and the audiological results were compared to those obtained using conventional small fenestra stapedectomy techniques. No significant statistical difference was present in the audiologic results after 1 year of observation. The clinical course of the laser stapedotomy patients suggested this technique was less traumatic than conventional techniques.

A biostatistical study of the results of 280 consecutive operations for clinical otospongiosis are analyzed over a seven-year period. One hundred forty-one (141) operations were done utilizing the "total stapedectomy" technique, and 139 were done utilizing the "small fenestra" technique. The auditory acuity of the two groups is compared with reference to conductive and sensorineural performance. All the surgery was performed by the authors, the data was collected by a third party and analyzed by a statistician. All audiograms were performed by the same audiologist under the same conditions. The data indicates that the preferred operation for this clinical disease is the small fenestra technique.

In recent years, the safety and efficacy of revision stapedectomy has come under scrutiny. Experienced surgeons report that the results of such surgery are often worse than the results after primary surgery and that the risks of sensorineural hearing loss, tinnitus, and vertigo are increased. With the addition of laser technology to revision stapes surgery, the procedure to open the neomembrane over the oval window and gain access to the inner ear can now be performed safely. This allows positive identification of the oval window and assures placement of the prosthesis through the fenestra rather than on an intermediate segment of scar or bone in the region of the footplate. Our studies have shown the laser to be an important tool that enhances the safety and efficacy of revision stapedectomy.

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