***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Otosclerosis is a progressive osteo-destructive disorder of the bony labyrinth in which the fixation of the stapes causes the hearing loss . The aim of this study was the postoperative determination of parameters of the effect of surgical intervention on hearing and the incidence of complications and , on the basis of the differences in the examined parameters of the study , the estimation of the efficacy of the two mentioned surgical techniques in the treatment of otosclerosis . METHODS In our research 40 patients with conductive hearing loss caused by otosclerosis underwent surgery with CO2 laser .  Functional results were compared postoperatively with the results of 40 patients operated by the classical technique without the use of CO2 laser . The research was accomplished as a prospect i ve comparative study . RESULTS The air-bone interval ( gap ) as the difference between the rim of air and bone conductivity for separate frequencies did not significantly differ between the control and the experimental group . Both methods were effective in closing the air-bone gap with the rates of closure to within 10 dB in 82.6 % and 75.3 % for the laser and drill , respectively . The incidence of tinnitus was significantly lower in patients who underwent surgery with CO2 laser . The frequency of intraoperative and postoperative complications was significantly lower in the laser group . Differences were statistically significant for all parameters ( p < 0.05 ) . CONCLUSION On the basis of the degree of postoperative hearing improvement , tinnitus and the incidence of complications it can be concluded that the use of CO2 laser during inverse stapedoplasty represents an effective and safe method , justifying the promotion of its use in the surgical management of otosclerosis OBJECTIVE To compare three stapedotomy modalities used to fenestrate the stapes footplate in patients with primary otosclerosis . MATERIAL S The non-r and omized and unblinded one-center study included 48 patients with primary otosclerosis who underwent stapes surgery between May 2008 and April 2009 . The patients were divided into three groups ( single shot and two-shot CO(2 ) laser stapedotomy , perforator ) depending on the modality used for stapedotomy . Bone conduction ( BC ) and air conduction ( AC ) thresholds , air-bone gap ( ABG ) , and the difference between mean pre-operative and 2- to 3-week post-operative BC thresholds were analyzed . RESULTS The temporary BC deterioration was most pronounced at 6 and 8kHz after 2-shot laser stapedotomy . A significant drop in AC or BC was not found in any of our 48 patients . Age , high-dose cortisone therapy , and ' preoperative hearing ' did not influence the post-operative hearing results . CONCLUSION Even though the number of patients presented here was small and statistical analysis was limited , the study showed a trend toward worse BC thresholds at 6 and 8kHz after a second shot CO(2 ) application . Whenever possible , treatment should avoid a second laser shot on the already opened inner ear with the laser parameters used for the initial shot OBJECTIVE The aim of this study was to present our experiences and results of stapedotomy performed with and without the piezoelectric device . DESIGN The article evaluates and compares the use of the piezoelectric device in performing primary stapedotomy  in patients affected by otosclerosis with the traditional method of microdrilling . SETTING The study was conducted with 100 patients in the Department of Otolaryngology of the University of Genoa ( Italy ) , between January 2007 and January 2008 . METHODS A prospect i ve , r and omized , controlled trial was undertaken on 100 stapedotomy patients performed using the piezoelectric device ( 50 patients ) or the microdrill ( 50 patients ) . MAIN OUTCOME MEASURES Before surgery and at 1 and 12 months afterward , all patients underwent the following : otomicroscopic evaluation of the external and middle ear , pure-tone audiometry , tympanometry , transient evoked otoacoustic emissions , distortion product otoacoustic emissions , and auditory brainstem response . RESULTS All patients treated with the piezoelectric device had an air-bone gap reduction , with a closure of the air-bone gap within 10 dB ; 44 ( 88 % ) patients who underwent traditional surgery had an air-bone gap reduction , with a closure of the air-bone gap within 10 dB. CONCLUSION All of our postoperative data confirm the safety of the device on the anatomic structures of the middle and inner ear and demonstrate the efficacy of the piezoelectric device in terms of safety , cutting precision , and protection of anatomic structures and its applicability to stapedotomy The early and long-term hearing results of 1,681 primary otosclerosis operations performed by the same surgeon , Jean Marquet , were review ed retrospectively and analyzed with very strict statistical st and ards . Significantly better short- and long-term results were achieved with the stapedotomy technique compared to total stapedectomy , mainly at the higher frequencies ( 4 and 8 kHz ) important for speech discrimination . Whatever technique was used to open the footplate ( micropick , microdrill , or laser ) , no statistical audiometric difference could be found . The results were equal whether or not the stapedial tendon was preserved . Perioperative problems like pronounced oozing , difficult anatomic relationships , and accidental perilymph aspiration could affect hearing at higher frequencies . The calibrated hole technique was equally as good as conventional oval window sealing in sealing of the fenestra to prevent fistula . The stapedotomy technique was found the safest , having fewer complications Objective : To valuate the influence of the color of footplate in the choice of the type of perforator . Study Design : Prospect i ve study . Level of Evidence 1b . Setting s : Single hospital study in Avellino , Italy . Subjects and Methods : From the first of September 2008 to the 30th of June 2009 , we considered 83 patients affected by otosclerosis . Patients were divided into 2 groups under footplate perforator used . In the group A , manual perforators ( the more traumatic drills ) were used . In group B , CO2 laser ( the less traumatic drill ) was used . The 2 groups under the color of visible portion of the footplate before removing the stapes superstructure were divided in 2 subgroups . Group IA includes 33 blue footplates and Group IIA 10 white footplates . Group IB includes 30 blue footplates and Group IIB 10 white footplates . We estimated whether there is statistical correlation between type of perforator , incidence of footplate complications , and color of footplate . Results : In group IA , we had 0 complications . In group IB , we had 0 complications . In group IIA , we had 7 complications . In group IIB , we had 2 complications . Comparison of incidence of footplate complications showed no statistical significance between group IA and IB and statistical significance between group IIA and IIB . Conclusion : The footplate color is important in the choice of the type of perforator Objective : To assess whether the incidence of complications of stapes surgery depended on the sequence of surgical steps and CO2 laser use in stapes surgery . Study Design and Setting : Retrospective and prospect i ve analysis of 420 consecutive stapedotomies was set in tertiary referral University Hospital . Patients : 376 patients with otosclerosis in whom 420 primary stapedotomies were performed . Intervention : Stapedotomy under local anesthesia using manual perforators and CO2 laser . Main Outcome Measure : The incidence of incus subluxation , floating footplate during stapedotomy . Results : Comparison of the incidence of incus luxation in groups with the piston inserted after removal of the stapes arch , and groups with the piston inserted on the intact ossicular chain showed statistical significance . In the group where perforation of the footplate was performed after removal of the stapes arch floating footplate occurred more often than in groups with reversed sequence of steps . Conclusion : Perforation of the footplate before removal of stapes arch reduces the risk of floating footplate , and placing the prosthesis on the incus before removal of stapes arch reduces the risk of subluxation of the incus .  CO2 laser stapedotomy with reversed sequence of steps was the safest method of stapes surgery Thirty-four ears with conductive hearing loss due to otosclerosis were operated upon using the laser stapedotomy technique . Audiological results were compared with the results of 316  non-laser stapedotomies . The post-operative air-bone gap , calculated as the difference between the post-operative air and bone conduction levels , was smaller with the laser stapedotomy group . Also , the bone conduction showed significant improvement with the use of laser .  Significant sensorineural hearing loss was not found in any of the laser-treated patients . According to our results , we concluded that laser is of benefit in stapes surgery for improving the hearing results and minimizing the inner ear trauma 
    Output:
    
Our overall results suggest that the laser stapedotomy had significantly better hearing results than non-laser stapedotomy .