***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 : To evaluate with a new otologic data base the results of primary stapes surgery for otosclerosis with up to 14 years of follow-up in a consecutive series of 2,525 patients operated on by the same surgeon with the same technique ( stapedotomy and vein graft interposition )  and to provide online access to the complete data of this study for the review ers . To study the effect of specific operative findings ( obliterative otosclerosis and simultaneous malleus ankylosis ) and age at the time of surgery on the long-term outcome . Study Design : Prospect i ve clinical study using a new computerized otologic data base . Setting : Tertiary referral center . Patients : Two thous and five hundred twenty-five patients who underwent 3,050 stapedotomies for otosclerotic stapes fixation were enrolled in this study from January 1991 to December 2004 . Separate analyses were made for two unique pathologies ( 92 cases of obliterative otosclerosis and 19 cases of simultaneous malleus ankylosis ) diagnosed during surgery and for patients in two age brackets ( ≤18 yr [ 28 patients ] and ≥65 yr [ 302 patients ] ) . Intervention : Stapedotomy with vein graft interposition and reconstruction with either a Teflon piston , a bucket h and le prosthesis , or a total prosthesis . Main Outcome Measures : Preoperative and postoperative audiometric evaluation using conventional audiometry . Air-bone gap ( ABG ) , bone-conduction thresholds , and air-conduction thresholds were all assessed . Postoperative audiometry was performed at 3 , 6 , 9 , 12 , 18 , and 24 months and then annually for 14 years . Results : Overall , the postoperative ABG was closed to 10 dB in 94.2 % of cases . The mean four-frequency postoperative ABG was 1.7 dB compared with 25.6 dB preoperatively . The mean four-frequency bone-conduction thresholds were unchanged postoperatively . A significant postoperative sensorineural hearing loss ( SNHL ; > 15 dB ) was seen in 0.5 % of cases in this series . Postoperative ABG was achieved to within 10 dB in 95 % of cases of obliterative otosclerosis and in 64.7 % of cases of simultaneous malleus ankylosis . A significant postoperative SNHL ( > 15 dB ) was seen in 4.8 % of cases of obliterative otosclerosis and was not observed in any cases of simultaneous malleus ankylosis . Postoperative ABG was achieved to within 10 dB in 93.5 % of cases in the pediatric series and in 94.5 % of cases in the senior series . A significant postoperative SNHL ( > 15 dB ) was seen in 0.7 % of cases in the senior group but was not observed in the children . Conclusion : Using a new otologic data base , our series confirms that stapedotomy with vein graft interposition for otosclerotic stapes fixation is a safe and successful treatment for long-term hearing improvement . The deterioration in hearing with time after stapedotomy did not exceed the rate of hearing loss because of presbyacusis . Therefore , argon laser stapedotomy with vein graft interposition is our preferred surgical technique in the treatment of otosclerosis . Obliterative otosclerosis and simultaneous malleus ankylosis may be encountered during stapedotomy . Our study shows that reasonable success rates can still be expected in these situations . Stapedotomy results in the elderly and in children are comparable to those obtained in patients of other groups of age undergoing surgery for otosclerosis without an increased risk for complications Objective : The objective of this study was to assess whether the use of the erbium : yttrium-aluminum-garnet ( Er : YAG ) laser has negative effects on  inner ear function and to compare the short- and long-term hearing outcome of patients undergoing conventional stapedotomy versus laser stapedotomy .  Study Design : Retrospective review of prospect ively collected audiometric data of patients with otosclerosis operated on by one experienced surgeon . Setting : Academic tertiary referral center . Patients : A total of 266 stapes surgeries were evaluated for intraoperative findings , of which 209 patients were evaluated for preoperative and postoperative hearing thresholds after a 6- to 452-week ( mean , 22 wk ) audiological follow-up . Intervention : One hundred fifteen ( 43 % ) of the operations were performed conventionally , using manual perforators for stapedotomy ( Group A ) ; in 115 ( 43 % ) surgeries , the perforators were used in combination with the Er : YAG laser ( Group B ) , and in 36 ( 14 % ) operations , the Er : YAG was used exclusively for footplate perforation ( Group C ) . Main Outcome Measures : Pure-tone audiometry was performed before surgery , 2 days postoperatively ( bone conduction only ) and at 5 , 26 , and 57 weeks postoperatively . Results : A postoperative temporary threshold shift of the bone conduction could be found in all groups . In Group C , where the laser was used exclusively for footplate perforation , this threshold shift was not only the most significant , but also-in contrast to the other groups-not totally reversible . In all techniques , a satisfactory air-bone gap closure could be achieved . The best long-term results ( 96 % of the patients had ≤20 dB air-bone gap after 57 wk ) could be found in Group B. Conclusion : If certain rules to minimize inner ear trauma are followed , the Er : YAG laser is a safe tool in middle ear surgery . Combining both the laser and the conventional technique , instead of the separate use of either technique , leads to superior postoperative hearing results Objectives : A prospect i ve r and omized audiological analysis of 336 otosclerosis operations was conducted to compare the evolution of bone conduction thresholds after  primary stapedotomy  with Two different techniques to open the footplate : microdrill and carbon dioxide laser stapedotomy . Methods : To monitor the inner ear function , we compared the preoperative bone conduction thresholds with the postoperative levels at day 2 , week 2 , week 6 , and month 6 . Evolution of the bone conduction was compared for the Two studied groups ( laser versus microdrill ) . Results : An average bone conduction loss of 1.8 dB was measured at day 2 for the middle frequencies ( 0.5 , 1 , and 2 kHz ) . At 4 kHz , a bone conduction loss of 7 dB was found . The bone conduction thresholds measured in the first and second months after surgery showed a gradual recovery with overclosure as the end result . Conclusions : Our results confirm the transient depression of inner ear function in the immediate postoperative period , with recovery within the first weeks after surgery . In the studied population , no statistically significant difference was found between the Two techniques that were used to make the calibrated hole ( laser versus microdrill ) . These results demonstrate that both techniques possess the same early effect regarding inner ear function . The authors hypothesize that an early inflammatory reaction could be the cause of the transient bone conduction shift Objective To compare the 3-month postoperative hearing results after laser stapedotomy using a flexible potassium titanyl phosphate ( KTP ) or CO2 laser fiber in patients with primary otosclerosis . Study Design Prospect i ve nonr and omized clinical study . Setting Tertiary referral center , 862 stapedotomies were performed in 818 study patients between November 2006 and July 2011 . Methods Otosclerotic stapes fixation was treated with flexible KTP laser fiber in 410 patients ( 431 stapedotomies ) and with flexible CO2 laser fiber in 408 patients ( 431 stapedotomies ) . Their preoperative and postoperative audiometric results were compared . Logistic regression analyses were performed to evaluate the main effect of laser fiber type and the effect after adjustment for independent predictors of a postoperative air-bone gap ( ABG ) 10 dB or lower . Results In the KTP laser group , the mean postoperative ABG was 4.3 dB compared with 3.1 dB in the CO2 group ( difference , 1.1 ; 95 % confidence interval , 0.4–1.9 ) . In 90.4 % of the patients in the KTP group , the postoperative ABG was 10 dB or lower , as compared with 96.5 % in the CO2 group . The mean postoperative ABG at 4 KHz was 5.4 dB with KTP and 2.2 dB with CO2 ( difference , 3.2 ; 95 % confidence interval , 2.2–4.2 ) . Sensorineural hearing loss was reported by 1 patient with KTP laser ( 0.3 % ) and by none with CO2 laser . “ Type of laser ” and “ sex ” were independent predictors of ABG 10 dB or lower . The chance to achieve a postoperative ABG 10 dB or lower for male subjects is 95 % , when treated with CO2 laser and 85 % when treated with KTP laser . For female subjects , these chances are 97 % and 94 % , respectively . Conclusion The use of the CO2 laser fiber may be associated with better hearing results than the KTP laser fiber , regarding the ABG closure within 10 This study reports the evaluation of hearing results after implantation of a Teflon piston of a different diameter in cases of otosclerosis requiring stapedotomy . By r and om selection , a Teflon piston with a shaft diameter of 0.3 mm was inserted in 34 cases and a piston with a shaft diameter of 0.4 mm in 26 cases . A retrospective analysis of the pre- and postsurgery audiological results of these two patient groups was carried out by microcomputer . A repeated statistical measures analysis of variance was used to test and estimate the air-conduction frequency-specific differences between the two prostheses with respect to changes in pre- and postoperative healing . The results of this comparative study of the two Teflon pistons with different diameters indicate statistically a greater hearing gain for the 0.4-mm prosthesis , especially in the lower frequencies Objective : To compare 3 different devices used to perforate the stapes footplate in otosclerotic patients . Study Design : The study design was a prospect i ve unblinded study . It was conducted at the ENT Department of a general hospital . Material s and Methods : Ninety subjects undergoing primary stapedotomy for otosclerosis by a senior surgeon participated . A stapedotomy operation was performed under local anesthesia with reversed sequence of surgical steps . Three different devices were used to perforate the posterior half of the footplate : a microdrill ( MD ) , a CO2 laser ( 
    Output:
    
The included studies show no consistent difference in postoperative air-bone gap closure or immediate postoperative vertigo .
CONCLUSIONS Both footplate fractures and sensorineural hearing loss appear to occur more frequently in the conventional group than in the laser group .
Therefore , we prefer laser above conventional methods for footplate fenestration in primary stapedotomy .