Laser versus non-laser stapedotomy in otosclerosis: A systematic review and meta-analysis

Abstract

To compare and evaluate the hearing outcome and complications of otosclerosis treated with the laser or non-laser stapedotomy using meta-analysis. A thorough search for publications and "in-process" articles with English abstract dating from January 1978 to July 2013 was conducted using Pubmed, EBSCO and Web of Science databases, as well as all related papers. The included criteria were otosclerosis as diagnosis, clear description of surgical methods, calibrated stapedotomy and regular collection of functional results. Hearing results and other comparable data (age, preoperative hearing status, and mean length of follow-up) were collected from the articles. Eleven studies with a total of 1614 subjects were identified to meet our criteria. There was a significant difference in the efficacy of stapedotomy with the laser or non-laser technique; current data showed a combined RR of 1.07 (95% CI: 1.02-1.13, p=0.005). But, the postoperative complication showed no advantage for the laser group, with a combined RR of 0.63 (95% CI: 0.30-1.34, p=0.23). Although there was publication bias in this study (p=0.005), the funnel plot would turn out to be symmetrical after six more studies were added by the trim and fill method. Our overall results suggest that the laser stapedotomy had significantly better hearing results than non-laser stapedotomy. However, current papers on laser and non-laser stapedotomy did not provide enough subjects to make a subgroup analysis of the hearing outcome between different laser groups. More studies reporting different laser techniques are required to provide us with a better understanding of laser stapedotomy.