Background

Controversy in the management of otosclerosis began in 1876 with the first attempt at surgery for otosclerosis with total stapedectomy by Kessel. Unsuccessful largely due to a lack of sterile technique and antibiotics, otosclerosis surgery was abandoned until 1923, when Holmgren performed a three-stage lateral semicircular canal fenestration, a technique later improved by Lempert. The next era of controversy paralleled advances in surgical technique. Very controversial at the time, the first modern successful stapedectomy technique was performed and described by Shea in 1956.1,2

Several modifications of the technique and prostheses have since evolved, with the overall success rates (four frequency average of conductive gap closure within 10 dB) in experienced hands climbing to more than 90%. Laser applications have added the ability to achieve hemostatic and atraumatic access to the footplate/oval window interface. This has become most useful during revision procedures when working with unknown footplate status, mucosal scarring at the oval window (OW) and the potential of intralabyrinthine adhesions. In recent series, laser revision techniques have demonstrated improved results, due to this ability to open the OW seal atraumatically and allow the surgeon to reestablish ossicular chain continuity.3-6 Before laser revision techniques, reopening of the OW was associated with a high rate of sensorineural hearing loss (SNHL) and was avoided. Lasers, of both visible and nonvisible wavelengths, have been shown to be safe and effective in primary and revision stapes surgery. With all laser types performing equally well, choice is determined by cost, availability, and delivery system preference.3-10

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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