{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:53:44Z","timestamp":1770026024816,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100016275","name":"Seoul National University Bundang Hospital","doi-asserted-by":"publisher","award":["06\u20102021\u20100109"],"award-info":[{"award-number":["06\u20102021\u20100109"]}],"id":[{"id":"10.13039\/100016275","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n \n Mastering otosclerosis surgery is challenging, especially in low\u2010prevalence Asian populations. This study defines the learning curve for a single surgeon's first 100 consecutive CO\n 2<\/jats:sub>\n laser\u2010assisted stapedotomies by analyzing audiometric and complication outcomes. Despite widespread descriptions of laser\u2010assisted stapes surgery, there is a paucity of data examining the learning process in low\u2010incidence, low\u2010volume regions like East Asia. We aim to characterize the unique challenges and surgical adaptations required in such an environment.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective review of 100 primary stapedotomy cases was performed. The proficiency changepoint was identified using Bayesian and cumulative sum (CUSUM) analyses based on success (postoperative air\u2010bone gap [ABG]\u2009\u2264\u200910\u2009dB and no significant bone\u2010conduction deterioration). Audiometric outcomes\u2014including postoperative ABG, achievement of \u201cNegative ABGe\u201d (postoperative air conduction superior to preoperative bone conduction), and change in high\u2010tone bone conduction\u2014were compared between the pre\u2010proficiency (cases 1\u201330) and post\u2010proficiency (cases 31\u2013100) phases.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A proficiency changepoint was robustly identified at 30 cases. Subsequently, outcomes improved significantly: mean postoperative ABG decreased from 12.1\u2009dB to 5.2\u2009dB (\n p<\/jats:italic>\n \u2009<\u20090.001), and the success rate (ABG \u2264\u200910\u2009dB) increased from 53.3% to 91.4%. The rate of achieving a Negative ABGe surged from 3.3% to 50.0% (\n p<\/jats:italic>\n \u2009<\u20090.001). The mean change in high\u2010tone bone conduction also shifted from \u22120.3 to +6.1\u2009dB of overclosure (\n p<\/jats:italic>\n \u2009<\u20090.001). All major complications occurred within the initial 30 cases.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n For CO\n 2<\/jats:sub>\n laser\u2010assisted stapedotomy, proficiency significantly improves after approximately 30 cases. This study uniquely highlights how surgical mastery develops under conditions of limited disease prevalence and restricted training exposure. The findings suggest that even in low\u2010volume environments, structured experience enables not only consistent ABG closure but also meaningful gains in patient\u2010centered outcomes such as Negative ABGe and cochlear preservation. Our results advocate for simulation\u2010enhanced education strategies tailored to resource\u2010constrained surgical contexts.\n <\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n 4.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lio2.70294","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T12:41:46Z","timestamp":1762346506000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Learning Curve for\n \n CO\n 2<\/sub>\n <\/scp>\n Laser Stapedotomy: A Single\u2010Surgeon Experience in South Korea"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2350-6077","authenticated-orcid":false,"given":"Dong Woo","family":"Nam","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Seoul National University Bundang Hospital Seongnam Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-7649","authenticated-orcid":false,"given":"Hyoungwon","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Seoul National University Bundang Hospital Seongnam Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5538-2785","authenticated-orcid":false,"given":"Ja\u2010Won","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Seoul National University Bundang Hospital Seongnam Republic of Korea"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Seoul National University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"issue":"5","key":"e_1_2_9_2_1","first-page":"674","article-title":"Long\u2010Term Hearing Results Following Stapedotomy","volume":"15","author":"Dornhoffer J. L.","year":"1994","journal-title":"American Journal of Otology"},{"issue":"1","key":"e_1_2_9_3_1","first-page":"52","article-title":"Forty Years of Stapes Surgery","volume":"19","author":"Shea J. J.","year":"1998","journal-title":"American Journal of Otology"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537\u2010199509000\u201000005"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mao.0000235311.80066.df"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010002\u20100457\u2010y"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2002.121517"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.5541011205"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000098861"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000098663"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.14639\/0392\u2010100X\u2010599"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/01421599009006645"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0194\u20105998(95)70103\u20106"},{"issue":"1","key":"e_1_2_9_14_1","first-page":"2","article-title":"Classification and Hearing Result Reporting Guideline in Chronic Otitis Media Surgery","volume":"49","author":"Kim H. J.","year":"2006","journal-title":"Korean Journal of Otorhinolaryngology\u2014Head and Neck Surgery"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215122001943"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002144"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8081182"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010007\u20100437\u20103"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070\u2010018\u20101336\u20101"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010021\u201007183\u20109"}],"container-title":["Laryngoscope Investigative Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.70294","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lio2.70294","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.70294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T05:43:54Z","timestamp":1769838234000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lio2.70294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/lio2.70294"],"URL":"https:\/\/doi.org\/10.1002\/lio2.70294","archive":["Portico"],"relation":{},"ISSN":["2378-8038","2378-8038"],"issn-type":[{"value":"2378-8038","type":"print"},{"value":"2378-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,5]]},"assertion":[{"value":"2025-07-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70294"}}