Comparison of Videonystagmography and Audiological Findings after Stapedotomy; CO2 Laser vs Perforator

Abstract

OBJECTIVE:Various types of laser, microdrill, and perforator are effectively used in the surgical treatment of otosclerosis. However, they have certain disadvantages along with advantages. The aim of this study was to evaluate the effects of carbon dioxide (CO 2 ) laser and perforator stapedotomy techniques on audiological outcomes and postoperative vestibular functions via videonystagmography (VNG). MATERIALS and METHODS:This prospective and randomized clinical study was conducted in an academic tertiary medical center. Sixty-nine patients diagnosed with otosclerosis who underwent stapedotomy were enrolled in this study. Patients were divided into two groups based on the technique used in stapedotomy: CO 2 laser and perforator. Postoperative hearing gain and VNG findings were the main outcome measures. Subsequently, the two study groups were compared for analysis. RESULTS:The preoperative air-bone gap was 32.7±8.9 decibel (dB) in the study population and it was improved to 12.9±8.4 dB after operation. There were no differences in VNG findings and vertigo symptoms between the laser and perforator groups at postoperative day 2. There was no significant gain difference regarding the air conduction, bone conduction, and air-bone gap between the two groups (p=0.294, p=0.57, and p=0.37, respectively). CONCLUSION:Both CO 2 laser and perforator stapedotomy have successful audiological outcomes with no difference in postoperative vestibular disturbance.

Posztoperatív vertigo vizsgálata stapedotomián és stapedectomián átesett betegeknél

“…A posztoperatív vertigo vizsgálatára az irodalom több módszert is említ: computerized dynamic posturography (CDP), video-oculography (VOG), vestibular evoked myogenic potentials (VEMP), video head-impulse test (vHIT), statikus poszturográfia, a szubjektív tünetek felmérése kérdőívvel -ideális azonban nincs [1,[12][13][14]. Az esetlegesen elhúzódó szédülésnél felmerül a használt piston vagy columella helyzetének az ovális ablakhoz való viszonyának tisztázása.…”

“…Karaca perforátorral és lézerrel végzett stapedotomiák után videonystagmographiát végzett hat órával a műtétet követően, valamint a második posztoperatív napon. A spontán és pozicionális nystagmus regisztrálásá-val nem találtak különbséget a vestibularis következmé-nyekben a különböző műtéti típusok között [13]. Hirvonen stapesműtétet követően egy órán belül végzett nystagmographiát.…”

Surgical treatment of otosclerosis leading to changes in postural control and quality of life

“…4,51 Several studies have demonstrated vestibular function to return within preoperative levels, as measured by VEMPS and caloric testing, in a time span ranging from 1 to 6 months, varying on different study design. 6,41,45 In our study, patients were evaluated 6 weeks after surgery; otoneurological examination showed no evident clinical sign, whereas vHIT scores for the operated ear showed a mild improvement, although not statistically significant (Table II). This result is consistent with a study by Catalano et al 6 who evaluated 20 patients before and after surgery and did not find any significant vHIT score change.…”

“…This is in line with previous studies failing to show connections between postoperative vestibular function, or presence of symptoms, and hearing improvement. 8,45 Extending these aspects, several studies have investigated whether otosclerosis impairs vestibular function along its natural course; the majority of authors focused on objective measurements with no definite findings about the extent of the relation between VEMP scores, 5,46 caloric response, 10,47 and auditory threshold or ABG in patients not undergoing surgical treatment. A possible link between otosclerosis and anatomophysiological impairment in the vestibular end organs has been postulated by postmortem studies on temporal bones, depicting interesting findings such as higher incidence of cupular deposits, 3 lower Scarpa's ganglion cell count, 48 and vestibular nerve atrophy.…”

Evaluation of Audiological Results and Cochleo‐Vestibular Subclinical Injury After CO2 Laser Stapedotomy

“…Preoperative and postoperative vestibular symptoms are common in otosclerosis [17] and stapes surgery [18,27]. However, there are only a few studies that quantify vestibular injury after laser stapedotomy, probably because no correlation was found between audiological results and vestibular sufferance [28], which is therefore underestimated when good hearing outcomes are obtained. Singh and coworkers [29] assessed the post-stapedotomy (manual perforator vs. CO 2 laser) vestibular function by measuring body sway velocity using the modified clinical test of sensory interaction on balance by static posturography; their study demonstrated a significant postoperative vestibular deficit regardless of the technique used.…”