Post Stapedotomy Vestibular Deficit: Is CO₂ Laser Better than Conventional Technique? A Non-randomized Controlled Trial

Abstract

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO₂ Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO₂ Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO₂ Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO₂ Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1 week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4 weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1 week after surgery. 4 weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO₂ Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.