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

  • Anubhav Singh
  • Rakesh Datta
  • B. K. Prasad
  • Ajith Nilakantan
  • Renu Rajguru
  • Manoj Kumar Kanzhuly
  • Salil Kumar Gupta
  • Inderdeep Singh
Original Article


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.


Stapes surgery CO2 laser Posturography Otosclerosis Vertigo Postural balance 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.


  1. 1.
    Aarnisalo AA, Vasama JP, Hopsu E, Ramsay H (2003) Long-term hearing results after stapes surgery: a 20-year follow-up. Otol Neurotol 24:567–571CrossRefPubMedGoogle Scholar
  2. 2.
    Wegner I, Kamalski DMA, Tange RA et al (2014) Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review. Laryngoscope 124:1687–1693. CrossRefPubMedGoogle Scholar
  3. 3.
    Ozmen AO, Aksoy S, Ozmen S et al (2009) Balance after stapedotomy: analysis of balance with computerized dynamic posturography. Clin Otolaryngol 34:212–217. CrossRefPubMedGoogle Scholar
  4. 4.
    Black FO (2001) Clinical status of computerized dynamic posturography in neurotology. Curr Opin Otolaryngol Head Neck Surg 9:314–318. CrossRefGoogle Scholar
  5. 5.
    Matković S, Kitanoski B, Malicević Z (2003) Advantages of CO2 laser use in surgical management of otosclerosis. Vojnosanit Pregl 60:273–278CrossRefPubMedGoogle Scholar
  6. 6.
    Badran K, Gosh S, Farag A, Timms MS (2006) How we do it: switching from mechanical perforation to the CO2 laser; audit results of primary small-fenestra stapedotomy in a district general hospital. Clin Otolaryngol 31:546–549CrossRefPubMedGoogle Scholar
  7. 7.
    Cuda D, Murri A, Mochi P et al (2009) Microdrill, CO2-laser, and piezoelectric stapedotomy: a comparative study. Otol Neurotol 30:1111–1115CrossRefPubMedGoogle Scholar
  8. 8.
    Kondo M, Kiyomizu K, Goto F et al (2015) Analysis of vestibular-balance symptoms according to symptom duration: dimensionality of the vertigo symptom scale-short form. Heal Qual Life Outcomes 13:4. CrossRefGoogle Scholar
  9. 9.
    Position Statement: Posturography| American academy of otolaryngology-head and neck surgery. Accessed 24 Jan 2018
  10. 10.
    Di Fabio RP (1995) Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction. Phys Ther 75:290–305CrossRefPubMedGoogle Scholar
  11. 11.
    Causse JB, Causse JR, Cezard R et al (1988) Vertigo in postoperative follow-up of otosclerosis. Am J Otol 9:246–255PubMedGoogle Scholar
  12. 12.
    Atacan E, Sennaroglu L, Genc A, Kaya S (2001) Benign paroxysmal positional vertigo after stapedectomy. Laryngoscope 111:1257–1259CrossRefPubMedGoogle Scholar
  13. 13.
    Jovanovic S (2006) Laser stapedotomy. In: Hildmann H, Sudhoff H (eds) Middle ear surgery. Springer, Heidelberg, pp 120–130CrossRefGoogle Scholar
  14. 14.
    Panda NK, Saha AK, Gupta AK, Mann SBS (2001) Evaluation of vestibular functions in otosclerosis before and after small fenestra stapedotomy. Indian J Otolaryngol Head Neck Surg 53:23–27. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Motta G, Moscillo L (2002) Functional results in stapedotomy with and without CO2 laser. ORL 64:307–310. CrossRefPubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of ORL-HNSArmed Forces Medical CollegeWanowrie, PuneIndia
  2. 2.Department of ORL-HNSCommand Hospital (CC)LucknowIndia
  3. 3.167 Military Hospitalc/o 56 APOPathankotIndia
  4. 4.Department of ORL-HNSINHS AsviniMumbaiIndia

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