High fluence in laser stapedotomy aggravates transient subjective dizziness

Abstract

Background

Laser fenestration in stapedotomy has thermal effect to the vestibule.

Aims/Objectives

To evaluate the role of energy density (fluence) in the severity of postoperative vestibular symptoms.

Materials and methods

The retrospective chart-review study included 84 patients with otosclerosis that underwent primary laser stapedotomy. Surgical outcomes, including nystagmus, and subjective vestibular symptoms during one-month follow-up, were compared between potassium titanyl phosphate (KTP) and CO₂ laser. According to this study and literature, we assessed the relationship between laser parameters and the incidence of persistent vestibular symptoms lasting more than one week after surgery.

Results

The KTP and CO₂ laser group included 48 and 36 patients, respectively. Fluence was different between the KTP (637 J/cm²) and CO₂ (141 J/cm²) laser (p < .001). The KTP group showed gradual decrease in dizziness during one-month observation period, while the CO₂ group exhibited a steep recovery curve in the first postoperative week (9 and 4 d of duration, respectively). The incidence of persistent vestibular symptoms was correlated with both fluence (r = 0.80, p = .01) and spot size (r = −0.74, p = .01).

Conclusions and significance

Appropriate setting of parameters with lower fluence is desirable for the efficiency and safety of laser stapedotomy.

Abbreviations: ABG: air-bone gap; SD: standard deviation.

Chinese Abstract

背景：镫骨切开术中的激光开窗术对前庭有热效应。

目的：评估能量密度（能流）对术后前庭症状的严重程度的作用。

材料和方法：回顾性图表审查研究纳入了 84 名接受初次激光镫骨切除术的耳硬化症患者。在磷酸氧钛钾 (KTP) 和 CO₂ 激光之间对手术结果, 包括眼球震颤和一个月随访期间的主观前庭症状, 进行了比较。 根据这项研究和文献, 我们评估了激光参数与术后持续超过一周的持续性前庭症状的发生率之间的关系。

结果：KTP 组和 CO₂ 激光组分别由 48 例和 36 例患者组成。在KTP（637J/cm²）和二氧化碳（141J/cm²) 激光之间, 能流不同(p<.001)。 KTP组在一个月的观察期内表现出头晕现象的逐渐减少, 而 CO₂ 组在术后第一周内则表现出陡峭的恢复曲线, 持续 时间分别为9 天和 4 天。持续性前庭症状的发病率与能流 (r=0.80, p=.01) 和光斑大小(r=−0.74, p=.01)相关。

结论及意义：适当设置较低能流的参数有利于激光镫骨切除术的有效性和安全性。

Keywords:

• Otosclerosis
• laser stapedotomy
• fluence
• vestibular symptoms

Acknowledgments

We would like to thank Editage (www.editage.com) for the English language editing.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

We have no funding to declare.