High fluence in laser stapedotomy aggravates transient subjective dizziness

Area of Science:

• Otolaryngology
• Ophthalmology
• Laser Surgery

Background:

• Laser fenestration during stapedotomy can cause thermal effects on the vestibule.
• Postoperative vestibular symptoms are a common concern following stapedotomy procedures.

Purpose of the Study:

• To investigate the relationship between laser energy density (fluence) and the severity of postoperative vestibular symptoms.
• To compare vestibular outcomes between potassium titanyl phosphate (KTP) and CO2 lasers in stapedotomy.

Main Methods:

• Retrospective chart review of 84 patients with otosclerosis undergoing primary laser stapedotomy.
• Comparison of surgical outcomes, including nystagmus and subjective vestibular symptoms, between KTP and CO2 laser groups.
• Assessment of the correlation between laser parameters (fluence, spot size) and persistent vestibular symptoms.

Main Results:

• The KTP laser group (fluence: 637 J/cm²) showed a gradual decrease in dizziness, while the CO2 laser group (fluence: 141 J/cm²) had a steeper recovery in the first week.
• The incidence of persistent vestibular symptoms (>1 week) was significantly correlated with higher fluence (r=0.80, p=0.01) and larger spot size (r=-0.74, p=0.01).
• Significant differences in fluence were observed between KTP and CO2 laser groups (p < .001).

Conclusions:

• Optimizing laser parameters, particularly reducing fluence, is crucial for enhancing the safety and efficacy of laser stapedotomy.
• Lower energy settings may minimize thermal effects and reduce the risk of persistent vestibular symptoms.