Surgical manipulations during laser stapedotomy
can produce intracochlear pressure
changes comparable to pressures created by high-intensity acoustic stimuli.
New-onset sensorineural hearing loss is a known risk of stapes surgery and may result from pressure changes from laser use or other surgical manipulations. Here, we test the hypothesis that high sound pressure levels are generated in the cochlea during laser stapedotomy
Human cadaveric heads underwent mastoidectomy. Fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures during key steps in stapedotomy
surgery, including cutting stapedius tendon, lasering of stapedial crurae, crural downfracture, and lasering of the footplate.
Key steps in laser stapedotomy
produced high-intensity pressures in the cochlea. Pressure transients were comparable to intracochlear pressures measured in response to high intensity impulsive acoustic stimuli.
Our results demonstrate that surgical manipulations during laser stapedotomy
can create significant pressure changes within the cochlea, suggesting laser application should be minimized and alternatives to mechanical downfracture should be investigated. Results from this investigation suggest that intracochlear pressure
transients from stapedotomy
may be of sufficient magnitude to cause damage to the sensory epithelium and affirm the importance of limiting surgical traumatic exposures.