Video-oculography findings and vestibular symptoms on the day of stapes surgery

Abstract

Vestibular symptoms are common after stapes surgery and may prevent outpatient treatment. The cause of vestibular symptoms is unclear, and in previous studies objective measurements have been obtained few days after the surgery. The aim of the study was to evaluate the existence and nature of any early, and possibly temporary vestibular irritation that occurs immediately after surgery. Twenty-one patients who had an opening of the oval window were prospectively included. Postoperative symptoms were collected and eye position curves were recorded with video-oculography (VOG) an average of 4 h after surgery. Early vestibular symptoms were found in 11 (52%) patients. Four patients had rotatory vertigo, three had floating sensation, one experienced a tilting sensation, and two had unspecific dizziness. Two patients vomited after surgery. When VOG was performed all but one were free of symptoms. After surgery, spontaneous nystagmus was found in three (14%) asymptomatic patients when gaze fixation was prevented. The prevalence of 33% (7 of 21 patients) of latent, spontaneous, horizontal-torsional nystagmus seen only during lateral gaze towards the direction of fast phase was significantly higher (P = 0.0001) than in healthy controls. The occurrence of nystagmus did not correlate with vestibular symptoms (P = 0.30). Slight, direction-fixed, latent, spontaneous horizontal-torsional nystagmus in some patients is consistent with a minor disturbance of semicircular canals, although it was not related to the sensation of dizziness. Recordings during stapes surgery may be needed to ascertain the origin of vestibular symptoms. Regarding vestibular symptoms and signs, patients may be safely discharged a few hours after stapes surgery.