Pain After Ear Surgery: A Prospective Evaluation of Endoscopic and Microscopic Approaches

Abstract

Objectives/Hypothesis Assumed advantages of a minimally invasive endoscopic transmeatal approach in ear surgery are less postoperative pain, faster healing, and preservation of functional anatomy. We evaluated pain after ear surgery and compared endoscopic transmeatal, microscopic endaural, and retroauricular approaches. Study Design Prospective cohort study. Methods A prospective evaluation of pain during 3 weeks after ear surgery was performed. Three groups were defined: endoscopic transmeatal, microscopic endaural, and retroauricular. Data from 20 fully completed questionnaires (Brief Pain Inventory–Short Form) per group were analyzed with Bayesian and frequentist statistics. Results For all approaches, low pain scores were found, not exceeding 4 on a scale of 0 to 10. Analysis of the worst, least, and average pain scores documented per 24 hours showed no statistically significant difference nor equality between groups. With Bayesian statistics, a Bayes factor of 1.07, 0.25, and 0.51 was found, respectively. With frequentist statistics a p value of .092, .783, and 0.291 was found, respectively. Small, but statistically significant, differences were found for sleep, natural sleeping position, normal work, and pain medication taken. The location of pain correlates with the incision site. Conclusions The results of this study show that the surgical approach has no clinically relevant influence on postoperative pain after ear surgery. The statistically significant differences on natural sleeping position, sleep, normal work, and amount of pain medication taken are small and should be interpreted with caution. Therefore, these should not be decisive factors in the choice of surgical approach in ear surgery. Level of Evidence 3 Laryngoscope, 131:1127–1131, 2021

Post-operative Pain: An audit of patient reported pain scores after endoscopic and microscopic ear surgery

“…5 Baazil et al reported that the endaural microscopic group required half as much medication as their retro-auricular microscopic and endaural transmeatal groups, a result which is unexplained. 6 However, their endoscopic group had a lower requirement for opioids for pain control post-operatively compared to the other groups, consistent with our findings. We therefore believe that the current evidence points towards lesser analgesia requirements after EES.…”

“…Of note, operations studied by Baazil et al, within the endoscopic group included tympanoplasty and atticotomy; and those within the microscopic groups included stapedotomy, tympanoplasty, atticotomy, and canal wall up mastoidectomies. 6 Our study included stapes procedures only within the endoscopic group, and canal wall down mastoidectomy within the microscopic group (Table 1), perhaps explaining our relatively higher pain scores in the microscopic group.…”

“…5 Our findings are contradictory to the results of Baazil et al , who found no difference in pain thresholds between endoscopic and microscopic groups, where pain was measured using the Brief Pain Inventory-Short Form (BPI-SF) on a scale of 0-10. 6 They compared pain after 20 operations carried out by endoscopic transmeatal, microscopic endaural, and retro-auricular approaches, respectively, and found no difference between groups. As pain scores were generally low, they concluded that any difference between pain scores were so small as to be of limited clinical relevance.…”

“…4,5 Where pain after endoscopic surgery has been prospectively studied, published literature from Japan and the Czech Republic is in favour of endoscopic surgery as being less painful than microscopic surgery, 4,5 but recent evidence from the Netherlands has suggested that no link between surgical approach and pain outcomes exist. 6…”

Endoskopische Ohrchirurgie in Deutschland

“…Mögliche Vorteile könnten v. a. in einer geringeren postoperativen Schmerzentwicklung bestehen. In einer Studie an insgesamt 60 Patienten mit jeweils transmeatal endoskopischer, endauraler Inzision und retroaurikulärem Zugang konnten allerdings keine signifikanten Unterschiede bezüglich dieser Vermutung aufgezeigt werden [ 4 ]. Insgesamt kann nach der vorliegenden Umfrage festgestellt werden, dass der chirurgische Zugangsweg in den EES-Kliniken in Deutschland sehr unterschiedlich gehandhabt wird.…”