Use of local anesthesia in ear surgery: technique, modifications, advantages, and limitations over 30 years’ experience

El-Begermy, Mohamed A.; El-Begermy, Marwa M.; Rabie, Ahmed; Ezzat, Abdelrahman E. M.; Sheesh, Ahmed A Kader

doi:10.4103/1012-5574.186541

Cited by 11 publications

(6 citation statements)

References 18 publications

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“…We considered use of local anesthesia in ear surgery as a practical non-expensive suitable method for these campaigns. It has many advantages as better hemostasis, testing hearing, facial nerve action, and Eustachian tube patency during operation [7,8] beside marked reduction of the surgical costs [9]. We had long experience to perform it at ASU.…”

Section: Discussionmentioning

confidence: 99%

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Save the hearing, an ear surgery training project program to combat deafness in developing countries

El-Begermy

Deghady

El-Seidy

et al. 2020

Egypt J Otolaryngol

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Background Hearing loss is one of the most common health problems affecting people in the developing countries so our aim of the “Save The Hearing Project” was to combat deafness by training local doctors for ear surgery in order to treat their local patients with low cost as possible. The project was done as ear surgery campaigns in peripheral areas in Egypt, Yemen, and other countries, to train young ENT specialists and to treat patients there. Our plan was put according to the frequency of different causes of deafness as shown by previous surveys. We used the previous local and evidence-based researches to make our protocols of management of different diseases. These protocols were further evaluated during our work. The project has five stages. The first stage included management of sudden sensory neural hearing loss (SSNHL), otitis media with effusion (OME), and local anesthesia for the ear surgery—cartilage tympanoplasty and ossiculoplasty. The second stage included mastoidectomy cholesteatoma surgery and otoendoscopy. The third stage included more advanced surgery as stapedectomy and tympanosclerosis. The fourth stage included combating SNHL mainly through audiology and rehabilitation program, beside referral for cochlear implants to specialized centers. The fifth stage was only a plan for doing stem cell research in management of hearing loss. Results Our teams did about 42 campaigns only and the data of 31 were recorded. There were 259 attendants, 70 had hands on training, and 35 were well trained and became trainers. We did 270 tympanoplasties, 52 mastoidectomies, and cholesteatoma surgery beside 16 operations of stage III. Conclusion Training an ear surgeon is a tedious and long process, but it is at the end very fruitful and useful for the community. Most causes of HL are preventable. We think that our project plan to combat HL is very suitable to be applied in developing countries in Africa and the Middle East.

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Section: Discussionmentioning

confidence: 99%

“…4. Protocol for local anesthesia in ear surgery as it has many advantages, reduces markedly the surgical costs and complications [7][8][9]. 5.…”

Section: The Ear Surgery Campaignsmentioning

confidence: 99%

Save the hearing, an ear surgery training project program to combat deafness in developing countries

El-Begermy

Deghady

El-Seidy

et al. 2020

Egypt J Otolaryngol

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“…Patient's anxiety caused by noise during surgery, dizziness, and discomfort due to positioning of head and neck, etc., are the most common disadvantages of LA during Tympanoplasty. [1][2][3] These problems can easily be overcome by administering appropriate sedatives as monitored anesthesia care. The most important elements of MAC are sedation, analgesia, and control of anxiety.…”

Section: Introductionmentioning

confidence: 99%

Comparison of nalbuphine and propofol verses pentazocine and promethazine in tympanoplasty surgeries under monitored anesthesia care

et al. 2022

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Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P<0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field.

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“…However, the method was subsequently modified by using standard adrenaline (1:1000) to injection xylocaine/lidocaine to preparing different concentration to prolong the anesthesia time and to achieve less bleeding. A bloodless operative field is essential, because even a few drops of blood can obscure the surgical field 2 . The techniques of headup tilt 20 to 30 degrees from the operating bed facilitate avoidance of venous obstruction, normocapnia, and controlled hypotension 3 .…”

Section: Introductionmentioning

confidence: 99%

Tympanoplasty under Local Anesthesia (LA) Without Sedation

Islam

Mamoon

Milki

et al. 2020

ijmsci

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Background & Objectives: Local Anesthesia (LA) is getting popularity in comparison to general anesthesia (GA) in underdeveloped and developing countries in many otolaryngological operations. The rationale for LA is the lack of trained anesthesia staff, lack of adequate anesthesia machines and monitoring equipment. LA is safe; and ability to perform more cases in a shorter period of time. This study aimed to find out patients compliance in the operative procedures under LA without sedation. Methods: 7905 patents underwent tympanoplsty under LA without sedation from 1999 to 2019 in the different hospital of Bangladesh. Preoperative thorough counselling with psychological motivation, advantages of LA, intraoperative surgeon patient conversation and watching surgical steps on monitor, tests of facial nerve function were explained to the patient. LA with different Adrenaline concentrations (1: 1000 to 1: 200,000) was used either by injection or topically. Patients’ satisfaction, vertigo, drowsiness, hangover, orientation and other parameters ware recorded. Results: Amongst 7905 patients; male 56.2% and 43.8% was female. Maximum numbers (26.3) were found between 26 year to 35 year of age. Patients’ intraoperative compliance showed excellent without sedation. Operative time was short with a bloodless field. The overall safety was good and needed shortest hospital stay (Hour/day); and of course very less expensive. Conclusion: Patient’s safety is the primary objective considered in all patients. The advantages recorded as day/hour care hospital stay, patients comfort, less bleeding, ability to assess patient’s hearing during surgery and cost effectiveness

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Use of local anesthesia in ear surgery: technique, modifications, advantages, and limitations over 30 years’ experience

Cited by 11 publications

References 18 publications

Save the hearing, an ear surgery training project program to combat deafness in developing countries

Save the hearing, an ear surgery training project program to combat deafness in developing countries

Comparison of nalbuphine and propofol verses pentazocine and promethazine in tympanoplasty surgeries under monitored anesthesia care

Tympanoplasty under Local Anesthesia (LA) Without Sedation

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