Office-Based Middle Ear Surgery Under Local Anesthesia: A Contemporary Review

Area of Science:

• Otolaryngology
• Surgical Anesthesia

Background:

• Middle ear surgery is a common otolaryngology procedure where pain control and a stable operative field are essential.
• General anesthesia (GA) is typically used, but local anesthesia (LA) presents a viable alternative, especially for office-based procedures.

Purpose of the Study:

• To review the literature on the feasibility of performing middle ear surgeries under local anesthesia (LA) in an office-based setting.
• To provide a concise guide for implementing LA in middle ear surgery, covering techniques, advantages, and limitations.

Main Methods:

• A scoping review of existing literature was conducted.
• The review focused on the feasibility, advantages, surgical techniques, limitations, and outcomes of middle ear surgery performed under LA in an office setting.

Main Results:

• Local anesthesia (LA) is a feasible option for middle ear surgery in an office setting.
• LA avoids rare but serious complications associated with general anesthesia (GA) and offers significant cost savings.
• LA allows for real-time surgeon feedback on hearing and prosthesis fit, potentially preventing complications like a dead ear.

Conclusions:

• Office-based middle ear surgery under LA is feasible and offers numerous benefits over GA.
• LA is an ideal alternative when operating room access is limited, staff are scarce, or GA is contraindicated.
• This review provides practical guidance for surgeons considering LA for middle ear procedures, aiming for optimal patient care and outcomes.