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

Middle ear surgery is a daily routine procedure in otolaryngology. Pain control, along with a bloodless and non-moving operative field during the surgery, is crucial for achieving better surgical outcomes and can be achieved easily under general anesthesia (GA). Nevertheless, local anesthesia (LA), especially if done as office-based surgery, is an ideal alternative to GA in certain scenarios. Despite the well-established nature of LA for middle ear surgery, only a small percentage of otolaryngologists choose to use it, and few publications in the literature address this topic. This article reviews the literature for the feasibility of performing middle ear surgeries in an office base setting. A scoping review of the literature was conducted on middle ear surgery under LA in an office-based setting, focusing on feasibility, advantages, surgical techniques, limitations, and outcomes, to provide a concise guide for its implementation. LA will avoid the rare but serious complications of GA, and there are cost savings of approximately 50% in LA, which is crucial for the sustainability of healthcare systems. It is an ideal alternative to GA in certain scenarios, including decreased access to operative rooms, staff shortage or contraindications for GA. Also, surgeons can appreciate hearing improvement and the need for prosthesis adjustment with instant feedback during the surgery or prevent significant complications such as a dead ear under LA. Office-based surgery for middle ear under LA is feasible and the present work offers a brief guide for beginners with some tips and tricks to ensure optimal patient care and outcomes.