Objective: To compare levels and causes of postoperative pain after cholesteatoma removal by transcanal endoscopic ear surgery (TEES) versus microscopic ear surgery (MES).
Study design: Prospective case series.
Setting: Tertiary referral center.
Patients: One-hundred-and-sixty-one patients who had undergone middle ear surgery between February 2013 and April 2016.
Interventions: Comparison of postoperative pain between TEES and MES groups and among TEES and MES subgroups divided by range of bone removal.
Main outcome measures: Two parameters were used to assess postoperative pain: a pain numeric rating scale (NRS) and number of times a non-steroidal anti-inflammatory drug (NSAID) was taken from postoperative days (PODs) 1 to 7. We also examined the primary factor behind postoperative pain looking at: 1) the surgical incision; 2) bone removal; and 3) number of involved middle ear regions.
Results: One-hundred-and-six patients underwent TEES and 55 underwent MES. The mean pain NRS for the 7-day postoperative period was significantly lower for the TEES group (1.1) than the MES group (2.8) (p < 0.001, Mann-Whitney U test). The number of times a NSAID was taken was lower for the TEES group (1.3 pills/wk) than the MES group (5.5 pills/wk) (p < 0.001, Mann-Whitney U test). The mean pain NRS of the TEES and MES subgroups also suggests that extent of bone removal or number of involved middle regions was less important in causing postoperative pain than presence or absence of the retroauricular incision.
Conclusions: TEES is associated with lower postoperative pain and lower use of NSAIDs compared with MES patients.