Subgroup analysis
Salzman et al ., set to address the differing uses of endoscopic and microscopic surgery by dividing operations into reconstructive and cholesteatoma procedures.5 All mastoid surgery was excluded. On subgroup analysis, endoscopic cholesteatoma patients suffered from less pain on post-operative day 1 than the microscopic group. Where the procedure was reconstructive, there was no significant difference between groups, but a trend towards less pain within the endoscopic group than the microscopic group. Unlike this study, we did not detect a statistically significant difference in pain scores between our microscopic and endoscopic groups for non-reconstructive procedures, which included both meatoplasty and cholesteatoma surgery; but found a statistically significant reduction in VAS after EES compared to microscopic ear surgery in our reconstructive group at post-operative days 1 and 2. Numbers within our subgroup analysis were small (Supplementary Table 1), therefore these results should be approached with caution. With regards to reconstructive procedures, case series and metanalysis provide some evidence to support that these may be less painful than microscopic surgery whilst being conducted endoscopically.14,15,16