Background
Endoscopic ear surgery (ESS) has been increasingly adopted into practice
over recent years.1 The endoscope affords the ability
to “look around corners” during middle ear surgery and provides a
detailed view of spaces within the middle ear such as the facial recess
and anterior epitympanum through the trans-meatal
approach.2 As such, EES is often described as
minimally invasive, with the potential advantages over microscopic
surgery of preventing additional bone removal or use of the
post-auricular approach in cholesteatoma surgery.3 In
addition, the endoscope is also being utilised for non-cholesteatoma
surgery, with proponents citing that this may reduce the need for ear
canal bony removal during myringoplasty, and reduce the potential for
chorda tympani injury in stapes surgery.2
As with every surgical technique, there is a responsibility to measure
and report outcomes. Although it is a widely held belief that EES is
less painful that microscopic ear surgery,1 there is
little evidence to support this supposition.4,5 Where
pain after endoscopic surgery has been prospectively studied, published
literature from Japan and the Czech Republic is in favour of endoscopic
surgery as being less painful than microscopic
surgery,4,5 but recent evidence from the Netherlands
has suggested that no link between surgical approach and pain outcomes
exist.6