Limitations
As stated, a limitation of this study is sample size, which diminishes
on subgroup analysis and would be better served by greater patient
numbers. As discussed, types of operations in each group differed due to
both patient and surgeon factors. Although subgroup analysis has helped
to eliminate some of this bias, a randomised control trial would be the
best way to measure pain outcomes between groups. Secondly, the number
of patients audited was dependent upon patients remembering to fill in
and return their forms, which may have opened our audit to bias.
Additionally, a previous study has reported that the threshold below
which patients consider themselves recovered postoperatively from
surgery to be 33mm on VAS.13 Overall median VAS scores
are lower that this value across our study, with the exception of a
median post-operative VAS at day 2 of 36 [20;63] mm for the
microscopic group (Table 1). However, as discussed above, the difference
between endoscopic and microscopic VAS scores has clinical relevance.
Ear surgery has been found to be 4 to 10 ten times less painful in
general compared to pain in other subsites of the head and neck, such as
oral cavity and pharynx, and therefore our lower VAS scores were not
unexpected.8 We believe that the generally low VAS
scores across our study should not preclude future groups from studying
differences in pain between otologic interventions in their population.