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.