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