Summary of results/Comparison with Literature
Overall, EES was associated with lower post-operative pain scores than microscopic ear surgery in our population. Our overall results agree with the findings of a group from Japan, who found that pain reported for total EES was significantly lower than for microscopic ear surgery from days 1 to 7 post-operatively.4 A study from the Czech Republic of the first four post-operative days, found less pain on VAS at the first post-operative day in their endoscopic group compared to their microscopic group.5
Our findings are contradictory to the results of Baazil et al. , who found no difference in pain thresholds between endoscopic and microscopic groups, where pain was measured using the Brief Pain Inventory-Short Form (BPI-SF) on a scale of 0-10.6They compared pain after 20 operations carried out by endoscopic transmeatal, microscopic endaural, and retro-auricular approaches, respectively, and found no difference between groups. As pain scores were generally low, they concluded that any difference between pain scores were so small as to be of limited clinical relevance. In our study, VAS was reported at a median of 1.5 [0;11.5] mm at post-op day one for the endoscopic group and a median of 27 [15;65] mm for the microscopic group. Difference in median results exceeds what is defined as the minimally clinically important difference (MCID) which has been measured for post-operative VAS scores as being 10mm.13 We therefore believe differences between our groups to be of significance. Of note, operations studied by Baazil et al., within the endoscopic group included tympanoplasty and atticotomy; and those within the microscopic groups included stapedotomy, tympanoplasty, atticotomy, and canal wall up mastoidectomies.6 Our study included stapes procedures only within the endoscopic group, and canal wall down mastoidectomy within the microscopic group (Table 1), perhaps explaining our relatively higher pain scores in the microscopic group.