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.