Discussion
Our study demonstrated that patients placed high value on minimizing
pain and numbness after ear surgery, within 10% as much as a good
hearing outcome. These patient-centric outcomes are important to measure
in future studies and justify the minimally invasive approach of TEES
over traditional postauricular microscopic middle surgery. Staff
friendliness was also highly valued, suggesting that the entire
perioperative experience is an important consideration for individuals
undergoing ear surgery.
Our study is novel and clinically significant. Previous studies have
demonstrated that TEES, compared to microscopic surgery, may be
associated with reduced operative time [1], improved educational
value [2,3], similar or better outcomes[4] for some procedures,
and decreased pain/numbness [6,7]. Other work has described the
prevalence of complications and perioperative outcomes (e.g., pain,
taste disturbances, satisfaction of perioperative care) in ear surgery.
However, no previous study has assessed which outcomes patient value
most when undergoing ear surgery. Identifying patient values,
preferences, and needs can also guide our surgical decision making
(i.e., transcanal endoscopic vs. postauricular microscopic) for patients
undergoing middle ear surgery. For example, postoperative pain
management has been shown to be a crucial component of perioperative
care—it is associated with decreased perioperative complications,
length of stay, costs, as well as increased quality of life.[8,9] In
a survey study of 82 patients who underwent microscopic ear surgery
utilizing a postauricular incision, 80% of patients wearing glasses
reported no discomfort or problems associated with their incision and
82% of patients who wear hearing aids were comfortable. Although most
did not express issues with their postauricular incision, almost 20% of
respondents experienced issues [10].
Our study includes several limitations related to its survey-based
design. Some participants may have rushed through the survey or did not
take it seriously. However, a control item was included on the survey
(color of the bandage given after surgery); the fact that it was by far
the lowest valued outcome validates the accuracy of the other responses.
Another limitation included sampling bias; participants were limited to
patients at the waiting room of an otolaryngology clinic at a tertiary
care center. The sampling population of an otolaryngology waiting room
limits generalizability to the general population. Most patients with
ear diseases suffer from otologic symptoms such as recurrent infection,
hearing loss, tinnitus, vertigo and pain. Patients with non-otologic
problems likely have less knowledge about the aims of ear surgery.
Moreover, for patients who are recommended ear surgery, expectations
regarding surgical outcomes may vary—for example, whether the goal be
to improve hearing and/or to stop recurrent ear infections. In the
latter case, patients may have other expectations with regard to
postoperative outcomes compared to those who undergo stapedectomy, where
a transcanal approach is typically used (whether with a microscope or
endoscope) and numbness, size of incision, visibility of scar, and pain
may only play a minor role.
Future directions include better quantifying values and preferences for
patients undergoing ear surgery. U tilization of validated
objective measurement tools in characterizing these patient outcomes
(e.g., postoperative pain during ear surgery) should be employed to
achieve homogeneity in reporting outcomes when comparing TEES and
microscopic middle ear surgery. These findings will help inform ear
surgeons and patients regarding any clinically significant differences
between microscopic and endoscopic ear surgery postoperative outcomes
that are valued by patients.
Conclusion :
Patients place high value on minimizing pain and numbness after ear
surgery, almost as much as a good hearing outcome. These findings have
implications for patient-driven interest in TEES, which has been
previously shown to reduce pain and numbness compared to the
postauricular approach [6].