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].