Bawazeer Naif
Department of Otolaryngology - Head and Neck Surgery and Ophthalmology, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia. Email:
J Clin Med Res. 2025 Jul 31;17(7):365-374. doi: 10.14740/jocmr6279. eCollection 2025 Jul.
Middle ear surgery is a daily routine procedure in otolaryngology. Pain control, along with a bloodless and non-moving operative field during the surgery, is crucial for achieving better surgical outcomes and can be achieved easily under general anesthesia (GA). Nevertheless, local anesthesia (LA), especially if done as office-based surgery, is an ideal alternative to GA in certain scenarios. Despite the well-established nature of LA for middle ear surgery, only a small percentage of otolaryngologists choose to use it, and few publications in the literature address this topic. This article reviews the literature for the feasibility of performing middle ear surgeries in an office base setting. A scoping review of the literature was conducted on middle ear surgery under LA in an office-based setting, focusing on feasibility, advantages, surgical techniques, limitations, and outcomes, to provide a concise guide for its implementation. LA will avoid the rare but serious complications of GA, and there are cost savings of approximately 50% in LA, which is crucial for the sustainability of healthcare systems. It is an ideal alternative to GA in certain scenarios, including decreased access to operative rooms, staff shortage or contraindications for GA. Also, surgeons can appreciate hearing improvement and the need for prosthesis adjustment with instant feedback during the surgery or prevent significant complications such as a dead ear under LA. Office-based surgery for middle ear under LA is feasible and the present work offers a brief guide for beginners with some tips and tricks to ensure optimal patient care and outcomes.
中耳手术是耳鼻喉科的一项日常常规手术。手术过程中的疼痛控制以及无血且静止的手术视野对于取得更好的手术效果至关重要，而在全身麻醉（GA）下很容易实现这一点。然而，局部麻醉（LA），尤其是在门诊手术的情况下，在某些场景中是GA的理想替代方案。尽管LA用于中耳手术已相当成熟，但只有一小部分耳鼻喉科医生选择使用它，而且文献中很少有出版物涉及这个主题。本文回顾了在门诊环境中进行中耳手术的可行性的文献。对在门诊环境下LA麻醉下的中耳手术进行了文献综述，重点关注可行性、优势、手术技术、局限性和结果，以提供其实施的简明指南。LA可避免GA罕见但严重的并发症，并且LA可节省约50%的费用，这对医疗系统的可持续性至关重要。在某些场景中，包括手术室使用受限、人员短缺或GA禁忌证等情况，LA是GA的理想替代方案。此外，在LA麻醉下手术期间，外科医生可以通过即时反馈了解听力改善情况以及假体调整的必要性，或者预防诸如死耳等重大并发症。在LA麻醉下进行门诊中耳手术是可行的，本研究为初学者提供了一份简要指南，并提供了一些技巧和窍门，以确保为患者提供最佳护理和治疗效果。
