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Postoperative Pain and Numbness in Endoscopic Ear Surgery: Patient Values and Outcomes
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  • Alexander Chern,
  • Rahul Sharma,
  • Maeher Grewal,
  • Justin Golub
Alexander Chern
Columbia Irving University Medical Center
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Rahul Sharma
Vanderbilt University
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Maeher Grewal
Columbia University Irving Medical Center
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Justin Golub
Columbia University Irving Medical Center
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Abstract

Purpose: Transcanal endoscopic ear surgery (TEES) avoids a postauricular incision, which has been shown to minimize pain and numbness. Our objective is to assess how much patients value minimizing pain and numbness relative to other postoperative otologic outcomes. Methods: Cross-sectional anonymous surveys were distributed to otolaryngology clinic patients in a tertiary care center. Patients were instructed to rate how much they value various outcomes when undergoing hypothetical ear surgery on a scale of 0 (not important) to 10 (very important). Linear regression was used to analyze demographic predictors of valued outcomes. Results: 102 patients responded (response rate 75%, 50% male). 51% presented for otologic complaints; other represented subspecialties included head & neck surgery, facial plastic surgery and rhinology. 10% of survey respondents were Spanish-speaking. Outcomes of highest importance included hearing (mean 9.3; SD 1.9), staff friendliness (8.9; 1.8), numbness (8.3; 2.4), and pain (8.1; 2.5). Outcomes of moderate importance included time spent under anesthesia (7.0; 3.2), scar visibility (6.3; 3.5), incision size (5.5; 3.4), incision hidden in the ear canal (5.4, 3.9), and surgery cost to the hospital (5.1; 3.9). In linear regression analysis, increasing age was associated with decreased value placed on size of incision (β=-0.06, p<0.001) and visibility of scar (β=-0.07, p<0.001). Conclusion: Patients placed very high value on minimizing pain and numbness after ear surgery, nearly as much as a good hearing outcome. This has implications for patient-driven interest in TEES, which has been previously shown to reduce pain and numbness compared to the postauricular approach.