509216
OTO
Letter to the Editor Otolaryngology– Head and Neck Surgery 149(6) 963 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2013 Reprints and permission: sagepub.com/journalsPermissions.nav http://otojournal.org
Letter to the Editor
RE: Local versus General Anesthesia for Stapes Surgery DOI: 10.1177/0194599813509216
No sponsorships or competing interests have been disclosed for this article.
In an analysis of the relative merits of local versus general anesthetic in stapes surgery, Wegner and colleagues1 performed a systematic review of the published evidence. After analyzing the data, they concluded that “all of the studies show no difference in air-bone gap, sensorineural hearing loss, and post-operative vertigo between the two groups.” They indicate that “no evidence based recommendation can be provided.” In their article, they used the literary device of presenting a patient with otosclerosis who was deciding between local and general anesthesia. In the article’s last sentence, they advised their patient to have local anesthesia in part due to a “risk of immediate dead ear.” Based on their unambiguously stated conclusion that no basis exists for such a recommendation, we were more than a bit surprised that the authors included this reason in their advice. We are concerned this statement might be misunderstood by the casual reader to represent a recommendation based on their data when this is clearly not the case. The authors’ comment purporting a higher risk of profound sensory hearing loss with general anesthetic is based on a single series that reported 108 cases under local anesthesia with no dead ears and 160 under general anesthesia with 3 dead ears.2 With a prevalence of hearing loss of ±1% in large published series, the results encountered in this modest-sized cohort could certainly have been found by chance alone. The authors themselves characterized this report as having a “high risk of bias.” There has long been variation in choice of anesthetic for stapes surgery. Grandmasters of the art such as Howard House preferred local anesthesia, while John Shea Jr preferred
general anesthesia. Shea3 reported a personal series of more than 14,400 with 0.6% complete sensory hearing loss. Clearly, if general anesthesia were fundamentally flawed, he would not have achieved such excellent results. The Causse Ear Clinic in Beziers, France, which likely has the largest current series, performs some 850 stapes procedures per year under general anesthesia (R. Vincent, Causse Ear Clinic, personal communication, September 2013). We agree with the authors that it is not yet definitely known whether or not the choice of anesthetic method affects outcome in stapes surgery. Based on the consistently excellent outcomes in large series using either method, it is most probable that the method of anesthesia does not affect the outcome of stapes procedures. C. Eduardo Corrales, MD Department of Otolaryngology-Head and Neck Surgery Stanford University Email: [email protected] Robert K. Jackler, MD Department of Otolaryngology-Head and Neck Surgery Stanford University Email: [email protected] Disclosures Competing interests: None. Sponsorships: None. Funding source: None.
References 1. Wegner I, Bittermann AJ, Zinsmeester MM, van der Heijden GJ, Grolman W. Local versus general anesthesia in stapes surgery for otosclerosis: a systematic review of the evidence. Otolaryngol Head Neck Surg. 2013;149:360-365. 2. Vital V, Konstantinidis I, Vital I, Triaridis S. Minimizing the dead ear in otosclerosis surgery. Auris Nasus Larynx. 2008;35:475-479. 3. Shea JJ. A personal history of stapedectomy. Am J Otol. 1998;19:S2-S12.
Downloaded from oto.sagepub.com at UNIV OF MONTANA on April 3, 2015
OTO
Letter to the Editor Otolaryngology– Head and Neck Surgery 149(6) 963 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2013 Reprints and permission: sagepub.com/journalsPermissions.nav http://otojournal.org
Letter to the Editor
RE: Local versus General Anesthesia for Stapes Surgery DOI: 10.1177/0194599813509216
No sponsorships or competing interests have been disclosed for this article.
In an analysis of the relative merits of local versus general anesthetic in stapes surgery, Wegner and colleagues1 performed a systematic review of the published evidence. After analyzing the data, they concluded that “all of the studies show no difference in air-bone gap, sensorineural hearing loss, and post-operative vertigo between the two groups.” They indicate that “no evidence based recommendation can be provided.” In their article, they used the literary device of presenting a patient with otosclerosis who was deciding between local and general anesthesia. In the article’s last sentence, they advised their patient to have local anesthesia in part due to a “risk of immediate dead ear.” Based on their unambiguously stated conclusion that no basis exists for such a recommendation, we were more than a bit surprised that the authors included this reason in their advice. We are concerned this statement might be misunderstood by the casual reader to represent a recommendation based on their data when this is clearly not the case. The authors’ comment purporting a higher risk of profound sensory hearing loss with general anesthetic is based on a single series that reported 108 cases under local anesthesia with no dead ears and 160 under general anesthesia with 3 dead ears.2 With a prevalence of hearing loss of ±1% in large published series, the results encountered in this modest-sized cohort could certainly have been found by chance alone. The authors themselves characterized this report as having a “high risk of bias.” There has long been variation in choice of anesthetic for stapes surgery. Grandmasters of the art such as Howard House preferred local anesthesia, while John Shea Jr preferred
general anesthesia. Shea3 reported a personal series of more than 14,400 with 0.6% complete sensory hearing loss. Clearly, if general anesthesia were fundamentally flawed, he would not have achieved such excellent results. The Causse Ear Clinic in Beziers, France, which likely has the largest current series, performs some 850 stapes procedures per year under general anesthesia (R. Vincent, Causse Ear Clinic, personal communication, September 2013). We agree with the authors that it is not yet definitely known whether or not the choice of anesthetic method affects outcome in stapes surgery. Based on the consistently excellent outcomes in large series using either method, it is most probable that the method of anesthesia does not affect the outcome of stapes procedures. C. Eduardo Corrales, MD Department of Otolaryngology-Head and Neck Surgery Stanford University Email: [email protected] Robert K. Jackler, MD Department of Otolaryngology-Head and Neck Surgery Stanford University Email: [email protected] Disclosures Competing interests: None. Sponsorships: None. Funding source: None.
References 1. Wegner I, Bittermann AJ, Zinsmeester MM, van der Heijden GJ, Grolman W. Local versus general anesthesia in stapes surgery for otosclerosis: a systematic review of the evidence. Otolaryngol Head Neck Surg. 2013;149:360-365. 2. Vital V, Konstantinidis I, Vital I, Triaridis S. Minimizing the dead ear in otosclerosis surgery. Auris Nasus Larynx. 2008;35:475-479. 3. Shea JJ. A personal history of stapedectomy. Am J Otol. 1998;19:S2-S12.
Downloaded from oto.sagepub.com at UNIV OF MONTANA on April 3, 2015
