BACKGROUND: In comparisons between retroauricular and transcanal approaches, recent studies suggest retroauricular approaches might result in higher postoperative pain. OBJECTIVES: to evaluate correlation between surgical approach (retroauricular or transcanal) and subjective postoperative pain intensity. MATERIALS AND METHODS: a prospective single-center cohort study was conducted on patients undergoing middle ear surgery from November 2022 to November 2023. Pain was measured using Visual Analog Scale (VAS) and self-reported analgesic consumption from postoperative day (POD) 1 to POD 30. Patients were grouped by surgical approach, with retroauricular cases stratified considering presence of mastoidectomy. RESULTS: eighty-five patients were included (37 retroauricular, 48 transcanal). Retroauricular access with mastoidectomy (canal-wall-up/down) showed higher VAS scores than retroauricular without mastoidectomy and transcanal access at discharge (4.67/4.00 vs 1.71/1.38) and POD 7 (3.13/3.00 vs 1.29/0.83). No significant differences were observed between retroauricular incision without mastoidectomy and transcanal access. Pain was effectively managed with Acetaminophen and NSAIDs; opioids were not required. No complications occurred during the 30-day follow-up. CONCLUSION AND SIGNIFICANCE: postoperative pain in middle ear surgery appears mainly related to mastoidectomy rather than retroauricular incision. Higher pain reported in retroauricular approaches in unstratified literature likely reflects confounding effect of mastoidectomy. Opioid drugs prescription after this surgery should be discouraged.
Bardon et al. (Mon,) studied this question.