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<p>Local anesthesia (LA) offers several advantages over general anesthesia for middle ear (ME) surgery, including reduced bleeding, faster recovery and intraoperative functional assessment. However, conventional techniques such as Plester’s method can be technically challenging and may lead to inadequate anesthesia and canal wall trauma. To assess the effectiveness, patient comfort and surgical conditions achieved using a modified sub-periosteal infiltration technique adapted from Plester’s method for ME surgeries under LA. This prospective observational pilot study included 20 adult patients undergoing ME surgery under LA with sedation at a tertiary care center. The modified technique altered the direction of external auditory canal infiltration to allow precise vertical sub-periosteal anesthetic deposition. Patient-reported pain, anxiety, noise perception and irritability were assessed using standardized scales. Surgeon-reported outcomes included intraoperative bleeding (Boezaart score), anesthetic adequacy and procedure-related complications. The mean patient age was 39.45&#xa0;years, with a female predominance (65%). Intraoperative and postoperative pain scores were low, and most patients reported no dominant distressing symptom. The mean intraoperative bleeding score was 1.75 (range: 1–3), with no cases of severe bleeding or canal wall bleb formation. No postoperative facial nerve dysfunction or other adverse events were observed. All patients expressed willingness to undergo future otologic surgery under LA. The modified sub-periosteal infiltration technique provides reliable anesthesia, tolerable bleeding and high patient and surgeon satisfaction during ME surgery under LA. This simple, reproducible refinement of Plester’s technique may promote wider adoption of LA in otologic practice.</p>

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A Prospective Observational Study from A Tertiary Care Centre to Validate the Efficacy of Modified Technique of Local Anaesthesia for Middle Ear Surgeries

  • 期刊论文

  • 发表日期：

    2026年7月11日

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  • Sunil Goyal,
  • Tanuj Madan,
  • Mahesh Ravunnikutty,
  • Rohit Singh,
  • Srijon Dawn,
  • Vijay Bhalla

摘要

Local anesthesia (LA) offers several advantages over general anesthesia for middle ear (ME) surgery, including reduced bleeding, faster recovery and intraoperative functional assessment. However, conventional techniques such as Plester’s method can be technically challenging and may lead to inadequate anesthesia and canal wall trauma. To assess the effectiveness, patient comfort and surgical conditions achieved using a modified sub-periosteal infiltration technique adapted from Plester’s method for ME surgeries under LA. This prospective observational pilot study included 20 adult patients undergoing ME surgery under LA with sedation at a tertiary care center. The modified technique altered the direction of external auditory canal infiltration to allow precise vertical sub-periosteal anesthetic deposition. Patient-reported pain, anxiety, noise perception and irritability were assessed using standardized scales. Surgeon-reported outcomes included intraoperative bleeding (Boezaart score), anesthetic adequacy and procedure-related complications. The mean patient age was 39.45 years, with a female predominance (65%). Intraoperative and postoperative pain scores were low, and most patients reported no dominant distressing symptom. The mean intraoperative bleeding score was 1.75 (range: 1–3), with no cases of severe bleeding or canal wall bleb formation. No postoperative facial nerve dysfunction or other adverse events were observed. All patients expressed willingness to undergo future otologic surgery under LA. The modified sub-periosteal infiltration technique provides reliable anesthesia, tolerable bleeding and high patient and surgeon satisfaction during ME surgery under LA. This simple, reproducible refinement of Plester’s technique may promote wider adoption of LA in otologic practice.