Awake stapedectomy under hypnoanalgesia: Efficacy and safety in the treatment of otosclerosis - 17/04/25

Doi : 10.1016/j.anorl.2025.04.001

E. Caillaud ^a,^c, L. Pellé-Boudeau ^a, M. Férrandière ^b, D. Bakhos ^a,^c,^d,^e, E. Lescanne ^a,^c,⁎ , F. Micaletti ^a
^a Service d’ORL et chirurgie cervico-faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
^b Service d’anesthésie réanimation, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
^c Faculté de médecine, université de Tours, 2, boulevard Tonnellé, 37044 Tours, France
^d Inserm U1253, iBrain, université de Tours, 2, boulevard Tonnellé, 37044 Tours, France
^e House Institute Foundation, 2100W 3rd Street, Suite 111, 90057 Los Angeles, CA, United States

^⁎Corresponding author. Service ORL, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.Service ORL, centre hospitalier universitaire de Tours2, boulevard TonnelléTours cedex 937044France

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Abstract

Objective

To evaluate the efficacy and safety of awake stapedectomy under hypnoanalgesia (HA) compared to general anesthesia (GA) and local anesthesia (LA) in patients with otosclerosis.

Methods

A single-center retrospective study included 131 adult patients (mean age: 49 years; 78% female) who underwent laser stapedectomy between 2020 and 2022: 58 GA, 23 LA, 50 HA. Primary outcome measures comprised operative room occupancy time, anesthetic consumption, and postoperative audiometric results.

Results

HA significantly reduced operative room occupancy time (73.5±18.6min vs 103.7±24.6min in GA, P<0.001; vs 81.8±20.5min in LA, P=0.092), stapedectomy duration (39.9±12.4min vs 48.9±21.5min in GA, P=0.0252; vs 38.9±13.2min in LA, P=0.4601), preoperative time (30.2±9.5min vs 45.7±9.5min in GA, P<0.001; vs 38.6±12.2min in LA, P=0.0022), and recovery room time (26±15.1min vs 67.5±20.7min in GA, P<0.001; vs 47.4±20.7min in LA, P<0.001). HA also significantly reduced remifentanil consumption (169.8±101.6μg vs 848.6±308.8μg in GA, P<0.001; vs 323.9±94.4μg in LA, P<0.001). Postoperative audiometric outcomes showed no significant differences between groups.

Conclusion

Hypnoanalgesia for awake stapedectomy provided significantly greater efficacy compared to general anesthesia, reducing operative time and anesthetic consumption, with comparable audiometric outcomes.

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Keywords : Otosclerosis, Stapedectomy, Hypnosis, Hypnoanalgesia, Local anesthesia, Awake surgery