Local versus general anesthesia in stapes surgery for otosclerosis: a systematic review of the evidence.

OBJECTIVE To assess hearing results following primary stapes surgery in patients with otosclerosis, comparing local and general anesthesia. DATA SOURCES PubMed, Embase, the Cochrane Library, CINAHL, and Scopus. REVIEW METHODS A systematic search was conducted, followed by assessment of directness of evidence and risk of bias. Studies reporting original data on the effect of local anesthesia, compared to general anesthesia, on closure of air-bone gap in patients undergoing stapes surgery for otosclerosis were included. RESULTS A total of 257 unique studies were retrieved, of which 3 (including 417 procedures) satisfied the eligibility criteria. Assessment showed that all studies carried high risk of bias, and only 1 study provided direct evidence. CONCLUSION There is no difference in postoperative air-bone gap, worsening of sensorineural hearing loss, and postoperative vertigo between the 2 groups. A statistically significant increased risk of immediate dead ear following stapes surgery performed under general anesthesia was reported in 1 study.