Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia and sedation.

Conclusion: Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia with sedation can be well tolerated by the patient, with minimum discomfort.
Objectives: To evaluate patient discomfort from pain, body/neck position, noise, and anxiety during tympanoplasties and mastoidectomies performed under local anesthesia with sedation.
Patients and Methods: This was a prospective study of 83 surgeries in 62 patients (28 type I tympanoplasties, 12 tympanoplasties with ossicular reconstruction, 40 canal wall up mastoidectomies, and 3 revision tympanoplasties). Local infiltration used lidocaine 2% with 1:100 000 epinephrine infiltrated in the retroauricular area and from below the pinna in a 'V' pattern. Sedation was achieved with 50 mg of intramuscular promethazine 1 h before surgery and intravenous midazolam (0.03 mg/kg) at the beginning of surgery. Subsequent doses of midazolam were given to maintain adequate sedation, up to 10 mg. The discomfort during surgery was assessed by the patient with a score from 0 to 4 (0 = no discomfort and 4 = extreme discomfort).
Results: Discomfort due to pain had a mean score of 0.83. Noise discomfort (from drilling and manipulation of instruments) had the lowest mean score (0.70), and discomfort from body and neck position had the highest mean score (1.51).