Skip to main content
SpringerLink
Log in

Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events.

Methods

A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded.

Results

1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months.

Conclusion

Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Raw data is available for analysis upon request.

References

  1. Saini AT, Citardi MJ, Yao WC, Luong AU (2019) Office-based sinus surgery. Otolaryngol Clin North Am 52:473–483. https://doi.org/10.1016/j.otc.2019.02.003

    Article  PubMed  Google Scholar 

  2. Lee JT, DelGaudio J, Orlandi RR (2018) Practice patterns in office-based rhinology: survey of the American rhinologic society. Am J Rhinol Allergy 33:26–35. https://doi.org/10.1177/1945892418804904

    Article  PubMed  Google Scholar 

  3. Varshney R, Lee JT (2016) New innovations in office-based rhinology. Curr Opin Otolaryngol Head Neck Surg 24:3–9. https://doi.org/10.1097/moo.0000000000000228

    Article  PubMed  Google Scholar 

  4. Abdullah B, Singh S (2021) Surgical interventions for inferior turbinate hypertrophy: a comprehensive review of current techniques and technologies. IJERPH 18:3441. https://doi.org/10.3390/ijerph18073441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Viera-Artiles J, Corriols-Noval P, López-Simón E et al (2020) In-office endoscopic nasal polypectomy: prospective analysis of patient tolerability and efficacy. Eur Arch Otorhinolaryngol 277:3341–3348. https://doi.org/10.1007/s00405-020-06196-0

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sikand A, Ehmer DR Jr, Stolovitzky JP et al (2018) In-office balloon sinus dilation versus medical therapy for recurrent acute rhinosinusitis: a randomized, placebo-controlled study. Int Forum Allergy Rhinol 9:140–148. https://doi.org/10.1002/alr.22248

    Article  PubMed  Google Scholar 

  7. Sudhoff H, Ay N, Todt I et al (2020) A novel technique for patulous Eustachian tube augmentation. Eur Arch Otorhinolaryngol 278:2219–2224. https://doi.org/10.1007/s00405-020-06277-0

    Article  PubMed  Google Scholar 

  8. Taylor RJ, Sherris DA (2015) Prosthetics for nasoseptal perforations. Otolaryngol Head Neck Surg 152:803–810. https://doi.org/10.1177/0194599815577084

    Article  PubMed  Google Scholar 

  9. Barrow EM, DelGaudio JM (2014) In-office drainage of sinus mucoceles: an alternative to operating-room drainage. Laryngoscope 125:1043–1047. https://doi.org/10.1002/lary.25042

    Article  PubMed  Google Scholar 

  10. Gittelman PD, Jacobs JB, Skorina J (1993) Comparison of functional endoscopic sinus surgery under local and general anesthesia. Ann Otol Rhinol Laryngol 102:289–293. https://doi.org/10.1177/000348949310200408

    Article  CAS  PubMed  Google Scholar 

  11. Kilty S, Thavorn K, Janjua A et al (2020) Endoscopic polypectomy performed in clinic for chronic rhinosinusitis with nasal polyps: study protocol for the EPIC multicentre randomised controlled trial. BMJ Open 10:e042413. https://doi.org/10.1136/bmjopen-2020-042413

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ng BHK, Annamalai S, Linger Sim LS, Tang IP (2020) A 5-year experience in functional endoscopic sinus surgery under local anaesthesia. Pol Ann Med. https://doi.org/10.29089/2020.20.00122

    Article  Google Scholar 

  13. Scott JR, Sowerby LJ, Rotenberg BW (2017) Office-based rhinologic surgery: a modern experience with operative techniques under local anesthetic. Am J Rhinol&Allergy 31:135–138. https://doi.org/10.2500/ajra.2017.31.4414

    Article  Google Scholar 

  14. Suzuki S, Yasunaga H, Matsui H et al (2015) Complication rates after functional endoscopic sinus surgery: analysis of 50,734 Japanese patients. Laryngoscope 125:1785–1791. https://doi.org/10.1002/lary.25334

    Article  PubMed  Google Scholar 

  15. Cuvillon P, Lefrant JY, Gricourt Y (2022) Considerations for the use of local anesthesia in the frail elderly: current perspectives. LRA 15:71–75. https://doi.org/10.2147/lra.s325877

    Article  Google Scholar 

  16. Prickett KK, Wise SK, DelGaudio JM (2012) Cost analysis of office-based and operating room procedures in rhinology. Int Forum Allergy Rhinol 2:207–211. https://doi.org/10.1002/alr.21020

    Article  PubMed  Google Scholar 

  17. Anderson J, Hu H (2023) Environmental sustainability: waste audit comparison operating room and in-office laryngeal surgery. Laryngoscope 134:803–806. https://doi.org/10.1002/lary.31005

    Article  PubMed  Google Scholar 

  18. Heo SJ, Cha EJ, Cho HS et al (2018) Comparison of patient satisfaction and complications of rhinoplasty between local and general Anesthesia. Korean J Otorhinolaryngol-Head Neck Surg 61:247–251. https://doi.org/10.3342/kjorl-hns.2017.00591

    Article  Google Scholar 

  19. Andrews P, Anschuetz L, Baptista PM et al (2021) Awake rhinology surgery in response to the COVID-19 pandemic in Europe. ORL 84:93–102. https://doi.org/10.1159/000517155

    Article  CAS  PubMed  Google Scholar 

  20. Desrosiers M, Evans GA, Keith PK et al (2011) Canadian clinical practice guidelines for acute and chronic rhinosinusitis. All Asth Clin Immun. https://doi.org/10.1186/1710-1492-7-2

    Article  Google Scholar 

  21. O’Halloran L (2003) The lateral crural J-flap repair of nasal valve collapse. Otolaryngol Head Neck Surg 128:640–649. https://doi.org/10.1016/s0194-5998(03)00096-2

    Article  PubMed  Google Scholar 

  22. Yip J, Hao W, Eskander A, Lee JM (2018) Wait times for endoscopic sinus surgery influence patient-reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria. Int Forum Allergy Rhinol 9:396–401. https://doi.org/10.1002/alr.22257

    Article  PubMed  Google Scholar 

  23. Papagiannopoulos P, Ganti A, Kim YJ et al (2020) Impact of COVID-19 pandemic on ambulatory and operating room rhinology practice in the US. Am J Rhinol&Allergy 35:441–448. https://doi.org/10.1177/1945892420961962

    Article  Google Scholar 

  24. Rotenberg B (2021) Moving surgical care out of hospitals to reduce wait times. CMAJ 193:E138–E138. https://doi.org/10.1503/cmaj.77461

    Article  PubMed  PubMed Central  Google Scholar 

  25. Radvansky BM, Husain Q, Cherla DV et al (2012) In-office vasovagal response after rhinologic manipulation. Int Forum Allergy Rhinol 3:510–514. https://doi.org/10.1002/alr.21121

    Article  PubMed  Google Scholar 

  26. Hopkins C, Browne JP, Slack R et al (2006) Complications of surgery for nasal polyposis and chronic rhinosinusitis: the results of a national audit in England and Wales. Laryngoscope 116:1494–1499. https://doi.org/10.1097/01.mlg.0000230399.24306.50

    Article  PubMed  Google Scholar 

  27. Smith KA, Orlandi RR, Oakley G et al (2018) Long-term revision rates for endoscopic sinus surgery. Int Forum Allergy Rhinol 9:402–408. https://doi.org/10.1002/alr.22264

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schröder S, Lehmann M, Sudhoff HH, Ebmeyer J (2015) Treatment of the patulous eustachian tube with soft-tissue bulking agent injections. Otol Neurotol 36:448–452. https://doi.org/10.1097/mao.0000000000000646

    Article  PubMed  Google Scholar 

  29. Besmens IS, Shahrdar C, Fontein DBY et al (2023) Efficacy of closed reduction of nasal fractures—a retrospective analysis with focus on factors affecting functional and aesthetic outcomes. J Plast Reconstr Aesthet Surg 77:371–378. https://doi.org/10.1016/j.bjps.2022.11.010

    Article  PubMed  Google Scholar 

  30. Orlandi RR, Kingdom TT, Hwang PH et al (2016) International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. https://doi.org/10.1002/alr.21695

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Author notes

  1. Brian W. Rotenberg and Leigh J Sowerby are co-senior authors.

Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada

    Andrew Kokavec, Sarah Zahabi, Taciano Rocha, Brian W. Rotenberg & Leigh J Sowerby

Authors
  1. Andrew Kokavec
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Zahabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taciano Rocha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian W. Rotenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leigh J Sowerby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew Kokavec.

Ethics declarations

Competing interests

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Tables 5 and 6 here.

Table 5 Overview of the indications for surgery
Full size table
Table 6 Overview of the office-based rhinologic surgeries
Full size table

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kokavec, A., Zahabi, S., Rocha, T. et al. Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08655-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00405-024-08655-4

Keywords

Search

Navigation