In recent years, there has been a push to perform more surgeries in the office setting. Most of these are modifications of procedures performed in the operating room with IV sedation or general anesthesia. The advantages of in-office surgery are less anesthesia, greater convenience and lower costs. The potential drawback of in-office surgery is diminished results. Better outcomes can be achieved in the operating room because a higher level of anesthesia allows more complex procedures to be performed. Still, there are many surgeries that can be performed in an office setting with safety and success.
The most important issue to address before planning in-office surgery is patient selection. Patients with low pain tolerance or high anxiety are not good candidates for an in-office procedure. Surgery manipulates tissue. While this tissue manipulation is done to achieve a desired goal, it is never painless. Some form of anesthesia is necessary. In-office procedures typically involve local injections to numb the tissue.
Often, an oral sedative is given prior to the procedure to relax the patient. These techniques work in most patients, allowing the patient to feel comfortable during the procedure. However, patients with low pain tolerance or high anxiety should consider having their surgery performed in the operating room, where they feel no discomfort and often remember nothing from the procedure.
More complex procedures that involve more tissue manipulation should also be performed in the operating room. On the flip side, patients with serious medical problems should consider in-office surgery, because their risk of complication from anesthesia is greater. Your surgeon will discuss with you the complexities and the risks to help you decide.
So, let’s discuss a few surgeries that are commonly performed in the office of an ENT surgeon. Perhaps, the simplest procedure is the placement of myringotomy tubes, which are tubes placed into the eardrums to prevent ear infections. Children are virtually always taken to the operating room for ear tubes because they won’t hold still. However, adults can safely have ear-tube placement while awake in the office with a simple anesthetic placed directly onto the eardrum.
Small lesions, such as polyps, warts and granulomas can easily be removed from the nasal cavity or the oral cavity with a simple anesthetic injection. Larger polyps that involve the sinus cavities will typically require general anesthesia in the operating room.
Complex nasal and sinus cases have historically been performed in the operating room, but recent advances in local anesthesia have allowed some of these cases to be performed in the office. Turbinate reduction can be performed using radio waves to widen the nasal airway, allowing the patient to breathe better. Various implants to keep the nose and sinuses open, as well as procedures to diminish snoring are easily tolerated in the office as well.
Let’s finish with a discussion of balloon sinuplasty (BSP), as this is one of the hottest topics for in-office ENT surgery. The concept is simple. Instead of surgically opening the sinuses under general anesthesia in the operating room, the sinus openings are widened with a balloon in the office. There is less bleeding and a quicker recovery with BSP, and the results are quite good. However, cases involving large polyps, ethmoid sinuses or a deviated septum will require a trip to the operating room for best results.