(824) Comparing Local Versus General Anesthesia in Stapes Surgery: A Systematic Review and Meta-analysis

Introduction: Stapes surgery can be performed under local or general anesthesia. This study represents the first meta-analysis to compare the two modalities on stapes surgery outcomes and provides the first update since the 2013 systematic review.

Methods: PRISMA-guided systematic review and meta-analysis of comparative studies searched from database inception to September 8, 2025 in PubMed, Embase, and CINAHL included patients undergoing stapes surgery, comparing anesthetic technique (local (LA) vs general (GA)); risk of bias (RoB) was assessed with ROBINS-I. Outcomes were air–bone gap (ABG) measures, surgical success (postoperative ABG ≤10 dB), and complications, with pooled analysis and heterogeneity (I²).

Results: Of 93 studies, 7 met inclusion criteria; 6 (5 serious RoB; 1 moderate RoB) provided extractable comparative data and were included in quantitative synthesis. Across outcomes, 1085 ears were analyzed (489 LA [45.1%], 596 GA). 5 studies found no significant differences between LA and GA for postoperative ABG (MD 0.22 dB [95% CI 1.08-1.52]; P = 0.74; I² = 30%) or change in ABG (MD 0.31 dB [95% CI 1.32-1.95]; P = 0.71; I² = 0%). 3 studies showed no significant difference in surgical success (OR 1.20 [95% CI 0.53-2.69]; P = 0.66; I² = 0%). In terms of complications, 3 studies found no difference in developing sensorineural hearing loss (OR 1.33 [95% CI 0.40-4.37]; P = 0.64; I² = 0%), or vertigo (OR 1.31 [95% CI 0.37-4.59]; P = 0.68; I² = 0%) between LA and GA. Similarly, 2 studies found no significant differences in rate of dead ear (OR 0.44 [95% CI 0.07-2.88]; P = 0.39; I² = 0%).

Conclusions: Despite 13 years of additional research, the literature evaluating anesthetic choice in stapes surgery remains limited by substantial risk of bias. Nevertheless, no statistically significant differences were found between LA and GA across outcomes. This supports current practice guidelines allowing anesthetic selection based on surgeon preference and patient-specific factors rather than evidence of anesthetic superiority.