Intraoperative electrophysiological monitoring of the facial nerve: Is it standard of practice?

Abstract

(Editorial Comment: This report details the results of a poll of facial nerve surgeons and clearly shows that routine facial nerve monitoring is not currently a standard of practice in the United States.) Iatrogenic injury to the facial (VII] nerve is the most feared complication of routine otologic surgery. Therefore, it would seem logical to recommend the use of any adjunctive technique that might reduce the incidence of intraoperative facial nerve injury. Intraoperative electrophysiological monitoring of the facial nerve has been used clinically for more than 10 years and is widely accepted as a useful adjunctive modality for many neurotologic procedures, especially those that involve removal of posterior fossa tumors. There have now been a number of articles that report compelling statistical data that show improved postoperative facial nerve function when the facial nerve is monitored during such procedures.lm3 Some surgeons are also using the intraoperative electrophysiological facial nerve monitoring in more routine otologic procedures such as tympanomastoid surgery, stapedectomy, and tympanoplasty. In both written and oral presentations, a few of these surgeons have strongly advocated the use of intraoperative monitoring as a routine adjunct to such otologic procedures.4*5 These recommendations are made on pragmatic grounds or based on anecdotal experiences. The effectiveness of monitoring in such cases has not been supported on the basis of objective statistical data. We do not use intraoperative electrophysiological monitoring for most of our routine otologic procedures. We do not believe it would be helpful and, in fact, suspect that it could be counterproductive. We are concerned that routine electrophysiological facial nerve monitoring may become regarded as the “standard of care” before confirming its efficacy with objective studies and without the consent of the otoiogic community at large. In an attempt to determine the sense of the otologic community with respect to this issue, we surveyed the membership of the American Neurotology Society and the American Otologic Society. It was our belief that most of the members of these two organizations dedicated much of their clinical time to the management of otologic problems and the performance of otologic operations. Moreover, we suspect that members of these two societies represent a fair cross-section of surgeons whose primary interest is otologic surgery.