Otologists Report Greater Widespread Use of Intra-Operative Facial Nerve Monitoring

More Voices of Support

Bruce J. Gantz, MD, professor and head of the department of otolaryngology-head and neck surgery at the University of Iowa Hospitals and Clinics in Iowa City, said that in his own practice, he uses FNM for a wide range of procedures, because the technique is very effective in reducing the risk for iatrogenic injury to the facial nerve. It has gained traction, he noted, because “it does reliably alert the operator if [he or she is] stimulating the nerve with an instrument or a drill.” In addition to chronic ear surgery, “we also use [FNM] routinely for cochlear implants and neurotology/skull base procedures,” said Dr. Gantz, who added that the monitoring “also is imperative in a training environment with residents and fellows.” As for whether more clinical data on FNM are needed, “I am not certain that further study is warranted; it has become universally accepted that nerve monitoring is an effective adjunct to otology, neurotology, and skull-based surgery.”

Richard Wiet, MD, another early pioneer of FNM who designed his own system in the early 1990s, said that he still uses a proprietary system today and finds it to be invaluable in avoiding iatrogenic injury to the facial nerve. Having such a tool in place “is very comforting,” he said, “because, as I noted in a 1996 paper on the legal aspects of surgical facial nerve injury [Ear Nose Throat J. 1996;75:737-738], even the most experienced otologic surgeon may have a patient who experiences facial paralysis as a complication of surgery. And that definitely places you at risk for legal action, with of course the primary concern being the effect on the patient.”

Gerard Gianoli, MD, an otolaryngologist in Covington, La., and an ENTtoday editorial board member, is in favor of widespread FNM use. He reiterated Dr. Kartush’s point about the operating surgeon being the best person suited to perform the monitoring, rather than a technician or other health professional. “I’ve seen cases where the technician had to lower the volume of the audible alert function in the monitoring system in order to communicate, ironically, the status of monitoring to the surgeon,” he said. “That can take several seconds, but all it takes is one second for a surgeon to get too close the facial nerve; remember, for some cases your operating field is only a few millimeters away. So that technician delay can prove disastrous.”