General Versus Local Anesthesia in Stapes Surgery for Otosclerosis: Systematic Review and Meta‐Analysis

ABSTRACT Objective The aim of this study was to investigate the influence of type of anesthesia on audiometric results, surgery duration, quality‐of‐life and complications associated with stapes surgery in patients with otosclerosis. Data Sources A comprehensive literature search was conducted in five databases, including PubMed, Embase, SCOPUS, WoS, and Google Scholar. Review Methods We have identified studies comparing the outcomes of stapes surgery under local‐anesthesia (LA) versus general‐anesthesia (GA) and published up to 30 May 2025. All analyses were performed using Comprehensive‐Meta‐Analysis‐software and Review‐Manager. Results Operating room occupancy was significantly lower in surgery under LA than GA ( MD = −17.27 min, 95% CI [−24.72, −9.83], p < 0.001, I 2 = 0%). Moreover, stapes surgery had a significantly shorter duration under LA compared to GA ( MD = −8.79, 95% CI [−15.69, −1.88], p = 0.01, I 2 = 0%). The meta‐analysis on changes in AC , BC , SR thresholds, and ABG showed no significant difference between patients who underwent LA or GA (AC: MD = 0.704, 95% CI [−3.344, 4.752], p = 0.733; BC : MD = 0.191, 95% CI [−2.231, 2.612], p = 0.877; SR : MD = 0.103, 95% CI [−3.621, 3.827], p = 0.957; ABG : MD = 0.451, 95% CI [−0.788, 1.689], p = 0.476). The meta‐analysis on ABG closure also showed no significant difference (< 10 dB : OR = 1.066, 95% CI [0.718, 1.582], p = 0.752; 10 to 20 dB : OR = 1.151, 95% CI [0.778, 1.705], p = 0.481; > 20 dB : OR = 0.833, 95% CI [0.537, 1.293], p = 0.416). Complications were the same for both types of anesthesia, but nausea and vomiting showed a marginally significant difference between LA and GA ( OR = 2.578, 95% CI [0.988, 6.732], p = 0.053, I 2 = 0%). Conclusion Stapes surgery under LA is associated with shorter surgical and operating room times while demonstrating non‐inferior audiometric and safety outcomes compared to GA . These findings suggest that LA represents a safe and efficient alternative to GA for stapesplasty procedures. Level of Evidence NA.