Intraoperative Nerve Monitoring in Otolaryngology: A Study of Clinical Practice Patterns in the Kingdom of Saudi Arabia

Introduction: In otolaryngology–head-and-neck surgery practice, critical neural structures such as the recurrent laryngeal nerve (RLN) and the facial nerve (FN) are at risk during procedures like thyroidectomy, parotidectomy, mastoidectomy, and cochlear implantation. Intraoperative nerve monitoring (IONM) is increasingly employed to enhance nerve identification and preservation and therefore to minimize iatrogenic injury. While the global data on IONM usage are robust, there is limited evidence documenting its use within Saudi Arabia. This study aims to assess clinical practice patterns, influencing factors, and barriers to IONM adoption among otolaryngologists in the Kingdom of Saudi Arabia (KSA). Methodology: An online cross-sectional survey was distributed via E-mail to all otolaryngology consultants in the KSA. The questionnaire examined demographic data, IONM use across different surgeries, training exposure, practice setting, complications, and rationale for or against using IONM in their practice. Results: A total of 65 responses were received. Around 53.8% of respondents had more than 10 years’ experience as consultants. Routine IONM usage was highest in cochlear implant surgery (100%) and parotidectomy (82.4%), followed by thyroidectomy (52.8%) and mastoidectomy (42.9%). Predictors for using IONM included training background experience with IONM, high case volume, and public practice setting were associated with higher IONM. With most of the responses currently practicing at public tertiary center (67.7%). Reducing nerve injury rates, enhancing surgeon comfort and confidence, and medicolegal protection were major drivers for IONM usage. Conclusion: The adoption of IONM in Saudi Arabia largely mirrors global trends, driven by patient safety, medicolegal considerations, and enhancing surgical safety. However, limitations such as device availability and cost persist.