Abstract
Virtual reality (VR) has emerged as a promising non-pharmacological adjunct for perioperative care, offering potential benefits in alleviating symptoms such as postoperative pain and reducing anxiety. However, its use in otorhinolaryngology (Ear, Nose and Throat (ENT)) surgical settings remains insufficiently explored. This systematic review and meta-analysis aimed to evaluate the efficacy of VR interventions compared to standard care across key perioperative outcomes in ENT and head and neck surgery. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO. Comprehensive searches were conducted in PubMed, Embase, and Cochrane Library from inception to April 2025. Studies were eligible if they compared VR interventions to control groups in ENT perioperative settings. Risk of bias was assessed using RoB 2 and ROBINS-I tools, and data synthesis was performed using a random-effects meta-analysis. A total of nine studies involving 527 participants were included. The postoperative pain scores demonstrated a statistically significant modest reduction, favoring VR (standardized mean difference (SMD) = -0.41; 95% confidence interval (CI) -0.78 to -0.05), with low heterogeneity (I² = 16.2%). A subgroup analysis for postoperative pain scores indicated a larger effect in pediatric populations (SMD = -0.59; 95% CI -3.70 to 2.51) compared to adults (SMD = -0.38; 95% CI -0.99 to 0.23), although neither subgroup reached statistical significance. A sensitivity analysis was also conducted for the postoperative pain scores which strengthened the findings (SMD = -0.47; 95% CI -0.80 to -0.13), and showed no observed heterogeneity (I² = 0%). For perioperative anxiety, VR interventions offered a slight reduction compared to standard care (SMD = -0.85; 95% CI -1.88 to 0.18), though this did not reach statistical significance. Patient satisfaction scores showed a small but statistically significant improvement (SMD = 0.32; 95% CI 0.05 to 0.59), with no observed heterogeneity. Although opioid outcomes could not be included in the meta-analysis due to reporting variability, narrative synthesis of three studies suggested consistent opioid-sparing effects. VR-related adverse events were rare, and dropout rates were minimal, reinforcing its safety and feasibility in ENT perioperative care. These findings support virtual reality as a feasible and well-tolerated adjunct to perioperative ENT care, particularly for improving pain and patient satisfaction. Anxiety outcomes showed a non-significant trend toward benefit, and opioid reducing effects appear promising but remain inconclusive. Larger, standardized trials with longer follow-up are needed to confirm VR's effectiveness in this setting.