Cochlear implantation under local anesthesia: a possible alternative for elderly patients

Abstract

Introduction As average life-expectancy increases, a sufficient hearing rehabilitation for elderly patients with severe-to-profound sensorineural hearing loss becomes more important. Cochlear implantation is a relatively safe surgical procedure also for elderly patients, the higher risk is caused by general anesthesia. We report on four patients who underwent cochlear implantation under local anesthesia. Methods After detailed preoperative examinations (audiological tests, imaging, genetic tests, evaluation of motivation and compliance of the patient), four patient with severe-to-profound hearing loss were selected for cochlear implantation under local anesthesia. For the electrode insertion, we used the posterior suprameatal approach technique. Pre- and postoperative pure tone audiometry and speech-perception tests were conducted to prove the success of the procedure. Results The mentioned technique was applied; the average length of the operation was 52 min. The intraoperative measurements showed normal impedance and normal neuronal response telemetry, all the patients had sound experience during the intraoperative examination of the engineer. No complications were observed. The postoperative audiological tests showed a significant increase in the hearing perception. Conclusion Cochlear implantation under local anesthesia is a safe and fast procedure for elderly patients. The intraoperative sound experience can give an extra motivation in the postoperative rehabilitation. Our results prove that by carefully selected elderly patients cochlear implantation can assure a significant increase in speech perception. We can establish that the new posterior suprameatal approach technique combined with local anesthesia presents a viable future option for those patients who were inoperable beforehand because of high risks of general anesthesia.

Cochlear Implantation in Older Adults: Effectiveness and Expanded Indications

“…Recently, some CI centers have developed methods for cochlear implantation under local anesthesia [27][28][29][30]. A modified surgical approach is used in combination with local anesthesia and minimal sedation.…”

Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report

“…Whilst many otological surgeries are routinely performed under LA with sedation, cochlear implants are generally performed under GA with only a few successful case series reported in the literature of unilateral CIs under LA (Dietz et al, 2016;Hamerschmidt et al, 2010Hamerschmidt et al, , 2011Hamerschmidt et al, , 2013Kecskeméti et al, 2019;Pateron et al, 2016;Toner et al, 2013). There is only one previous case reported overseas of simultaneous bilateral CIs under LA (Vaid et al, 2016).…”

“…The main factor here is the length of operation required which dictates the choice of LA used. In unilateral cases of CI under LA reported in the literature, lidocaine has been the local anaesthetic of choice for subcutaneous infiltrationits duration of action is 30-60 minutes, increasing to 120 minutes with the addition of epinephrine (Kecskeméti et al, 2019;Schug and Krshnan, 2010;Shabashev et al, 2017;Toner et al, 2013). In the only other case reported of bilateral CIs under LA by Sanjay et al, bivocaine was used for local anaesthesia (Vaid et al, 2016).…”

“…We used a target control infusion of propofol and remifentanil to achieve conscious sedation in our patient. Other groups have reported using oral midazolam, intravenous fentanyl by itself, combination of intravenous fentanyl and midazolam only, or combinations of dexmedetomidine with fentanyl, midazolam and propofol, to achieve conscious sedation for cochlear implantation under LA (Hamerschmidt et al, 2013;Kecskeméti et al, 2019;Shabashev et al, 2017). The choice and doses of these drugs used is dictated by the necessary level of sedation and analgesia required which is specific to each patient's needs.…”

“…Whilst cochlear implant (CI) procedures are usually carried out under general anaesthesia (GA), various centres have reported their experience of safely and effectively carrying out unilateral CIs under local anaesthetic (LA) (Hamerschmidt et al, 2010(Hamerschmidt et al, , 2013Kecskeméti et al, 2019;Mistry et al, 2017;Shabashev et al, 2017;Toner et al, 2013). This has the benefit of making CI surgery accessible to those deemed unfit for a GA by avoiding the morbidity and risks associated with GA, whilst also reducing costs and length of hospital stay with high levels of patient satisfaction (Hamerschmidt et al, 2013;Mistry et al, 2017;Shabashev et al, 2017).…”