How we do it: Local anaesthetic cochlear implantation

Abstract

Our experience shows LA cochlear implantation to be a safe and effective procedure. It has the benefit of avoiding the operative mortality risk predicted by P-POSSUM Scores. Cochlear implantation is known to significantly improve quality of life for users. Our findings suggest a potential group of cochlear implant recipients considered 'unfit' for GA may be being denied access to this intervention or being exposed to additional risk.

Safety and outcomes of cochlear implantation in the elderly: A review of recent literature

“…While this has not been specifically evaluated in an elderly cohort, the few published reports on this technique have included some elderly patients. Toner et al. (2013) reported on 16 patients aged 29–92 years (mean 68 years) who underwent successful, uncomplicated unilateral CI under LA with intravenous sedation.…”

“…(2013) reported on 16 patients aged 29–92 years (mean 68 years) who underwent successful, uncomplicated unilateral CI under LA with intravenous sedation. Using an anesthesia risk assessment scale (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity or POSSUM), the authors retrospectively calculate the preoperative POSSUM score of each patient and compare it to post-operative scores ( Toner et al., 2013 ). Although specific peri-operative complications are not reported, the authors suggest that LA avoided a 9% mortality as predicted by the pre-operative POSSUM scale ( Toner et al., 2013 ).…”

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).…”

“…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).…”

Cochlear Implant Surgery in the Elderly

“…The few studies and case reports that have reported on CI surgery under local anesthesia and sedation have found it to be feasible, safe, effective, and to result in significantly shorter recovery times and hospital stays, and therefore, significant cost savings, than did CI surgery under general anesthesia (14)(15)(16)(17)(18). However, more data is needed before CI surgery under local anesthesia and sedation can be confidently recommended as a surgical option.…”