Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-26T17:24:54.529Z Has data issue: false hasContentIssue false
  • English
  • Français

Common challenges in cochlear implant surgery performed under local anaesthesia and how to overcome them: the experience of UK surgeons

Published online by Cambridge University Press:  23 January 2023

R Abrar Open the ORCID record for R Abrar [Opens in a new window]  and
E Stapleton Open the ORCID record for E Stapleton [Opens in a new window]
R Abrar
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
E Stapleton*
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
*
Corresponding author: Emma Stapleton; Email: emmastapleton@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cochlear implantation performed under local anaesthesia is an increasingly accepted technique worldwide, though the literature to date includes only single-surgeon and single-centre experiences. This study explored the national experience of UK surgeons using this challenging surgical technique, with the goal of providing consensus recommendations.

Methods

A qualitative analysis was conducted of semi-structured interviews with 10 UK-based cochlear implantation surgeons, focusing on common challenges, how to overcome them and candidate selection.

Results

Cochlear implantation under local anaesthesia can potentially be offered to all eligible adult patients with favourable anatomy. A posterior tympanotomy and round window approach is recommended. Common challenges and recommendations are explored thematically: managing patient, surgeon and staff expectations; optimising communication; patient comfort and position; minimising pain and vertigo; and safe use of sedation.

Conclusion

This is the first study of national experience of cochlear implantation performed under local anaesthesia. Key themes, including refinements to surgical technique and optimising patient comfort and communication, have been explored in depth.

Keywords

Hearing losscochlear implantsanesthesia
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1289 - 1292
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr E Stapleton takes responsibility for the integrity of the content of the paper

This work was presented orally at the British Cochlear Implant Group 2021 Virtual Meeting, 22 December 2020, online, and presented orally (and awarded first prize for best oral presentation in the ‘Junior Doctor’ category) at the British Society of Otology Junior Free Papers Meeting, 30 June 2021, online.

References

Amieva, H, Ouvrard, C, Meillon, C, Rullier, L, Dartigues, JF. Death, depression, disability, and dementia associated with self-reported hearing problems: a 25-year study. J Gerontol A Biol Sci Med Sci 2018;73:1383–9CrossRefGoogle ScholarPubMed
Francis, HW, Chee, N, Yeagle, J, Cheng, A, Niparko, JK. Impact of cochlear implants on the functional health status of older adults. Laryngoscope 2002;112(8 Pt 1):1482–8CrossRefGoogle ScholarPubMed
Hamerschmidt, R, Moreira, ATR, Wiemes, GRM, Tenório, SB, Tĝmbara, EM. Cochlear implant surgery with local anesthesia and sedation: comparison with general anesthesia. Otol Neurotol 2013;34:75–8CrossRefGoogle ScholarPubMed
Alzahrani, M, Martin, F, Bobillier, C, Robier, A, Lescanne, E. Combined local anesthesia and monitored anesthesia care for cochlear implantation Eur Ann Otorhinolaryngol Head Neck Dis 2014;131:261–2CrossRefGoogle ScholarPubMed
Pateron, B, Bakhos, D, Lelouarn, A, Bordure, P, Bozorg Grayeli, A, Godey, B et al. Local anaesthesia and conscious sedation for cochlear implantation: experience with 20 patients. J Laryngol Otol 2016;130:151–6CrossRefGoogle ScholarPubMed
Mistry, SG, Carr, S, Martin, J, Strachan, DR, Raine, CH, Fyrmpas, G. Cochlear implantation under local anaesthesia – our experience and a validated patient satisfaction questionnaire. Cochlear Implants Int 2017;18:180–5CrossRefGoogle Scholar
Shabashev, S, Fouad, Y, Huncke, TK, Roland, JT. Cochlear implantation under conscious sedation with local anesthesia; safety, efficacy, costs, and satisfaction. Cochlear Implants Int 2017;18:297–303CrossRefGoogle ScholarPubMed
Kecskeméti, N, Szőnyi, M, Küstel, M, Gáborján, A, Tamás, L, Répássy, G. Cochlear implantation under local anesthesia: a possible alternative for elderly patients. Eur Arch Otorhinolaryngol 2019;276:1643–7CrossRefGoogle ScholarPubMed
Vincenti, V, Plantone, F, Ciavarro, G, Lusetti, F, Bartoli, R, Di Lella, F et al. Cochlear implantation under local anesthesia and conscious sedation: an Italian experience. Eur Arch Otorhinolaryngol 2021;278:3667–72CrossRefGoogle ScholarPubMed
Mason, SE, Noel-Storr, A, Ritchie, CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis 2010;22(suppl 3):67–79CrossRefGoogle ScholarPubMed
Djalilian, HR, Roy, S, Benson, AG, Regala, C, McDonald, TB, Leman, T. Transcanal cochlear implantation under monitored anesthesia care. Otol Neurotol 2005;26:674–7CrossRefGoogle ScholarPubMed
Toner, F, Jackson, CP, Toner, JG. How we do it: local anaesthetic cochlear implantation. Cochlear Implants Int 2013;14:232–5CrossRefGoogle Scholar
Vaid, N, Jana, JJ, Kothadiya, A, Deshpande, S, Vaid, S. Bilateral cochlear implantation under local anaesthesia in a young adult – a case report. Cochlear Implants Int 2016;17:207–10CrossRefGoogle Scholar
Dietz, A, Wustefeld, M, Niskanen, M, Lopponen, H. Cochlear implant surgery in the elderly: the feasibility of a modified suprameatal approach under local anesthesia. Otol Neurotol 2016;37:487–91CrossRefGoogle ScholarPubMed
Deep, NL, Connors, J, Roland, JT. Cochlear implantation under local anesthesia with conscious sedation in the elderly patient: focus on surgical technique. Oper Tech Otolaryngol Head Neck Surg 2020;31:231–7CrossRefGoogle Scholar
Abrar, R, Mawman, D, Martinez de Estibariz, U, Datta, D, Stapleton, E. Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: a case report. Cochlear Implants Int 2021;22:176–81CrossRefGoogle Scholar
Connors, JR, Deep, NL, Huncke, TK, Roland, JT. Cochlear implantation under local anesthesia with conscious sedation in the elderly: first 100 cases. Laryngoscope 2021;131:E946–51CrossRefGoogle ScholarPubMed
Bajwa, S, Kulshrestha, A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013;3:475–83CrossRefGoogle ScholarPubMed
Bruggen, FFJAT, Ceuppens, C, Leliveld, L, Stronks, DL, Huygen, FJPM. Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: a single-center single-blinded randomized controlled trial. Acta Anaesthesiol Scand 2019;63:1321–9CrossRefGoogle ScholarPubMed
Bingol Tanriverdi, T, Koceroglu, I, Devrim, S, Gura Celik, M. Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: single-centre randomized controlled trial. J Clin Pharm Ther 2019;44:312–17CrossRefGoogle ScholarPubMed
Goettel, N, Bharadwaj, S, Venkatraghavan, L, Mehta, J, Bernstein, M, Manninen, PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. Br J Anaesth 2016;116:811–21CrossRefGoogle ScholarPubMed