Cochlear implantation under local anesthesia and conscious sedation: an Italian experience
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OTOLOGY
Cochlear implantation under local anesthesia and conscious sedation: an Italian experience Vincenzo Vincenti1 · Francesca Plantone2 · Giovanni Ciavarro1 · Francesca Lusetti1 · Roberto Bartoli2 · Filippo Di Lella1 · Maurizio Negri3 · Maria Luisa Fiorella2 · Nicola Quaranta2 Received: 27 April 2020 / Accepted: 3 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To report our experience in performing cochlear implantation under local anesthesia in a group of patients who were deemed unfit for general anesthesia. Methods A retrospective chart review was performed to analyze undesirable events and any other discomfort complained by patients during cochlear implantation. Analysis of patient’s satisfaction was performed by means of a survey instrument. We have also compared the duration of surgery and hospitalization time with a control group that was implanted under general anesthesia. Result Twenty-one cochlear implantation in 20 patients were performed under local anesthesia. Age of patients ranged from 38 to 85 years. All interventions were successfully completed without any conversions to general anesthesia. Discomfort during surgery was reported in five cases: vertigo triggered by electrode insertion in two patients, pain during the round window approach in two patients and distress during the use of drill in one case; no patient experienced agitation. During the postoperative period, no complications or unpleasant experiences were reported. Only two patients stated that they would not perform cochlear implantation again under local anesthesia. Lower duration surgery and hospitalization time were found in the local anesthesia group. Conclusion Local anesthesia with conscious sedation is a safe and effective alternative for cochlear implant candidates considered unfit for general anesthesia. Fundamental for a successful procedure are preoperative counselling, accurate selection of the patients and constant intraoperative assistance. Unfeasibility of facial nerve monitoring and minor detrimental effect on training are the principal disadvantages in performing cochlear implantation under local anesthesia. Keywords Cochlear implantation · Hearing loss · Local anesthesia · Conscious sedation · Comorbidity
Introduction
* Giovanni Ciavarro [email protected] 1
Department of Otolaryngology and Otoneurosurgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
2
Otolaryngology Unit, Section of Otologic and Neurotologic Surgery, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
3
Otorhinolaryngology Department, Ramazzini Hospital, Carpi, Italy
Cochlear implantation (CI) is widely considered a highly effective method for auditory rehabilitation in patients with severe-to-profound sensorineural hearing loss. As experience in the field of CI has increased, the candidacy criteria have been expanded in both adult and children [1, 2]. Pediatric CI is now indicated in children
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