Bilateral cochlear implantation under local anaesthesia in a young adult – A case report

Abstract

A 28-year-old female with a history of multidrug-resistant tuberculosis presented with bilateral severe to profound sensorineural hearing loss. On evaluation, she was found to be a suitable candidate for cochlear implantation. However, she was clinically unfit to undergo the surgery under general anaesthesia. After counselling the patient, the decision to undertake the procedure under local anaesthesia was made. The procedure took 105 min and was uneventful. The patient was discharged the next day Conclusion: In the hands of an experienced surgeon and anaesthesiology team, bilateral cochlear implantation is possible under local anaesthesia. Patient motivation and cooperation are extremely important for the procedure to be done under local anaesthesia. This is an option for patients needing cochlear implantation who are medically unfit for general anaesthesia.

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

“…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 levobupivacaine in our patient which has a similar clinical profile to bivocaine.…”

“…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). For unilateral CIs, minimal patient discomfort and good hearing outcomes have been reported using LA (Dietz et al, 2016;Pateron et al, 2016;Toner et al, 2013).…”

“…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. Other centres have also reported the need to administer antiemetics either pre-operatively or during the procedure as intracochlear manipulation can lead to nausea and vomiting, greatly impacting patient comfort and cooperation (Hamerschmidt et al, 2010;Vaid et al, 2016). Two different series comparing CI surgery under LA with conscious sedation versus CI surgery under GA, by Shabashev et al (2017) and Hamerschmidt et al (2013) have both observed a lower rate of nausea and vomiting in patients who have had their cochlear implantation under LA with conscious sedation.…”

Cochlear implantation under local anesthetic: A systematic review andmeta‐analysis

“…Surgical incision and approach was reported in 14 studies, a post auricular (standard) approach was used in 12 studies, 10,[14][15][16]18,[20][21][22][23][24][25][26] with a posterior suprameatal approach used in two further studies. 21,27 Facial nerve monitoring was only reported for one patient undergoing local anesthetic-conscious sedation (LA-CS).…”

“…all except one regimen also using adrenaline/epinephrine. 25 Alternative agents to lidocaine included bupivacaine (n = 2) and levobupivacaine (n = 1).…”