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

Abrar, Rohma; Mawman, Deborah; Estibariz, Unai Martinez de; Datta, Debapriya; Stapleton, Emma

doi:10.1080/14670100.2020.1851498

Cited by 5 publications

(7 citation statements)

References 30 publications

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“…16,29 Lidocaine is a popular choice; its duration is 30-60 min (increasing to 120 min with adrenaline). 14 Bupivacaine acts over 120-240 min (increasing to 240 with adrenaline) 14 and levobupivacaine is the longest acting over 240-480 min. 14 Intraoperatively, gelfoam soaked with LA can be intermittently administered for local pain relief; however, prolonged application risks paralytic nystagmus from LA absorbing into the round window.…”

Section: Discussionmentioning

confidence: 99%

“…Full electrode insertion was achieved by the majority of authors, with only three implants by two authors experiencing partial electrode implantation. 14,15…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Four studies (n = 43 participants) 14,[16][17][18] used the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) scoring tool, a tool which was developed by Copeland et al 19 which predicts mortality in patients undergoing different types of surgery. A combined 32 participants in the LA groups of these studies had an average predicted morbidity of 46.38% (10.2-93.6%) and average predicted mortality of 6.76% (0.4-36%), compared with 39.16% (18.5-70.3) and 2.94% (0.8-7.1%) of 11 participants who underwent CI under general anesthesia (GA), respectively.…”

Section: Comorbidity Gradingmentioning

confidence: 99%

“…A single case report utilizing the surgical outcome risk tool calculated their patient's predicted risk of 1%, with a frailty score of four. 14 Of the eight studies where postoperative audiological function testing is recorded, only six compare these with preoperative results.…”

Section: Comorbidity Gradingmentioning

confidence: 99%

“…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).…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

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

Walters

Gaskell

Muzaffar

et al. 2022

Laryngoscope Investig Oto

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Objectives: As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia. Methods: A systematic review and meta-analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CIN-AHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. There were no limitations on year of publication or language.Results: Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta-analysis showed surgical time was significantly shorter under LA.Conclusions: CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved costeffectiveness profile. However, larger scale, robust trials are required to assess this further.

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Section: Discussionmentioning

confidence: 99%

“…Full electrode insertion was achieved by the majority of authors, with only three implants by two authors experiencing partial electrode implantation. 14,15…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Comorbidity Gradingmentioning

confidence: 99%

Section: Comorbidity Gradingmentioning

confidence: 99%

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

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

Walters

Gaskell

Muzaffar

et al. 2022

Laryngoscope Investig Oto

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

Abrar

Stapleton

2023

J. Laryngol. Otol.

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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 UKbased 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.

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Patient, parental and multi-disciplinary team rationale for non-implantation following the paediatric cochlear implantation assessment

Hall

McClenaghan

Nash

et al. 2022

Cochlear Implants International

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

Cited by 5 publications

References 30 publications

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

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

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

Patient, parental and multi-disciplinary team rationale for non-implantation following the paediatric cochlear implantation assessment

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