Роль предоперационной подготовки к кохлеарной имплантации у пациентов с тяжелой сопутствующей патологией

Abstract

The own experience of managing patients with severe hearing loss and severe somatic concomitant pathology at all stages of cochlear implantation (CI) under local anesthesia is presented. Patients and methods. On the basis of the Center for Otorhinolaryngology, CI was performed under local anesthesia in 25 patients with sensorineural hearing loss grade IV or deafness with concomitant somatic pathology, 25 patients consisted of 17 men (68%) and 8 women (32%). The average age was 53.2±2.6 years. CI was performed under local anesthesia with 2% lidocaine solution using 1 mg adrenaline for 20 mL 2% lidocaine. The operation was performed using the classical method under the control of an OMPI Sensera S8 Karl Zeiss operating microscope. Results. Before the operation, all patients in the conversation were familiarized with each stage of the operation and with visual tables for contact between the doctor and the patient during the operation to monitor their subjective feelings. During the operation, anesthesia was well tolerated, and there were few complications. None of the patients showed feelings of anxiety, worry, or fear during the operation. After surgery, patients were questioned to identify early postoperative symptoms. Pain in the wound area of mild and moderate severity, mainly on the 1st day after the operation, was experienced by all patients; systemic dizziness, 7 patients (28%), hematoma around the implant was noted in 2 patients (8%). These symptoms were relieved by standard therapy by the 3rd day after surgery. Deterioration of the general condition associated with concomitant pathology was not observed in any of the patients. Conclusion. Compliance with the patient management algorithm at all stages of CI under local anesthesia with high-quality psychological preparation ensures good tolerability of the operation, psychological comfort of the patient during the operation, and a small number of complications, both during and after the operation.