Abstract
IntroductionAs average life-expectancy increases, a sufficient hearing rehabilitation for elderly patients with severe-to-profound sensorineural hearing loss becomes more important. Cochlear implantation is a relatively safe surgical procedure also for elderly patients, the higher risk is caused by general anesthesia. We report on four patients who underwent cochlear implantation under local anesthesia.MethodsAfter detailed preoperative examinations (audiological tests, imaging, genetic tests, evaluation of motivation and compliance of the patient), four patient with severe-to-profound hearing loss were selected for cochlear implantation under local anesthesia. For the electrode insertion, we used the posterior suprameatal approach technique. Pre- and postoperative pure tone audiometry and speech-perception tests were conducted to prove the success of the procedure.ResultsThe mentioned technique was applied; the average length of the operation was 52 min. The intraoperative measurements showed normal impedance and normal neuronal response telemetry, all the patients had sound experience during the intraoperative examination of the engineer. No complications were observed. The postoperative audiological tests showed a significant increase in the hearing perception.ConclusionCochlear implantation under local anesthesia is a safe and fast procedure for elderly patients. The intraoperative sound experience can give an extra motivation in the postoperative rehabilitation. Our results prove that by carefully selected elderly patients cochlear implantation can assure a significant increase in speech perception. We can establish that the new posterior suprameatal approach technique combined with local anesthesia presents a viable future option for those patients who were inoperable beforehand because of high risks of general anesthesia.
Highlights
As average life-expectancy increases, a sufficient hearing rehabilitation for elderly patients with severe-toprofound sensorineural hearing loss becomes more important
We could demonstrate that cochlear implantation under local anesthesia can be a safe alternative of procedures under general anesthesia
Few articles are available about cochlear implantation under local anesthesia
Summary
According to a statement of the World Health Organization (WHO) published in March 2018, there are 466 million people worldwide with hearing impairment. Cochlear implantation is a relatively safe procedure for elderly patients [4]; the higher surgical risk is caused by general anesthesia. A long-lasting complication of general anesthesia can be postoperative cognitive dysfunction (POCD) [7] which appears as slowed psycho-motor function, mild change in personality which can last for weeks or months. Both POD and POCD can postpone the start of rehabilitation after a cochlear implantation and influence the efficiency of the procedure. The advantage of PSMA procedure is that the tunnel ends behind the long process of the incus in the tympanic cavity which results in a lower risk of injury of the incus and the facial nerve and avoids removing a part of the annulus which results in a shorter surgical procedure length
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