Vladislav Kuzovkov
Saint-Petersburg Research Institute of Ear, Nose, Throat and Speech, Russia.
Biography
Vladislav Kuzovkov is Head of Hearing Implantation Group in Saint-Petersburg Research Institute of Ear, Nose, Throat and Speech, Russia.
He performed more than 5500 Cis in total since 2007. At the CI2018 in Antwerp, Belgium, he was awarded with Buriani-Helms Prize for contribution in the field of cochlear implants.
Abstract
Cochlear implantation (CI) has become the standard treatment for profound sensorineural deafness in the last 30 ears, but some patients are denied from the surgery due to anesthesiology related reasons. The other problems are anesthesia risks in elderly patients, mainly related to the development of cognitive dysfunction postoperatively.
The aim of the study was to assess the possibilities to increase the accessibility of CI for different populations groups.
Twelve adults (aged 21 – 74 years) underwent unilateral CI under LA at our institution between 2014 and 2017. All subjects had an ASA Physical Status classification of 3-4, corresponding 
with significant comorbidity.
No conscious sedation was used at our institution due risk of adverse side effects. However, patients were controlled by the anesthetist. Naropin 7.5 mg/ml with Epinephrine (1:80 000) was used for infiltration.
A series of prepared cue-cards were shown to the patient throughout the procedure, these cards included questions and instructions.
The mean operating time was 27 ± 5.2 min. The time included electrode impedances testing and our originally developed electrically evoked audiometry (evA). All patients had hearing sensations and low intraoperative impedances.
Subjects’ pain was assessed intraoperatively, in 6 and 24 h after surgery with the Numeric Pain Rating Scale (NRS-11).
Ten subjects did not experience any pain during surgery and reported the NRS score was 0 (no pain). In two patients NRS score was 2. All subjects, however, reported that they were comfortable during the procedure.
Simple cognitive tests were administered before and after surgery to 5 patients older than 60. None of the patients had evidence of cognitive decline after CI under local anesthesia.
CI surgery under local anesthesia was found to be safe in patients with significant comorbidities where general anesthesia is contraindicated. Moreover, local anesthesia could prevent possible postoperative cognitive decline.