Personalized Anesthesia Strategies for Cochlear Implantation: Insights on Local Anesthesia From a Single-institution Experience.

OBJECTIVE

To assess the feasibility and safety of cochlear implantation (CI) under local anesthesia (LA) with minimal conscious sedation, and to present institution-specific criteria for anesthesia selection in high-risk adult patients.

PATIENTS: Between January 2021 and February 2025, a total of 980 ears underwent CI at a single tertiary referral hospital. Of these, 17 ears from 16 adult patients (mean age, 65 y; range, 35 to 87) were selected for CI under LA based on predefined clinical indications.

INTERVENTION: CI procedures were performed under LA with minimal sedation following a standardized institutional protocol, which included preoperative patient counseling, targeted anesthetic administration, restricted operative time, and strategies to minimize cognitive impact.

MAIN OUTCOME MEASURES: Primary outcomes included the completion rate of CI under LA, rate of conversion to general anesthesia (GA), and perioperative complication rates.

RESULTS

CI was successfully completed under LA in 16 of 17 ears (94.12%). One case required intraoperative conversion to GA due to behavioral issues associated with preexisting cognitive impairment. No perioperative mortality or major complications were observed. The most frequent indication for LA was mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome due to the m.3243A>G variant, which accounted for 29.41% of LA cases.

CONCLUSION

CI under LA is a viable and safe alternative for selected high-risk patients. Implementation of tailored anesthesia protocols, particularly for individuals with mitochondrial disorders or cognitive vulnerability, facilitates optimized patient outcomes. These findings support a personalized approach to anesthesia selection in auditory rehabilitation.