UCSF OHNS Introduces Local Anesthesia with IV Conscious Sedation in Cochlear Implantation Surgery

June 14, 2024

Cochlear implantation surgery can restore functional hearing for individuals struggling with severe hearing impairment. Hearing loss is very common in the elderly population, and when conventional hearing aids are no longer adequate, cochlear implants are indicated. Recent studies have found a link between hearing loss and cognitive decline, and restoring hearing in the elderly population is crucial to their ability to communicate and remain socially engaged. However, older patients often have concerns about the risk of surgery, and many would rather avoid surgery even if it may help them hear again. 

Song Cheng, MD, of the Department of Otolaryngology-Head and Neck Surgery at the University of California, San Francisco (UCSF OHNS), has initiated an effort to perform cochlear implant surgeries at UCSF using local anesthesia and intravenous sedation, which is commonly referred to as monitored anesthesia care (MAC). During the procedure, patients are comfortable, conscious and monitored by an anesthesiologist throughout the procedure. Dr. Cheng explains that "the adoption of this technique is primarily aimed at elderly patients and patients with other medical comorbidities that put them at an increased risk during general anesthesia." 

According to Dr. Cheng, "receiving a cochlear implant can be life-changing for patients who are socially isolated because of hearing loss. Cochlear implant surgery can be performed safely and comfortably without undergoing general anesthesia. We hope that this initiative will help more patients pursue the treatment they need." 

Patient selection is key because patients are awake throughout the procedure and need to remain still during the surgery. Dr. Cheng explains, "patients must lie on their back with their head turned to one side for about 1.5 hours during the procedure, which can be challenging for those with neck or spine issues." Patients must also understand that there is a chance of needing to switch to general anesthesia during the procedure if that is deemed to be safer.

Dr. Cheng's initiative to implement cochlear implantation under MAC at UCSF OHNS is built on extensive experience gained under the mentorship of J. Thomas Roland Jr., MD, at NYU Langone Health, who has completed over 450 cochlear implantations under MAC. Motivated by the successful outcomes he has witnessed, Dr. Cheng aims to make this innovative technique available to patients at UCSF, reducing fears associated with general anesthesia. "We have had great feedback from our patients, and I am very excited that we can now offer this option," shares Dr. Cheng. 

He expresses gratitude for the collaborative effort and support extended by our anesthesia team and OR staff, affirming a shared commitment to optimizing patient outcomes through innovation. This effort represents a continued evolution of patient-centered care at UCSF OHNS. Grounded in evidence-based practice and driven by a passion for innovation, this initiative embodies the spirit of progress in health care, offering hope to individuals with severe hearing impairment.