Walters Ben, Gaskell Peter, Muzaffar Jameel, Iftikhar Haissan, Monksfield Peter, Bance Manohar
Royal Stoke University Hospital Stoke On Trent UK.
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham Birmingham UK.
Laryngoscope Investig Otolaryngol. 2022 Jan 5;7(1):226-236. doi: 10.1002/lio2.720. eCollection 2022 Feb.
As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia.
A systematic review and meta-analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. There were no limitations on year of publication or language.
Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta-analysis showed surgical time was significantly shorter under LA.
CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved cost-effectiveness profile. However, larger scale, robust trials are required to assess this further.
随着人口老龄化以及植入标准的放宽，越来越多患有复杂合并症的患者符合人工耳蜗植入（CI）条件。这些患者接受全身麻醉的风险更高。本系统评价评估局部麻醉下人工耳蜗植入后的结局和并发症，以检验其对被认为不适合全身麻醉或全身麻醉风险高的患者的适用性。
根据2020年PRISMA指南进行系统评价和荟萃分析。检索的数据库有MEDLINE、PubMed、EMBASE、CINAHL、科学网核心合集、Cochrane系统评价数据库、Cochrane对照试验中央注册库和ClinicalTrials.gov。对发表年份和语言没有限制。
共识别出132篇独特文献。在根据纳入标准筛选摘要和全文后，共纳入18篇文章。在报告了听力学数据的9项研究中，所有患者在局部麻醉（LA）下植入后听力学结局均有改善。仅报告了短暂性眩晕、伤口感染、面神经麻痹、意识模糊和耳鸣等轻微并发症，但均为短暂性。荟萃分析显示局部麻醉下手术时间明显更短。
对于因合并症而不能接受全身麻醉的患者，局部麻醉下人工耳蜗植入是安全的，并发症极少，成本效益更高。然而，需要更大规模、更有力的试验来进一步评估这一点。
