Anesthesia for Middle Ear Surgeries and Cochlear Implant

ABSTRACT The attending anesthesiologist face several challenges in safe conduction of anesthesia for middle ear and cochlear implantation surgeries. Preoperative challenges includes counseling elderly patients with impaired hearing and counseling the parents of children with congenital ear anomalies, thorough evaluation of these patient with several comorbidities. Intraoperative challenges are to provide bloodless field, head positioning, effect of nitrous oxide on middle ear, facial nerve monitoring and avoid electrical disturbances due to electrocautery during stimulation of the cochlear implant electrode assembly. Postoperative challenges includes smooth and calm recovery, prevention and treatment of postoperative nausea and vomiting (PONV) and excellent analgesia. A close understanding and cooperation between the anesthesiologist and surgeon is the key for a positive outcome. How to cite this article Madan HK, Kosare S. Anesthesia for Middle Ear Surgeries and Cochlear Implant. Int J Otorhinolaryngol Clin 2015;7(1):1-9.

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Retraction: Systematized Intraoperative Facial Nerve Monitoring in Middle Ear and Mastoid Surgery; 'Surgical Dehiscence' and 'Electrical Dehiscence'

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2011.54.1.109 ◽

2011 ◽

Vol 54 (1) ◽

pp. 109

Keyword(s):

Facial Nerve ◽

Middle Ear ◽

Nerve Monitoring ◽

Facial Nerve Monitoring ◽

Mastoid Surgery

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Learning from Anaesthetists: A Technique for Safe and Effective Facial Nerve Monitoring

Reports ◽

10.3390/reports2010009 ◽

2019 ◽

Vol 2 (1) ◽

pp. 9

Author(s):

Jayan George ◽

Anton Alatsatianos ◽

Amir Farboud ◽

Laysan Pope

Keyword(s):

Facial Nerve ◽

Head And Neck ◽

Middle Ear ◽

Neck Surgery ◽

Contralateral Side ◽

Secure Attachment ◽

Nerve Monitoring ◽

Surgical Tool ◽

Facial Nerve Monitoring ◽

The Face

To develop a technique to reliably secure facial nerve monitoring electrodes, NeurosignTM facial nerve monitor electrodes were attached as per the manufacturer’s instructions. The electrodes were secured with ½ inch steristripsTM before connecting leads were brought to the contralateral side of the face and a single torque loop was created and secured with either more Steri-StripsTM, Micropore tapeTM, or a TegedermTM. By creating a single torque loop, a buffer between the electrode and its anchor point to the contralateral face was formed. This allowed for the secure attachment of leads from the electrodes by removing tension, thereby reducing the likelihood of displacement. We have used this technique successfully for the last three years in over 50 parotid procedures and 50 middle ear explorations. Facial nerve monitoring is an important surgical tool used in otology and head and neck surgery. Using torque loops when preparing a patient for surgery prevents the dislodgement of electrodes during operation, thereby ensuring the safety of the patient in a sometimes perilous environment.

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Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham

The Journal of Laryngology & Otology ◽

10.1258/002221505774481291 ◽

2005 ◽

Vol 119 (10) ◽

pp. 759-764 ◽

Cited By ~ 33

Author(s):

Sunil N Dutt ◽

Jaydip Ray ◽

Edward Hadjihannas ◽

Huw Cooper ◽

Ivor Donaldson ◽

...

Keyword(s):

Cochlear Implant ◽

Complication Rate ◽

Complete Resolution ◽

Electrode Array ◽

Major Complication ◽

Minor Complication ◽

Nerve Monitoring ◽

Device Failure ◽

Facial Nerve Monitoring ◽

Major Complication Rate

One hundred consecutive adult cochlear implant patients, numbered 101 to 200 in an ongoing series, were prospectively monitored and data collected using the same protocol as for the first 100 patients. The study period was 1999 to 2001. The total number of procedures was 122. Changes in practice following the first 100 implants included a standard surgical technique with a smaller incision and lesser flap mobilization, and routine facial nerve monitoring. As far as was practicable, the same commercial type of implant was used. There were 111 (91 per cent) implantation episodes, five (4 per cent) explantation episodes, four (3.3 per cent) reimplantation episodes and two (1.6 per cent) revision procedures. Eighty-nine patients underwent unilateral implantation and 11 underwent bilateral implantation.Major complications included flap breakdown (1.6 per cent), extrusion of electrode array (0.8 per cent) and device failure (0.8 per cent). The overall major complication rate was 3.2 per cent (4/122). The overall minor complication rate was 18 per cent. In addition, 7.3 per cent experienced transient vertigo and 5.7 per cent experienced local discomfort lasting three days on average with complete resolution. The overall complication rate in the second 100 implant patients was lower than in the first 100. Smaller incision and lesser flap mobilization reduced the minor complication rate.

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Intraoperative Facial Nerve Monitoring During Cochlear Implant Surgery

Medicine ◽

10.1097/md.0000000000000456 ◽

2015 ◽

Vol 94 (4) ◽

pp. e456 ◽

Cited By ~ 7

Author(s):

Hui-Shan Hsieh ◽

Che-Ming Wu ◽

Ming-Ying Zhuo ◽

Chao-Hui Yang ◽

Chung-Feng Hwang

Keyword(s):

Facial Nerve ◽

Cochlear Implant ◽

Nerve Monitoring ◽

Implant Surgery ◽

Facial Nerve Monitoring ◽

Cochlear Implant Surgery

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Systematic facial nerve monitoring in middle ear and mastoid surgeries: “Surgical dehiscence” and “electrical dehiscence”

Otolaryngology ◽

10.1016/j.otohns.2006.04.008 ◽

2006 ◽

Vol 135 (6) ◽

pp. 872-876 ◽

Cited By ~ 18

Author(s):

Yun-Hoon Choung ◽

Keehyun Park ◽

Min Jung Cho ◽

Pill-Hoon Choung ◽

You Ree Shin ◽

...

Keyword(s):

Facial Nerve ◽

Middle Ear ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Anaesthesia for ENT, dental, and maxillofacial surgery

10.1093/med/9780199642045.003.0065 ◽

2017 ◽

Author(s):

Michael G. Irwin ◽

Chi Wai Cheung ◽

Gordon Tin Chun Wong

Keyword(s):

Maxillofacial Surgery ◽

Postoperative Nausea And Vomiting ◽

Postoperative Management ◽

Excessive Alcohol Consumption ◽

Nerve Monitoring ◽

Patients With Cancer ◽

Co Morbidity ◽

Poor Nutritional Status ◽

Bloodless Field ◽

Excessive Alcohol

The principles of anaesthesia management for otolaryngological and maxillofacial surgery share some similarities and unique challenges. Patients present at all ages and surgery can range from simple, short interventions to major, prolonged, and complicated cases with potential for massive blood loss. Some procedures can be performed under local anaesthesia with sedation whereas, at the other extreme, general anaesthesia with invasive monitoring is required. Microsurgery will necessitate a bloodless field, nerve monitoring is often required, and there is a susceptibility to postoperative nausea and vomiting. Patients with cancer often have poor nutritional status because of catabolism and eating difficulties and, since many head and neck cancers are associated with smoking and excessive alcohol consumption, significant co-morbidity is not unusual. Airway management especially can be challenging because of abnormal anatomy, pathology in this area, and the inherent difficulties of a shared airway. Postoperative management of the airway is particularly challenging as alterations to the anatomy and tissue swelling may have occurred during the course of surgery or thereafter. Last but not least, patients may present acutely with airway complications that require emergent management.

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