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Objectives: Cochlear implantation (CI) has become the standard treatment for severe-to-profound sensorineural deafness in the last 30 ears. It is well known that some patients are denied from the surgery due to surgical reasons (ossification, severe malformations) and anesthesiology related reasons (severe comorbidities). Material and Method: Twelve adult (aged 21 -- 64 years) subjects underwent unilateral CI under LA in our institution between October 2014 and August 2017. All subjects had an American Society of Anesthesiologists (ASA) Physical Status classification of 4, corresponding with significant comorbidity. In comparison with some other studies no conscious sedation was used at our institution due to the potential risk of adverse side effects. Result and Conclusion: Total operating time was calculated as time from incision to dressing placement, the mean time was 27 ± 5.2 min. The time included electrode impedances testing and our new developed electrically evoked pure tone audiometry (ePTA). Subjects' pain was assessed intraoperatively, in 6 and 24 h after surgery with the Numeric Pain Rating Scale (NRS- 11). The NRS-11 is 11-point scale in which a score of 0 means ''no pain'' and 10 means ''worst pain imaginable.'' Ten subjects did not experience any pain during surgery and reported the NRS score was 0. One subject reported some pain during the drilling of the antrotomy and his intraoperative NRS score was 2. And one subject experienced pain during round window overhang removal (NRS score 3). NRS scores varied from 0 to 3 in the postoperative period (6 and 24 h) and analgesics were administered when the LA had worn off. CI surgery under local anesthesia was found to be safe in patients with significant comorbidities where general anesthesia is contraindicated. [ABSTRACT FROM AUTHOR]

Conclusion: Remote programming is safe and is well received by health-care professionals and cochlear implant (CI) users. It can be adopted into clinic routine as an alternative to face-to-face programming., Objectives: Telemedicine allows a patient to be treated anywhere in the world. Although it is a growing field, little research has been published on its application to CI programming. We examined hearing professionals' and CI users' subjective reactions to the remote programming experience, including the quality of the programming and the use of the relevant technology., Methods: Remote CI programming was performed in Italy, Sweden, and Russia. Programming sessions had three participants: a CI user, a local host, and a remote expert. After the session, each CI user, local host, and remote expert each completed a questionnaire on their experience., Results: In all, 33 remote programming sessions were carried out, resulting in 99 completed questionnaires. The overwhelming majority of study participants responded positively to all aspects of remote programming. CI users were satisfied with the results in 96.9% of the programming sessions; 100% of participants would use remote programming again. Although technical problems were encountered, they did not cause the sessions to be considerably longer than face-to-face sessions.

The concept of remote long-term support of the patients with cochlear implants is suggested to cope with the problem of the increasingly growing number of patients with cochlear pathology. The authors deem it necessary to provide intraoperative support and postoperative follow-up technologies for the patients living far from the cochlear implantation centres. A scheme for the remote selection of patients and their intraoperative monitoring is proposed with the use of implant telemetry, electrical stapedial reflex (eSRT) testing, auditory response telemetry (ART), and surgical on-line counseling. Remote follow-up and rehabilitation should include cochlear implant tuning, speech therapy, and on-line workshops for the patients and/or specialists. The choice and the use of software and hardware for this purpose are discussed. The concept of remote long-term support turned out to be an efficacious, reliable, time-saving, and cost-effective tool for providing high-tech medical aid to patients with ENT diseases in the Krasnoyarsk kray (territory).