UC Davis Health performs first cochlear implant procedure while patient is awake

UC Davis Health has successfully performed its first cochlear implant surgery with the patient awake. This marks an important milestone in expanding treatment options for people with severe hearing loss, especially at an older age.

Doron Sagiv, associate clinical professor in the Department of Otolaryngology, led the procedure, which offers a promising alternative for patients who may not be ideal candidates for general anesthesia.

Restoring hearing and quality of life

Cochlear implants have been transforming lives for more than 40 years. The external microphone and sound processor worn behind the ear helps people with severe hearing loss regain functional hearing and reconnect with loved ones.

Unlike hearing aids, which amplify sound, cochlear implants bypass damaged portions of the inner ear and directly stimulate the auditory nerve. During the procedure, a surgeon places an electrode array into the cochlea and implants an internal receiver beneath the skin behind the ear. After a healing period of several weeks, an audiologist activates and programs the external sound processor, allowing patients to begin interpreting sounds through the device.

While cochlear implants have long been associated with pediatric patients, a growing number of older adults benefit from the technology.

The need is significant. The number of Americans living with hearing loss is expected to increase from 44 million in 2020 to more than 73 million by 2060, with the vast majority of those affected being adults age 60 and older. Hearing loss impacts approximately 65% of U.S. adults age 71 and older and is one of the most common chronic health conditions among older adults.

Untreated hearing loss has been linked to cognitive decline, an increased risk of dementia and a higher likelihood of falls. Yet fewer than 30% of adults who could benefit from hearing aids use them.

"For many patients, receiving a cochlear implant is truly life-changing," said Sagiv. "Hearing loss can create profound isolation. People may struggle to communicate with their spouse, children or grandchildren, and they often withdraw from social interactions. Our goal is to help patients understand that there are effective treatments available and that they can regain the joy of hearing and improve their quality of life."

Why perform the procedure while the patient is awake?

Cochlear implant surgery is traditionally performed under general anesthesia as an outpatient procedure lasting one to three hours. However, not every patient can safely undergo general anesthesia.

For some older adults and medically complex patients, general anesthesia may carry increased risks and can result in a longer recovery period. Awake cochlear implantation offers an alternative for patients with significant cardiac or pulmonary conditions, as well as others who may benefit from avoiding general anesthesia.

"Part of our mission is to continue advancing our skills and developing new ways to care for patients," Sagiv explained. "Awake cochlear implantation allows us to offer hearing restoration to individuals who might otherwise face additional challenges or risks with general anesthesia."

Patients who undergo awake procedures may also experience a faster recovery and avoid some of the after-surgery grogginess and nausea that can accompany general anesthesia.

A team effort

The success of UC Davis Health's first awake cochlear implant procedure was the result of extensive collaboration among surgeons, anesthesiologists, nurses and operating room staff.

Throughout the surgery, the patient remained comfortable and conscious while being closely monitored by the anesthesia team. Because the patient was awake, the surgical team developed ways to communicate each stage of the procedure despite the patient's hearing limitations.

"We were able to explain what was happening throughout the surgery and keep the patient engaged and informed," Sagiv said. "We even created visual signs and communication cues so the patient would understand each step of the process. That level of interaction helped make the experience more comfortable and collaborative."

The procedure went smoothly, and the patient was discharged about 30 minutes after the surgery.

Looking ahead

Sagiv and his team plan to continue offering awake cochlear implant procedures to carefully selected patients.

Individuals must be able to remain still throughout the operation and be comfortable staying awake during the procedure. The approach is expected to be particularly valuable for patients who would benefit from avoiding general anesthesia while still gaining access to the life-changing benefits of cochlear implantation.

"As we continue refining this technique, our hope is to expand access to cochlear implants for more patients," said Sagiv. "Hearing loss should not prevent people from staying connected to the people and experiences that matter most."