Local anesthesia vs. general anesthesia in cochlear implant surgery: Impact on surgical duration, postoperative recovery, costs and clinical insights. An extensive meta-analysis.

INTRODUCTION: recent studies have shown that around 30 % of men and 20 % of women at the age of 70 have a hearing loss, rates that rise to 55 % and 45 % respectively at the age of 80. Treatment options include hearing aids and cochlear implants. Cochlear implant surgery under local anesthesia (L.A.) is gaining popularity for its potential benefits. We analyzed the current literature comparing L.A. and general anesthesia (G.A.) surgery by assessing operation duration, post-operative observation time and length of hospital stay. METHODS: The study was conducted following the PRISMA guidelines. The search was performed on different database for articles published from 1984 to 2023. Comparative studies between cochlear implants in L.A. and G.A. with information on duration of surgery, length of hospital stay and time in postoperative care unit (PACU) were included. RESULTS: Of 65 articles identified, 5 studies were included, involving 634 patients. The studies showed that L.A. surgery had a shorter surgical time than G.A. (p < 0.0001). No significant differences were found in length of hospital stay (p = 0.14) or time in PACU (p = 0.08). The cost of anesthesia was significantly lower for L.A. DISCUSSION: The LA procedure has become popular, especially among elderly patients. The LA procedure has a shorter operative time and lower costs, without significantly affecting hospitalisation or time in PACU. Our study highlighted the advantages of L.A. in cochlear implant surgery, also showing the relatively low costs of the procedure. Better post-operative management could bring further benefits for patients and reduce hospital costs.

Efficacy of tailor-made notched music training for primary tinnitus: A systematic review and meta-analysis.

OBJECTIVE: We systematically reviewed and meta-analyzed the efficacy of Tailor-Made Notched Music Training (TMNMT) for primary subjective tinnitus in adults. The main goal was to evaluate TMNMT's impact on tinnitus symptoms. METHODS: Following PRISMA guidelines, we included randomized and non-randomized trials. Studies considered involved adults with primary subjective tinnitus treated with TMNMT alone or combined with other therapies. Bias risk was assessed using the Cochrane RoB 2 and ROBINS-I tools. Comprehensive database searches were conducted, and relevant data were extracted and analyzed. RESULTS: Three studies (total: 99 TMNMT patients, 109 sound therapy) were meta-analyzed. Using THI scores, the Forest plot showed no significant difference in tinnitus distress between TMNMT and listening to music groups (p > 0.05), with low study heterogeneity (I2 = 0 %). CONCLUSION: While TMNMT offers a non-invasive approach with a potential to reduce tinnitus distress, it did not significantly outperform the only listening to music. More research is needed to optimize TMNMT for tinnitus management and to better document its safety profile.