‘Leave no one behind’: cochlear implantation under regional anaesthesia in a humanitarian setting – a case series

Background: Cochlear implantation (CI) is the standard of care for severe-to-profound hearing loss. While traditionally performed under general anaesthesia (GA), GA poses significant logistical and safety challenges during humanitarian missions in low-resource settings, often excluding patients with complex medical comorbidities. Regional anaesthesia (RA) offers a practical alternative that avoids GA-related risks, reduces operative time, and allows treatment for otherwise ineligible patients, upholding the humanitarian principle of 'leaving no one behind'. Therefore, the objective of the study is to report the feasibility, safety, and outcomes of cochlear implantation performed under regional anaesthesia during humanitarian missions, with the implementation of early activation protocols. Methods: This case series includes eight patients (age range 20-66 years) of Palestinian, Somali, and Senegalese nationality who underwent cochlear implantation under regional anaesthesia during humanitarian missions conducted in Jordan (serving Palestinian patients), Kenya (serving Somali patients), and Senegal (serving Senegalese patients) in April and December 2025. Results: All eight procedures were successfully completed under regional anaesthesia without conversion to general anaesthesia. The diverse case mix included medically complex patients and challenging surgical anatomy. Early activation was achieved in all cases. Conclusions: Regional anaesthesia enables cochlear implantation in medically complex patients who cannot undergo general anaesthesia - including those with failed intubation or high cardiac risk - while allowing intraoperative or immediate postoperative activation, ensuring no one is left behind in humanitarian missions. Early activation protocols are achievable with logistical efficiency in resource-limited environments.