Cochlear implant surgery is best and most safely performed under a combination of general anaesthetic with assistance from local anaesthesia injected into the skin behind the ear to make the recovery after the surgery almost painless. The surgery involves drilling hard bone in the skull to enter the cochlea, while negotiating several sensitive structures including the facial nerve and nerve of taste. The ear drum, lining of the brain as well as the carotid artery and jugular vein are only a few millimetres away. The opening into the cochlea (cochleostomy) is around 1 millimetre in diameter (less than a dressmaker’s pin head) and the cochlear implant electrode around 0.6mm in diameter (like a bristle on your toothbrush). The surgery is performed under a microscope which magnifies these structures many times to make them clearly visible to the operating surgeons and generally takes around an hour and a half to perform. As you can imagine, trying to lie perfectly still for that period of time while the surgery is being performed is uncomfortable. The slightest movement (not to mention more vigorous movements such as deep breathing, a cough, sneeze or even swallowing) appears like a mini earthquake under the microscope. The sensation of the drilling would also be unpleasant, and lastly when the electrode is finally inserted into the cochlea extreme dizziness (vertigo) might occur. For all these reasons it best that implant surgery is performed while the patient is pleasantly asleep. We are fortunate today to have excellent new general anaesthetic agents which are safe, act quickly and have very few side effects which were commonly a problem with the older agents. All patients are carefully evaluated before surgery and any health factors which might interfere with the anaesthetic or surgery can be identified and corrected, if possible, or controlled beforehand. I have performed ear and mastoid surgery in hundreds of patients including over 200 CI surgeries, many of them elderly patients (the oldest 92!) – rarely has their fitness for a general anaesthetic been a reason to prevent the surgery for occurring.