**Abstract**

Cochlear implantation (CI) is usually performed under general anesthesia using the classic surgical approach, the mastoidectomy posterior tympanotomy approach (MPTA), which was originally described by William House in 1961. Many alternative surgical approaches have been described for CI. Robotic image-guided cochlear implantation has also been described as a new advance in CI. Also, in some situations, CI can be performed under conscious sedation with local anesthesia (CS-LA) instead of general anesthesia (GA). With the ongoing advance in CI devices and surgical techniques, CI surgery nowadays could preserve hearing in ears with preoperative residual hearing. This chapter describes different approaches and techniques in CI surgery, whether classic or alternative technique, with special attention to advantages and disadvantages of each approach or technique. Also this chapter describes, in surgical points of view, the anesthetic techniques in CI, whether GA or CS-LA, with focus on indications, advantages, and disadvantages of CS-LA in CI.

**Keywords:** cochlear implantation, mastoidectomy posterior tympanotomy approach, alternative approaches, round window, conscious sedation with local anesthesia, general anesthesia, receiver/stimulator
