What are the other Names for the Procedure?
- Auditory Nerve Stimulator
- Cochlear Device Implantation
- Cochlear Prosthesis
What is Cochlear Implant surgical procedure?
A Cochlear Implant procedure involves the surgical implantation of a microelectronic device, which aids hearing in individuals, who are hearing-impaired. The Cochlear Implant device consists of:
- Cochlear electrode
What part of the Body does the Procedure involve?
A Cochlear Implant procedure involves the cochlea and skin behind the ear. The cochlea is a part of the inner ear that converts sound to nerve impulses.
Why is the Cochlear Implant surgical procedure Performed?
- There could be various reasons for performing a Cochlear Implant surgical procedure. Some of these include:
- To treat severe hearing loss
- To help the auditory nerve transmit sound, when the cochlea is unable to, due to an injury or damage to the inner ear
What are some Alternative Choices for the Procedure?
A Cochlear Implant procedure remains the gold standard technique to treat severe hearing loss.
What are the Recent Advances in the Procedure?
The Cochlear Implant procedure is an advancement in itself, which help in treating patients with profound hearing loss.
What is the Cost of performing the Cochlear Implant surgical procedure?
The cost of Cochlear Implant procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Cochlear Implant procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.nidcd.nih.gov/health/hearing/pages/coch.aspx/ (accessed on 20th July, 2012)
http://cochlearimplants.med.miami.edu/medical/01_Cochlear%20Implant%20Surgery.asp (accessed on 20th July, 2012)
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/CochlearImplants/ucm062843.htm (accessed on 20th July, 2012)
Prior to Cochlear Implant surgical procedure:
How is the Cochlear Implant surgical procedure Performed?
- During a Cochlear Implant surgery, a small portion of hair behind the ear is shaved
- Next, a small incision is made behind and just above the ear and a small hole is made in the mastoid bone using a small drill-like device
- The surgeon then inserts the cochlear electrodes deep into the inner ear and an internal coil is also placed in the cochlea. It may be secured to position with stitches
- The incision is then closed and allowed to heal, after which an external stimulator /receiver component and microphone, is placed behind the ear
Where is the Procedure Performed?
A Cochlear Implant procedure is performed in a hospital. The individual gets admitted, undergoes the procedure and is discharged, as per the instruction of the physician.
Who Performs the Procedure?
The Cochlear Implant surgery is performed by an ear, nose, and throat (ENT) surgeon along with an anesthesiologist.
How long will the Procedure take?
The procedure may take anywhere between one to three hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
- What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Cochlear Implant procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Cochlear Implant surgical procedure?
The individual has to undergo certain tests prior to a Cochlear Implant procedure, such as:
- Auditory tests
- Routine blood and urine analysis
The physician may suggest further tests depending on the health of the individual and their medical history. Do note that sometimes, only a few of the above mentioned tests, or all of the tests may have to be taken.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Cochlear Implant?
- Why is this procedure necessary?
- What does the procedure involve?
- How will this procedure help?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- Are there any lifestyle restrictions or modifications required, after the procedure is performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- Is there any medication that needs to be taken for life, after the procedure?
- How many such procedures have you (the physician) performed?
- What are the costs involved?
During the Cochlear Implant surgical procedure:
What kind of Anesthesia is given, during the Procedure?
During the procedure, the individual is administered general anesthesia.
How much Blood will you lose, during the Procedure?
The amount of blood lost during the procedure is usually not significant. This varies from one individual to another.
What are the possible Risks and Complications during the Cochlear Implant surgical procedure?
The possible risks or complications that may arise during the surgery are as follows:
- Excessive bleeding
- Accidental injury to the neighboring tissue or bone
- Facial nerve damage
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Cochlear Implant surgical procedure?
At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.
After the Cochlear Implant surgical procedure:
What are the possible Risks and Complications after the Cochlear Implant surgical procedure?
Post Cochlear Implant, the following complications may arise:
- Infection in the surgical wound
- Technical failure of the implant
- Blood and fluid collection at the surgery site
- Taste disturbances
- Numbness around the ear
- Reparative granuloma, which is localized inflammation in case of an implant rejection
- Implant rejection
- Perilymph fluid leakage; the fluid around the cochlea leaks
- Cerebrospinal fluid leakage
What is the Prognosis after the Surgery?
- The recovery from a Cochlear Implant procedure is usually excellent and it ensures a partial or near normal hearing
- However, the degree of hearing that is regained may vary from one individual to another, and so is the time period required, for each individual to adapt to the implant device
When do you need to call your Physician?
Do contact your surgeon/physician if you notice any of the following symptoms:
- Pain around the surgical wound
- Swelling and redness
- Bleeding or drainage
- Muscle ache
- Nausea or vomiting
- Signs of infection
- If any new symptom or discomfort is observed
What Post-Operative Care is needed at Home after the Cochlear Implant surgical procedure?
At home, the following post-operative care is recommended, post Cochlear Implant procedure:
- Complete the course of prescribed medication
- Avoid ‘bending over’ for a few days
- Avoid sudden head movements ; refrain from blowing your nose or sneezing
- Keep the incision site clean and dry
- Wash the incision site with mild soap while bathing
- Use warm compress to relieve incisional pain
- Avoid taking non-prescribed medications
How long does it normally take to fully recover, from the Procedure?
It takes anywhere between a few weeks to a month, to recover from the procedure. However, in order to regain the hearing ability, the time taken may be longer, which varies from one person to the other.
What happens to tissue (if any), taken out during the Procedure?
The procedure does not involve the surgical removal of any tissue.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.
Who will you receive a Bill from, after the Cochlear Implant surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The hospital
- An ear, nose and throat surgeon
- An anesthesiologist (if anesthesia was administered)
- The patient is advised to inquire and confirm the type of billing, before a Cochlear Implant procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA