Cochlear Implant Surgery

KUNNAMPALLIL GEJO JOHN, BASLP, MASLP

BASIC CRITERIA OF SUITABILITY FOR AN IMPLANT

Audiologically appropriate candidate Enough neurones to discriminate electrodes. Able to attend to sound Rehabilitation available Fit for general anaesthetic Very little risk of infection.

CLINICAL PREPARATION
Audiometry and medical examination CT Scan and objective audiometry Evaluation of residual hearing Fix medical and personal problems Consider alternatives Preparation for consent Preop. Prep.- caloric, skin and nose culture.

FACTORS AFFECTING SUITABILITY

Serous otitis - better to have tubes Open mastoid cavity - obliterated with fat first. CSOM unless frequent review is available Dysplasia with total deafness since birth Adult with no sound percept on prom stim test.

BAD EFFECT ON DISCRIMINATION (MUST BE HIGHLY MOTIVATED)

Unaided, prelinguistic after 7, Demented, retarded, depressed psychotic Deafness from radiation to the brainstem Fractured cochlea, head injury.

SURGICAL PROCEDURE
Operation is performed under G.A. Patient is placed in the supine otologic position with head turned away from the surgeons sitting position. Facial nerve monitor - optional - Recommended in cases of - Congenital abnormalities of T. bone - Repeat surgery - Less experienced surgeon.

COCHLEAR IMPLANT SURGICAL TECHNIQUE

Neural Response Telemetry

Modified Stenver View X-ray

Magnet Removal for MRI

POST -OPERATIVE CONSIDERATION

X-Ray - Modified Stenver view Antibiotics Magnetic Resonance imaging (MRI) Magnet removal prior to implantation. - Removal - In known condition that requires MRI - Replaced with a non magnetic titanium plug.

COMPLICATIONS
Infection - most serious, avoid it - Round window unsealed 6 weeks. - Report unsteadiness. Wound breakdown - use adult size flap Device failure < 1% Poor result if insufficient neurones.

COMPLICATIONS (continued)
Tinnitus Facial - usually less than before - Worse in 10% - paralysis possible - 0.71 % - twitch programmed out - rare - with Mondini dysplasia

Vertigo CSF leak

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