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Cochlear Implant Surgery
KUNNAMPALLIL GEJO JOHN, BASLP, MASLP
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BASIC CRITERIA OF SUITABILITY FOR AN IMPLANT
Audiologically appropriate candidate
Enough neurones to discriminate electrodes.
Able to attend to soundRehabilitation available
Fit for general anaesthetic
Very little risk of infection.
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CLINICAL PREPARATION
Audiometry and medical examination
CT Scan and objective audiometry
Evaluation of residual hearing
Fix medical and personal problems
Consider alternatives
Preparation for consentPreop. Prep.- caloric, skin and nose
culture.
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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.
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SURGICAL PROCEDURE
Operation is performed under G.A.
Patient is placed in the supine otologic positionwith head
turned away from the surgeons sittingposition.
Facial nerve monitor - optional
- Recommended in cases of
- Congenital abnormalities of T. bone
- Repeat surgery
- Less experienced surgeon.
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COCHLEAR IMPLANT
SURGICAL TECHNIQUE
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Ne ral Response Telemetr
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Neural Response Telemetry
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Modified Stenver View X-ray
M t R l f MRI
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Magnet Removal for MRI
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POST -OPERATIVECONSIDERATION
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.
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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.
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COMPLICATIONS (continued)
Tinnitus - usually less than before
- Worse in 10%
Facial - paralysis possible- 0.71 %
- twitch programmed out
Vertigo - rareCSF leak - with Mondini dysplasia
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THANK YOU
