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Cochlear Implant Education Center

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Introduction
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What is a CI?
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Candidacy
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Performance
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Decision Making
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Process
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Insurance
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Surgery
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Education
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Language and Communication
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References
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Deaf Community
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Speech Processor
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Versión en Español (muy pronto)


Surgical Considerations

Developed by Debra Berlin Nussbaum, Coordinator, Cochlear Implant Education Center, Laurent Clerc National Deaf Education Center

Download the PDF version:

Surgery for a cochlear implant is usually outpatient, is completed under general anesthesia, and typically lasts from one to three hours. The internal component of the device, which is implanted during surgery, houses an FM receiver and the electrodes (see module: What is a Cochlear Implant?). The FM receiver, cased with a magnet used for the purpose of attaching the internal component to the external component of the implant, is set into the mastoid bone. The attached electrode array is inserted into the cochlea.

During Surgery

  • The hair around the incision is sometimes shaved (with some surgical procedures, the incision placement and size of the incision do not necessitate that the hair is shaved).
  • A post-auricular (behind the ear) incision is made.
  • A small depression is created in the mastoid bone directly behind the incision to hold the receiver so that it is flush with the skull.
  • The surgeon drills through the mastoid bone to the inner ear and the electrode array is then inserted into the cochlea.
  • The receiver is secured to the skull and the incision is closed with stitches.

After Surgery

  • The individual returns to daily activities as soon as he or she feels well enough to do so, usually within a week of surgery. Children are typically up and about 1-2 days following surgery.
  • The implant is typically activated approximately three to four weeks after implantation, allowing enough time for the incision to heal properly. Some hospital implant centers will consider activation prior to this time on a case-by-case basis.

Associated Risks

  • As with other surgeries, there are associated risks related to general anesthesia. With trained pediatric anesthesiologists, anesthesia-related risks for cochlear implantation are considered minimal.
  • As the surgery is performed in the vicinity of the facial nerve, there is the rare possibility that temporary or permanent facial paralysis may occur. There are surgical monitors used throughout the surgical procedure to avoid this possibility.
  • The surgical site could possibly become infected following surgery. In extreme cases this could warrant removal of the internal device.
  • There may be pain at the wound following surgery—this is typically temporary.
  • There is a slight risk of taste disturbances, such as food having a metallic taste.
  • There is the risk that residual hearing may be lost following implantation despite improvements in the implanted components of the device as well as surgical techniques that attempt to preserve residual hearing.
  • Following surgery, dizziness is sometimes noted.
  • There are risks associated with possible meningitis following implantation. A vaccination for meningitis is required prior to implantation. For more information on this topic, see considerations in the Cochlear Implant Process.

Note: According to the June 2010 issue of Archives of Otolaryngology—Head & Neck Surgery, ear tubes to treat infections do not appear to adversely affect children with cochlear implants regardless of whether the tubes are left in place or removed before implantation.

For information from the manufacturers related to preparing a child for surgery:

Cochlear Corporation—

Advanced Bionics—

For general information about the surgical procedure (including video clips of the surgery itself):

  • Otology and Neurotology-Dr. Daniel Lee, surgeon, Massachusetts Eye and Ear, Harvard (discussion and videos of actual surgical procedures)

              General information

              Minimally Invasive approaches

              Advanced Bionics: Helix insertion

              Cochlear Corporation insertion (Freedom device)

               Surgical instructions (post-operative)

Revised May 2012