Cochlear Implant Surgery

What is cochlear implant surgery?

If a person has severe hearing loss, a cochlear implant may help. A cochlear implant is different from a hearing aid. A hearing aid makes sounds louder and helps someone who has some hearing loss. But a cochlear implant can help a person with very little or no hearing (partial or complete deafness).

A cochlear implant is a small electronic device that electrically stimulates the cochlear nerve (nerve for hearing). It has two parts. One part sits behind the ear. It picks up sounds with a microphone. It then processes the sound and transmits it to the second part of the implant. The second part is put through the skin and implanted in the inner ear during a surgery. A thin wire and small electrodes leads to the cochlea, which is part of the inner ear. The wire sends signals to the auditory nerve. This is the nerve that sends sound impulses to the brain. A cochlear implant helps give a person a sense of sounds. It doesn't restore hearing to normal. But it can help a person understand speech and noises in the environment.

Why might I need a cochlear implant surgery?

You and your healthcare provider may think about a cochlear implant if your hearing hasn’t improved after using a hearing aid for at least 6 months. You also must have severe hearing loss from an auditory nerve conduction disorder in both ears (sensorineural hearing loss).

How cochlear implants help varies from person to person. Some people can hear many sounds. But some people will have no change in hearing. A person may be able to:

• Perceive different sounds, such as footsteps, a door closing, a phone ringing
• Understand speech without lip reading, or be helped with lip reading
• Understand voices over the phone
• Watch TV
• Hear music

Before thinking about a cochlear implant, it's important to understand certain facts. These include:

• A cochlear implant requires a period of training and therapy after surgery. During this time, you will learn how to care for the implant. You will also have aural rehabilitation to assist with coping with hearing loss. This will help to improve your use of the implant. How long you have aural rehab depends on your age and your hearing before surgery.
• Cochlear implants do not restore hearing to normal. And in some people, they may not help with hearing at all.
• You may lose the rest of your natural hearing in the ear where the implant is placed.
• You may need to use new or recharged batteries every day.
• You will need to remove the external part of the implant when bathing or swimming
• The implant may irritate your skin. In some cases, it may need to be removed.
• Static electricity may harm a cochlear implant. You will need to take care around computer and TV screens, man-made fabrics, carpeting, and other things that make static electricity.
• An implant can set off security systems, such as metal detectors. Implants may be affected by cell phones and radio transmitters. They must be turned off during takeoff and landing in an airplane.
• You may not be able to have certain medical tests or treatments. These include magnetic resonance imaging (MRI), electroconvulsive therapy (ECT), and ionic radiation therapy.
• The implant can be damaged during an accident or while playing sports. Or, the implant can fail. Repairing the implant or replacing a damaged part may be expensive. In some cases, a new surgery may be needed to replace the implant.

What are the risks of cochlear implant surgery?

Risks of cochlear implant surgery include:

• Bleeding
• Swelling
• Infection in the area of the implant
• Ringing in the ears (tinnitus)
• Dizziness or vertigo
• Numbness around the ear
• Changes in taste
• Leakage of the fluid in the cochlea
• Leakage of spinal fluid
• Injury to the facial nerve, which can cause movement problems in the face
• Infection of the membrane that covers the brain (meningitis)
• Chronic inflammation around the implant (reparative granuloma)
• Risks of general anesthesia
• Need to have the implant removed because of an infection

There may be other risks, depending upon your medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.  

How do I get ready for cochlear implant surgery?

A cochlear implant is not right for everyone. To find out if an implant is right for you:

• You will need to meet with hearing and speech specialists. These may include an audiologist, otologist, and speech-language pathologist.
• You will need to meet with a psychologist or other counselor.
• You will have hearing tests and physical exams.
• You may have imaging tests to look at the structure of your ear. These may include X-rays and MRI. These can help show how well a cochlear implant will work in your ear.
• The healthcare staff will help you to shave and clean the scalp around the implant site.
• Your healthcare provider may need other tests or preparation, depending on your medical condition.

What happens during cochlear implant surgery?

Cochlear implant surgery is done in a hospital or clinic. The surgery lasts 2 to 4 hours. You are given medicine (general anesthesia) to make you sleep during the procedure.

• The surgeon makes a cut behind the ear to open up the mastoid bone.
• Then the surgeon makes a small cut in the cochlea. He or she inserts the implant electrodes into the cochlea.
• The surgeon places an electronic device called the receiver under the skin behind the ear.
• The incisions are then closed and you will be moved into the recovery area and watched closely.
• You may go home the same day. Or you may need to stay in the facility overnight.

What happens after cochlear implant surgery?

When leaving the hospital you will be given instructions on how to care for the incisions. You’ll also learn how to change dressings, and care for your stitches. You will also be given instructions on how to wash the scalp, head, and how to shower. You may be advised to make certain diet changes during recovery. A follow up appointment is made for about one week later to inspect the incisions and remove the stitches.

You should report increased pain, drainage, or fever to your healthcare provider following the procedure.

You will have some time to heal after the initial surgery before the implant process is completed. This lets the swelling go down and the implant to fit correctly. About 4 to 6 weeks after the surgery, the external parts of the cochlear implant will be added. These include a microphone and speech processor. This is where the implant is programmed and activated. The external parts work with the internal part of the implant.

You will also learn the basics of using and caring for the implant. You may need to return for several visits over a few days for adjustments. Further fine-tuning may take place over several months. Learning to use a cochlear implant is a gradual process. It will likely require visits with speech-language pathologists, audiologists, counselors, and teachers. But with commitment, you can experience an improved quality of life with a cochlear implant. 

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure