Cochlear Implant - The Operation, Post-implantation Therapy and Ongoing Effects

The Operation, Post-implantation Therapy and Ongoing Effects

The device is surgically implanted under a general anesthetic, and the operation usually takes from 1½ to 5 hours. First a small area of the scalp directly behind the ear may be shaved and cleaned. Then an incision is made in the skin behind the ear and the surgeon drills into the mastoid bone, creating a pocket for the receiver/stimulator, and then into the inner ear where the electrode array is inserted into the cochlea. The patient normally goes home the same day or the day after the surgery, although some cochlear implant recipients stay in the hospital for 1 to 2 days. As with every medical procedure, the surgery involves a certain amount of risk; in this case, the risks include skin infection, onset of (or change in) tinnitus, damage to the vestibular system, and damage to facial nerves that can cause muscle weakness, impaired facial sensation, or, in the worst cases, facial paralysis. There is also the risk of device failure, usually where the incision does not heal properly. This occurs in 2% of cases and the device must be removed. The operation also destroys some or all of the residual hearing the patient may have in the implanted ear; as a result, some doctors advise single-ear implantation, saving the other ear in case a biological treatment becomes available in the future.

After 1–4 weeks of healing (the wait is usually longer for children than adults), the implant is "activated" by connecting an external sound processor to the internal device via a magnet. Initial results vary widely, and post-implantation therapy is required as well as time for the brain to adapt to hearing new sounds. In the case of congenitally deaf children, audiological training and speech therapy typically continue for years, though infants can become age appropriate—able to speak and understand at the same level as a hearing child of the same age. The participation of the child's family in working on spoken language development is considered to be even more important than therapy, because the family can aid development by participating actively—and continually—in the child's therapy, making hearing and listening interesting, talking about objects and actions, and encouraging the child to make sounds and form words. Professionals trained to work with children who have received cochlear implants are a major part of the parent-professional team when addressing the task of teaching children to use their hearing to develop speech and spoken language. These professionals include, but are not limited to:

  • Speech-Language Pathologists (SLP)
  • Certified Auditory-Verbal Therapists (LSLS Cert. AVT) A.G. Bell
  • Pediatric Audiologist (AuD)
  • Teacher of the Deaf (ToD) with a specialization in Oral Deaf Education

Some users, audiologists, and surgeons also report that when there is an ear infection causing fluid in the middle ear, it can affect the cochlear implant, leading to temporarily reduced hearing.

The implant has a few effects unrelated to hearing. Manufacturers have cautioned against scuba diving due to the pressures involved, but the depths found in normal recreational diving appear to be safe. The external components must be turned off and removed prior to swimming or showering, except for users of the Advanced Bionics Neptune processor, which is waterproof. In most cases, certain diagnostic tests such as magnetic resonance imaging (MRI) cannot be used on patients with cochlear implants without first removing the small internal magnet (an outpatient procedure usually performed with a local anesthetic), but some implants are now FDA approved for use with certain strengths of MRI machine. Large amounts of static electricity can cause the device's memory to reset. For this reason, children with cochlear implants are also advised to avoid plastic playground slides. The electronic stimulation the implant creates appears to have a positive effect on the nerve tissue that surrounds it.

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