What is cochlear implant surgery?

If a person has severe hearing loss, a cochlear implant may help. It's different from a hearing aid. A hearing aid makes sounds louder and helps if you have some hearing loss. But an implant can help if you have very little or no hearing (partial or complete deafness).

A cochlear implant is a small electronic device. It electrically stimulates the cochlear nerve. This is the nerve for hearing. The device has 2 parts. One part sits behind the ear. It picks up sounds with a microphone. It processes the sound and then sends it to the second part of the implant. The second part is placed in the inner ear during a surgical procedure. A thin wire and small electrodes lead to the cochlea in the inner ear. The wire sends signals to the auditory nerve. This is the nerve that sends sound impulses to the brain. An implant helps give you a sense of sounds. It doesn't restore hearing to normal. But it can help you understand speech and noises around you.

Why might you need cochlear implant surgery?

You and your health care 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. This is called sensorineural hearing loss.

Cochlear implants help each person differently. Some people can hear many sounds. But some people will have no change in hearing. A person may be able to:

• Notice different sounds, such as footsteps, a door closing, or a phone ringing.

• Understand speech without lip reading, or be helped with lip reading.

• Understand voices over the phone.

• Hear the TV.

• Hear music.

Here are some facts to consider about getting an implant:

• You'll need training and therapy after surgery. During this time, you will learn how to care for the implant. You'll have aural rehabilitation (rehab) to help you cope 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 don't 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'll 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'll need to take care around things that make static electricity. These include computer and TV screens, synthetic fabrics, and carpeting.

• An implant can set off security systems, such as metal detectors. Implants may be affected by cellphones and radio transmitters. They must be turned off during takeoff and landing in a plane.

• You may not be able to have certain medical tests or treatments. These include 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. Fixing 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.

• Leaking cochlea fluid.

• Leaking 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.

• Needing to have the implant removed because of an infection.

There may be other risks, depending on your health condition. Discuss any concerns with your doctor before the procedure.

How do you 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'll need to meet with hearing and speech specialists. These may include an audiologist, otologist, and speech-language pathologist.

• You'll need to meet with a psychologist or other counselor.

• You'll 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. They can help show how well a cochlear implant will work in your ear.

• The health care staff will help you to shave and clean the scalp around the implant site.

• Your doctor may need other tests or preparation, depending on your health 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 (incision) behind the ear to open up the mastoid bone.

• The surgeon makes a small cut in the cochlea. They insert the implant electrodes into the cochlea.

• The surgeon places a device called the receiver under the skin behind the ear.

• The incisions are closed. 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?

You will be given directions on how to care for the incisions. You’ll also learn how to change dressings and care for your stitches. The directions will include how to wash the scalp and head, and how to shower. You may be advised to make some diet changes during recovery. A follow-up appointment is made for about 1 week later. Your doctor will check the incisions and remove the stitches.

Report any increased pain, drainage, or fever to your doctor after the procedure.

You will have some time to heal after the surgery before the implant process is finished. This lets the swelling go down so the implant fits correctly. About 4 to 6 weeks after the surgery, the external parts of the implant will be added. These include a microphone and speech processor. This is when the implant is programmed and activated. The external and internal parts of the implant now work together.

You will also learn how to use and care for the implant. You may need to return for several visits over a few days for adjustments. More fine-tuning may be done over several months. Learning to use a cochlear implant is a slow process. You will likely need visits with speech-language pathologists, audiologists, counselors, and teachers. But with commitment, your quality of life can improve with a cochlear implant.

If you get an inner ear infection, you should get medical care until it goes away. Untreated middle ear infections can go on to cause meningitis. This can lead to problems like permanent hearing loss and paralysis of the face. Vaccines don't end the risk for meningitis. The surgeon should check for any discharge, pain, or swelling in the ear with the implant. The surgeon should also check for redness, abnormal ear symptoms, or a runny nose.

Get a checkup every year by an audiologist to map and reprogram the implant.

Next steps

Before you agree to the procedure, make sure you know:

• The name of the procedure.

• The reason you're having the procedure.

• What results to expect and what they mean.

• The risks and benefits of the procedure.

• What the possible side effects or complications are.

• When and where you'll have the procedure.

• Who will do the procedure and what that person’s qualifications are.

• What would happen if you don't have the procedure.

• Any other procedures to think about.

• When and how you'll get the results.

• Who to contact your doctor after the procedure, if you have questions or problems.

• How much will you have to pay for the procedure.