Cochlear implant surgery: Purpose, Procedure, Benefits and Side Effects

A cochlear implant surgery is a procedure used most commonly to implant a mechanical cochlea into a human ear to help the patient with his partial or total hearing loss. The treatment is generally done under the influence of anesthesia and is known as Mastoidectomy.

A cochlea is a component of the human ear that resembles a tube that is hollow, and is often wound up like a snail's shell. The Organ of Corti, the hearing sense organ, is housed within the cochlea. As a result, the cochlea functions as an essential component of the human ear, coordinating the ear's nerve cells to aid in hearing. When a person's cochlea is destroyed, leaving them unable to hear anything at all or nearly nothing, they are given a device to help their cochlea function. This whole procedure is called cochlear implant surgery.

For a number of temporal bone disorders, such as mastoiditis and cholesteatoma, mastoidectomy is a very common treatment. In addition to surgical excision, it entails removing a portion of the mastoid's bony wall to facilitate drainage. The extent of the operation will depend on your particular situation. Based on the method of surgery here are some of the types variants of this procedure;

A simple mastoidectomy will cure any illness in your mastoid while totally preserving the structures of your ear canal and middle ear. The mastoid's lateral wall is taken out. The external acoustic meatus's posterosuperior wall has been retained. The ossicular chain cannot be visualized using this method.

Also known as tympanomastoidectomy, it removes more bone than a simple mastoidectomy. This is done to provide your surgeon access to the three small bones that transport sound waves inside of your ear, known as the ossicles, which are located in the middle-ear area below your eardrum. Your ear canal is entirely unharmed following this operation.

When the illness has irreparably destroyed your ear canal or when the removal of your ear canal is necessary for the total elimination of the disease, a canal-wall-down mastoidectomy or tympanomastoidectomy is done. The mastoid cavity, also known as the mastoid bowl, is created during this treatment by joining your ear canal and mastoid bone.

To make future cleaning of your mastoid cavity easier, your ear canal's entrance is routinely expanded. This procedure, which is frequently referred to as a radical or modified mastoidectomy, is saved for cases of significant disease or recurrent (recurring) illness that have failed a less comprehensive procedure.

All of the various mastoidectomy procedures include the removal of one or more sections of the mastoid bone in order to access the cochlea region where the implant has to be placed.

When hearing aids are no longer helpful for someone with severe hearing loss, cochlear implant surgery can help them hear better. Their quality of life and ability to communicate can be enhanced through cochlear implants. Here are some of the many benefits of Cochlear implant surgery;

• The ability to understand speech without using visual signals, such as lipreading
• The ability to identify common ambient noises
• The ability to hear in a loud setting
• The ability to locate the source of noises
• The ability to hear music, telephone conversations, and television shows
• The patient can concentrate better in the crowd and can hear conversations across the table
• Reconnect with the missed sounds
• Enjoy music on the phone.

Depending on the individual, cochlear implants can aid to varying degrees. Four to six weeks following surgery, or when the cochlear implant is turned on, most people observe a noticeable improvement in their awareness of sounds. Speech comprehension advances more gradually, with the majority of people observing the biggest advancements within the first six months. Each person experiences this improvement to varying degrees. Hearing rehabilitation following surgery can help with speech comprehension improvements.

If you are experiencing hearing loss and continue to rely extensively on lip reading, your healthcare provider, and an audiologist may suggest you getting a cochlear implant. People who are candidates for cochlear implant surgery include those who have hearing loss and others whom hearing aids do not assist. Cochlear implant surgery is done when;

• The patient has low hearing clarity in both ears
• Misses 50% or more of spoken words, even while wearing hearing aids
• While using hearing aids, strongly rely on lip reading.

A partly implanted cochlear implant is used to retain hearing in situations of more moderate hearing loss such that a hearing aid and the cochlear implant can be worn in the same ear concurrently. To completely benefit from electrical hearing, however, a fully placed cochlear implant is required in situations with more severe hearing loss.

Usually, this condition is present at birth. Such afflictions are recommended to be treated at a young age for better results.

Surgery for cochlear implants is a painless and secure process. Rarely, but like with other procedures, there are some risks involved too with this surgery, such as:

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

Just like any other minor surgery, Cochlear implant surgery doesn’t require much preparation as the patient usually gets discharged on the same day of the surgery or sometimes just a day stay in the hospital is required. Here are few tips on how to prepare for Cochlear implant surgery;

• Remove any jewelry, especially necklaces and earrings.
• From midnight on the day of your scheduled operation, refrain from eating or drinking anything. This is due to the anesthetic's temporary suppression of your body's responses. There is a chance of vomiting or putting food up into your throat if your stomach contains food and liquid.
• Clean your scalp and behind the ears area where the implants will be done, with anti-bacterial shampoo or soap as this site will receive incision for surgery.
• Wear something with a broad nick line or something that can be removed without taking it upside from your head to avoid any touch with your post surgery site.

A cochlear implant is generally done under the influence of anesthesia. The procedure used most commonly to implant a mechanical cochlea into a human ear is called mastoidectomy with facial recess approach (MFRA). This is done by removal of the mastoid cells. There are various types of this surgery: Radical mastoidectomy, Canal Wall Down Mastoidectomy, Canal Wall Up Mastoidectomy, Cortical Mastoidectomy and Modified Radical Mastoidectomy. All the different types of mastoidectomy are done by removal of one or more parts of the mastoid bone in order to get the part of the cochlea where the device needs to be implanted.

This surgery takes about two hours, but may also extend up to three hours at a stretch. Before the surgery is done, the audiologist and the physician decide which ear to operate on and a thin line of hair is shaved along the incision line. The operator cuts a section of the skull behind the ear to accept an internal receiver. Under a surgical microscope, a meticulous drilling in the mastoid bone provided access to the cochlea. A small cavity in the round window membrane allows insertion of the electrode array. The electrode array is tested previously before putting it into the purpose of hearing

Generally the ear with better understanding of speech is recommended for this surgery as residual hearing predicts better post implant performance.

You usually check in, put on a gown, and prepare for surgery when you go to your surgical facility. The procedure typically takes two hours each ear, plus time spent in the preparation and recovery rooms. While you are being prepared for the surgery, you can expect;

• Few intravenous (IV) lines will be placed by the hospital staff to give medication through an IV
• Your surgical site will be shaved or cleansed
• To monitor your vital signs, the nurse will place wires, monitors, and patches on your skin
• An oxygen and anesthetic gas mask will then be placed over your face
• Now to induce sleep and general anesthesia, and the face mask

Surgery for cochlear implants is performed at a hospital or clinic. It takes two to four hours to perform the surgery. To put you to sleep throughout the surgery, general anesthetic is administered.

• To reach your mastoid bone, your surgeon will strategically make a cut behind your ear to hide the scar from your mastoidectomy.
• He will then open your mastoid bone using specialist tools.
• Under a surgical microscope, a meticulous drilling in the mastoid bone provided access to the cochlea.
• The cochlea is then opened when the surgeon locates the facial nerves and cuts a gap between them to have access to it.
• A small cavity in the round window membrane allows insertion of the electrode array.
• Your mastoid's contaminated air cells will be removed.
• The medical personnel now place the cochlea with the implant electrodes.
• Use stitches to close the surgical site.
• Use gauze to cover the surgery wound.
• Generally the ear with better understanding of speech is recommended for this surgery as residual hearing predicts better post implant performance.

After the incisions are stitched up, you'll be transported into the recovery area, where you will be put under careful observation.

After at least two hours of observation, you will be let go as cochlear implant surgery is an outpatient procedure and you may get your discharge on the same day of the surgery.

You will get instructions on how to take care of the incisions before leaving the hospital. Additionally, you'll learn how to take care of your sutures and change dressings. After a day or two, you can wash your ears as normal. After approximately a week or at activation, a follow-up visit is scheduled to examine the wounds and remove the sutures.

Based on the type of surgery, cochlear implants in India start at a price of Rs. 65,000. In some circumstances, it might increase to Rs. 9.5 lakhs. A lot of variables may affect the cost of surgery. Along with tier-1 or tier-2 cities; hospital or clinic brand names, the fees of the treating consultant, admission fee, type of the surgery, post-surgical complications that are involved, admission room that you opted for, may have an influence on hospital billing expenses.

The total cost of the procedure may also be impacted by the number of diagnostic tests performed. The entire cost of the surgery may be reduced based on the patient's insurance plan.

Following the surgery, you should inform your healthcare practitioner of any increasing discomfort, drainage, or fever.

• After the initial operation, you will need some time to recover before the implant device is turned on or activated.
• The external components of the cochlear implant will be inserted four to six weeks following the operation. A voice processor and microphone are among them.
• The inside gadget is then configured and turned on, which prompts it to stimulate the auditory nerve in reaction to sounds.
• The fundamentals of utilizing and maintaining the implant will also be covered. For modifications, you might need to come back multiple times over a few days. Over the course of several months, there will be more fine-tuning.
• The process of becoming familiar with a cochlear implant is slow. Visits with audiologists and speech-language pathologists will probably be necessary. With dedication, a cochlear implant can help you live a better quality of life.

No specific food or diet is required after cochlear surgery however to reduce the impact of chewing insides of your surgical ear try to eat food that is soft to chew. Also the food that can boost your immunity and fasten you recovery such as;

• Leafy green vegetables
• Cruciferous vegetables
• Eggs
• Poultry
• Organ meats
• Salmon
• Shellfish
• Berries
• Nuts and seeds
• Sweet potatoes.

Cochlear implant surgery is very safe and has minimal risks and complications attached to it. As medical prosthesis, cochlear implants have a great success record, with just 0.2% of patients rejecting them. Adults frequently gain right away from implant insertion.

For around three months following the initial tuning sessions, the sound quality keeps getting better. The internal device is designed to last for your lifetime, and the manufacturers offer a ten year warranty, with some restrictions. While rare, internal devices can and do fail.

During your mastoidectomy, you shouldn't experience any pain as it is performed under general anesthesia. However, just like with other surgical treatment, a mastoidectomy may leave you with some pain after the procedure is done. Your ear may feel full or congested, and the incision behind it probably hurts. Over-the-counter painkillers, such as acetaminophen or ibuprofen, can be used to treat these adverse effects. Additionally, you will get post-operative advice from your physician that will help keep you at ease as your body heals.

After the procedure is completed, a short hospital stay of one or two days is all that is required for recovery. The individual with hearing loss will be able to hear every sound clearly as soon as the procedure is carried out under the supervision of a medical professional who specializes in this area. Once he or she spends some time getting acclimated to the equipment, there won't be any more issues.

Various surgical procedures have different potential side effects. Some of them related to cochlear implant surgery are;

• Surgery-related infections are possible.
• Extrusion of the implant, where the scalp lays on top of the implant, may disintegrate and expose the implant. In that case, further surgery to remove the implant or cover it with new tissue may be required.
• You may lose the rest of your natural hearing in the ear where the implant is placed; a hearing aid should be used instead to maintain the remaining natural hearing ability.
• Although a rare occurrence, the implant can fail. In some cases, a new surgery may be needed to replace the implant.
• The implant can also fail during a sport or in an accident.
• You risk losing the remaining portion of your natural hearing in the ear where the implant is inserted; a hearing aid should be worn in its place to preserve the remaining natural hearing capacity.

Recovery Period Recovery following surgery usually happens very rapidly. Once the incision site has healed, which usually takes three to four weeks, the implant will be switched on. Here are some post-operative care tips for cochlear implant surgery;

• Use an ear plug or shower cap to keep water out of your ears. Put off submerging your head until your doctor gives the all-clear.
• Find out from your doctor when you may resume driving.
• For the first two to three days following surgery, avoid leaning over and making rapid head movements.
• When showering or swimming, you must remove the implant's external parts.
• Get a good night's sleep and be on time for your appointment to assist reduce anxiety on activation day.
• Your brain may need to practice hearing the noises you have been missing for days or even weeks before it becomes accustomed to doing so.
• Practice and perseverance will be essential to your hearing success over the coming weeks and months.
• You should put in as much speaking and listening practice as you can.
• It could take some time for you to see results, being persistent and consistent can really assist.
• In the days immediately following surgery, the majority of doctors advise against lifting even moderately high weights.
• You may need to use new or recharged batteries every day.
• You will receive specific post-operative care instructions from your surgeon. You'll probably need to set up a post-surgery appointment so your surgeon can assess your incision and progress.

Cochlear implant surgery is a minor surgical procedure to aid people with partial or complete hearing loss. During the cochlear implant surgery, an electrical system is implanted in the ear by making a tiny incision behind the ear by a medical expert. Just like any other surgical procedure this too has some risks and complications involved but given to its benefits and advantages it is worth going for cochlear implant surgery.