Pediatric Cochlear Implant (CI) Surgery

Pediatric Cochlear Implant (CI) Surgery

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Summary

Cochlear implant surgery is common and is typically performed as a day surgery and does not require an overnight say at the hospital.

Surgery

Our office will assist you and your child thru the surgical process from beginning to end.

Pre-operative appointment

Surgery

  • Preparation - The child is placed under general anesthesia.  Facial monitoring is utilized in all cases and consists of small electrode needles above the eye and over the corner of the mouth.  If the facial nerve is disturbed during the operation, the facial nerve monitor will make an audible sound alerting the surgeon to the stimulation of the nerve. A small amount of hair may be shaved if necessary.  The surgical region is prepped and draped in a sterile fashion. Intra-operative antibiotics are administered.
  • Soft tissue exposure - An incision is made about a finger-breadth from the crease behind the ear.  A pocket is then made behind the ear where the implant will be placed.  Sometimes a well will be created in the bone to seat the implant.  The mastoid bone and ear canal are then visualized.
  • Mastoidectomy - A standard mastoidectomy is performed.  This entails removal of the bone under and behind the ear.  The small ear bones and balance canals are visualized as landmarks.  A facial recess is opened that allows visualization in the middle ear without disturbing the ear drum.  The facial recess is a space between the facial nerve, chorda tympani nerve (nerve that provides taste to the tip of the tongue), and the ear drum.  Once the facial recess has been opened, the round window of the cochlea is visualized.
  • Cochleostomy - A small hole (cochleostomy) is created in the wall of the cochlea near or including the round window.  This allows access to the inside of the cochlea where the cochlear implant electrode will be placed.  A slick substance called Healon is placed over the cochleostomy and the electrode is gently placed into the cochlea.  Small pieces of tissue are packed around the cochleostomy.
  • Securing the Implant - The implant is then secure into the well or under a tissue pocket.  Sutures are often used to secure the implant to surrounding bone or soft tissue to prevent the implant from moving.
  • Closing the surgical incision - The surgical site is closed in layers to prevent the implant from protruding through the skin.  The skin is usually closed with Dermabond that prevents the need for suture removal. The child is then awakened and transported to the recovery room. Your child may notice the receiver as a small  bump behind her ear. 
  • Between one and four weeks after surgery, to allow time for healing, the doctor will place the speaker and transmitter outside your child’s ear. 

Post Operative Follow Up

Auditory rehabilitation and/or speech-language therapy is recommended for children.

Audiology

Cochlear implantation is a life-long commitment from the family and child. Following cochlear implantation children return for their initial stimulation of the cochlear implant three to four weeks after surgery. This appointment and other follow-up appointments are completed at the UTD/Callier Center. 

Children typically attend seven MAPping or programming appointments with the audiologist during the first year after implantation. MAPping or programming is the process by which the audiologist determines the amount of electrical stimulation each electrode delivers to the auditory nerve so that the child can respond. 

After the first year, children are typically seen twice a year for MAPping or programming. Of course, some children may need to be seen more often depending on their specific needs. Additional appointments for troubleshooting of the cochlear implant equipment or for FM system fittings may also be scheduled.

Speech-Language

The amount and type of therapy is dependent of each child’s individual needs. However, in general, children need weekly individual therapy sessions that emphasize listening with a cochlear implant and improving their communication skills.

From Childhood to Adulthood

Our affiliation with the Dallas Cochlear Implant Program allows our pediatric patients the opportunity to continue uninterrupted, consistent care into adulthood. This program has some of the world's most widely recognized cochlear implant speech-language scientists working hard to understand how cochlear implants can most effectively be used to improve speech and language outcomes and quality of life.

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