Cochlear Implant Surgery Workup

  • Author: Cliff A Megerian, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Nov 6, 2011
 

Laboratory Studies

Preoperative laboratory studies include those germane to any standard otologic procedure. These studies include CBC count, electrolytes, and clotting time studies.

Controversy exists regarding the preoperative laboratory workup with respect to issues particular to patients with severe sensorineural hearing loss.

  • If the patient has rapidly progressive hearing loss or other signs or symptoms of autoimmune hearing loss, an immunologic workup is often indicated during the evaluation of the patient. Treatment of autoimmune inner-ear disease should be instituted in patients with bilateral progressive hearing loss in the event that the hearing loss is rapid over weeks. The immunologic workup may include a Western blot analysis for antibodies to the heat shock protein. Failure to achieve serviceable hearing after a course of steroid therapy is often an indication for cochlear implantation.
  • If syndromic causes of hearing loss are suggested (eg, Pendred syndrome, Alport syndrome), obtain appropriate complementary serologic tests (eg, thyroid studies, renal studies).

Although genetic testing regarding the molecular basis for a patient's deafness most likely would not change the plans for cochlear implantation, obtaining available blood tests for genetic markers of specific mutations known to cause sensorineural hearing loss, such as the test for connexin 26 mutations, is helpful for counseling reasons.

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Imaging Studies

Traditionally, high-resolution CT scanning of the temporal bone has been the mainstay of the preoperative radiographic workup of cochlear implant candidates.

  • This study helps determine the absence of malformations that contraindicate implantation (eg, cochlear aplasia, absence of the auditory nerve). Additional relative contraindications, such as chronic otitis media, are revealed with high-resolution CT.
  • CT scanning also reveals abnormalities that alter the standard insertion procedure of the electrode array. These abnormalities include Mondini dysplasia, common cavity, and cochlear ossification. Suspect cochlear ossification in patients with a history of meningitis.

In some centers, high-resolution T2-weighted fast spin echo MRI is complementing and even replacing CT scanning because of its increased ability to reveal cochlear ossification.

In patients older than 40 years, preoperative chest radiography is performed as per protocol in most hospitals. In addition, before leaving the operating room after cochlear implantation, plain film radiography of the cochlea in the anteroposterior plane (transorbital) is useful to confirm correct placement of the electrode array, but, more importantly, chest radiography is used to provide evidence and confirmation of correct initial placement in the event that delayed implant malfunction arises and electrode migration is suspected.

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Contributor Information and Disclosures
Author

Cliff A Megerian, MD, FACS  Medical Director of Adult and Pediatric Cochlear Implant Program, Vice-Chairman and Director of Otology and Neurotology, University Hospitals of Cleveland; Professor, Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery, Case Western Reserve University School of Medicine

Cliff A Megerian, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Association for Research in Otolaryngology, Massachusetts Medical Society, Society for Neuroscience, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: cochlear americas Consulting fee Board membership

Coauthor(s)

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting

Gail S Murray, PhD, MEd  Clinical Director, Cochlear Implant Program, Director, Department of Audiology Services, University Hospitals of Cleveland, Rainbow Babies, and Children's Hospital of Cleveland

Gail S Murray, PhD, MEd is a member of the following medical societies: American Academy of Audiology and American Speech-Language-Hearing Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Battista, MD, FACS  Assistant Professor of Otolaryngology, Northwestern University Medical School; Physician, Ear Institute of Chicago, LLC

Robert A Battista, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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  2. Van Naarden K, Decoufle P, Caldwell K. Prevalence and characteristics of children with serious hearing impairment in metropolitan Atlanta, 1991-1993. Pediatrics. Mar 1999;103(3):570-5. [Medline].

  3. National Institute on Deafness and Other Communcation Disorders. National Institute of Health. National strategic research plan. In: US Department of Health and Human Services. Vol 5. 1996.

  4. Linthicum FH Jr, Fayad J, Otto SR, et al. Cochlear implant histopathology. Am J Otol. Jul 1991;12(4):245-311. [Medline].

  5. National Institutes of Health. NIH Consensus Statement. Cochlear Implants in Adults and Children. 1995, May15-17;13(2):1-30.

  6. Gantz BJ, Tyler RS, Knutson JF, et al. Evaluation of five different cochlear implant designs: audiologic assessment and predictors of performance. Laryngoscope. Oct 1988;98(10):1100-6. [Medline].

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  9. Biernath KR, Reefhuis J, Whitney CG, et al. Bacterial meningitis among children with cochlear implants beyond 24 months after implantation. Pediatrics. Feb 2006;117(2):284-9. [Medline].

  10. Das S, Buchman CA. Bilateral cochlear implantation: current concepts. Curr Opin Otolaryngol Head Neck Surg. Oct 2005;13(5):290-3. [Medline].

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  14. House WF, Urban J. Long term results of electrode implantation and electronic stimulation of the cochlea in man. Ann Otol Rhinol Laryngol. Jul-Aug 1973;82(4):504-17. [Medline].

  15. Nadol JB Jr. Hearing loss. N Engl J Med. Oct 7 1993;329(15):1092-102. [Medline].

  16. Ng M, Niparko JK, Nager GT. Inner ear pathology in severe to profound sensorineural hearing loss. In: Niparko JK, Mirk KI, Mellon NK, et al, eds. Cochlear Implant. Philadelphia: Lippincott Williams & Wilkins; 2000:57-87.

  17. Niparko JK. The epidemiology of hearing loss. In: Niparko JK, Tucci DL, Robbins AM, Kirk KL, Mellon NK, eds. Cochlear Implants: Principles and Practices. Philadelphia: Lippincott Williams & Wilkins; 2000:88-92.

  18. Niparko JK, Wilson BS. History of cochlear implants. In: Niparko JK, Tucci DL, Robbins AM, Kirk KL, Mellon NK, eds. Cochlear Implants: Principles and Practices. Philadelphia: Lippincott Williams & Wilkins; 2000:103-107.

  19. Rubinstein JT, Gantz BJ, Parkinson WS. Management of cochlear implant infections. Am J Otol. Jan 1999;20(1):46-9. [Medline].

  20. Tambyraja RR, Gutman MA, Megerian CA. Cochlear implant complications: utility of federal database in systematic analysis. Arch Otolaryngol Head Neck Surg. Mar 2005;131(3):245-50. [Medline].

  21. Tucci Dl, Niparko JK. Medical and surgical aspects of cochlear implantation. In: Niparko JK, Tucci DL, Robbins AM, Kirk KL, Mellon NK, eds. Cochlear Implants: Principles and Practices. Philadelphia: Lippincott Williams & Wilkins; 2000:194-195.

 
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Postauricular incision for cochlear implant.
Mastoidectomy has been performed, as well as facial recess approach. Attention is now turned to marking the site for implant-well drilling.
Tie-down holes have been created and 2-0 nonabsorbable sutures have been placed through 1-mm holes drilled into the ledge of bony well.
Cochleostomy is performed (upper left hand corner) prior to placing implant into receiver well (main photo).
Once electrodes are placed into cochleostomy and extracochlear electrode lead is placed under temporalis muscle, closure of periosteal tissue can begin.
A water-tight periosteal closure is performed, and skin closure begins with a subcutaneous absorbable suture line.
Implant well is drilled down to the dura.
Cochlear Implant is secured into the skull via suture. The ground electrode is placed under the temporalis muscle and the electrode array is inserted into the scala tympani. The stylet is then removed.
Depicts patient prepped out in sterile techique. Post-auricular incision marked
Dummy template helps determine drill site for cochlear implant
 
 
 
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