BackTable / ENT / Topic / Procedure

Cochlear Implantation

It is estimated that nearly 50 million people worldwide suffer from severe hearing loss. The majority of that burden is due to sensorineural hearing loss (SNHL). Current therapies for SNHL include hearing aids for milder hearing loss and cochlear implants as hearing loss advances. While hearing aids function to amplify sound through the traditional auditory pathway, cochlear implants directly stimulate spiral ganglion neurons which can enhance hearing even in patients with advanced hearing loss. Cochlear implants are often considered to be the most successful implanted sensory device in the world having restored hearing to thousands of individuals.

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Ep 157 Working Together: Language Development in Deaf & Hard of Hearing Children with Dr. Anita Jeyakumar

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Pre-Op Evaluation

Pre-operative evaluation involves a detailed hearing assessment to identify the relative benefit of well-fit hearing aids compared to cochlear implants. Insurance coverage is usually provided for patients who have bilateral SNHL that is moderate-severe at low frequencies and profound at high frequencies even when using hearing aids. It is common for the ear with the worse hearing to be selected for implantation first, thereby allowing the patient to retain the hearing aid in the contralateral ear.

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In this crossover episode of BackTable, Dr. Eric Gantwerker interviews Dr. Chris Kaufmann and Dr. Marlan Hansen from the University of Iowa about their startup company, iotaMotion, which has developed the first FDA-approved robotic cochlear implant insertion system.

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Adult Cochlear Implantation

We speak with Dr. Jacob Hunter about Adult Cochlear Implantation, including patient workup and counseling, surgical tips and tricks, and post procedure followup.

Surgical Approach

The classic surgical approach is a facial recess/posterior tympanotomy approach which is used in both pediatric and adult patients. Such an approach allows for a relatively direct route to the round window membrane through which the cochlear implant electrode is inserted. Alternative approaches are often reserved for patients with unique anatomic considerations that necessitate deviation from the facial recess approach.

Cochlear Implantation Articles

Read our exclusive BackTable ENT Articles for quick insights on cochlear implantation, provided by physicians for physicians.

Pediatric Cochlear Implant Risks, Complications & Counseling

Cochlear implant risks include infections of the middle ear, injury to the dura causing CSF leaks, and facial nerve injury. Certain cochlear implant precautions can be taken to ensure that these risks and complications are minimized.

Pediatric Cochlear Implants: Candidacy, Diagnosis, & Mapping

There are many considerations to keep in mind when screening pediatric cochlear implant candidates. Certain diagnostic testing can help aid in management with special importance given to pediatric cochlear implant mapping.

Cochlear Implant Surgery Procedure Techniques & Complications

Cochlear implant surgery can greatly improve the quality of life for adults facing hearing loss. Dr. Jacob Hunter provides his insights on the cochlear implant procedure. Additionally, he covers potential cochlear implant techniques, complications, & special considerations for elderly populations.

Adult Cochlear Implantat Indications & Evaluation

Cochlear implant indications are typically bilateral severe-to-profound sensorineural hearing loss with little to no benefit from appropriately fit hearing aids. It is important to perform a proper cochlear implant evaluation & screening for candidacy. Learn more about the cochlear implant journey.

Post-Op Considerations

The cochlear implant itself is typically not activated until 2-4 weeks following the procedure. The decision to undergo implantation in a second ear is often dictated by patient response to the first implant. Cochlear implant surgery is relatively low-risk and is often performed as an outpatient surgical procedure. Complications can include infection, hematoma, surgical site pain, and facial nerve paralysis. Additionally, nearly half of patients who undergo CI lose their pre-operative residual hearing ability, known as acoustic hearing, and become reliant on electrical stimulation. However, new technologies are being developed to mitigate this loss.

References

[1] Naples JG, Ruckenstein MJ. Cochlear Implant. Otolaryngol Clin North Am. 2020 Feb;53(1):87-102. doi: 10.1016/j.otc.2019.09.004. Epub 2019 Oct 31. PMID: 31677740.
[2] Carlson ML. Cochlear Implantation in Adults. N Engl J Med. 2020 Apr 16;382(16):1531-1542. doi: 10.1056/NEJMra1904407. PMID: 32294347.

Disclaimer: The Materials available on https://www.BackTable.com/ are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.