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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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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.
Cochlear Implantation Podcasts
Listen to leading physicians discuss cochlear implantation on the BackTable ENT Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Episode #197
It’s not an overstatement to say that surgeons from The House Clinic revolutionized otology / neurotology in the second half of the twentieth century. In this episode of the BackTable ENT podcast, Dr. John House, son of the clinic’s founder, Howard, discusses the clinic’s fabled history with guest host Dr. Walter Kutz (UT Southwestern).
Episode #180
Any otolaryngologist or cochlear implant (CI) patient can tell you that the journey to better hearing begins in earnest after CI activation. When the patient in question is a child, what does that journey look like? In this episode of the BackTable ENT podcast, Dr. Sarah Cordingley, audiologist with Peak ENT (Provo, Utah), joins host Dr. Gopi Shah to discuss aural rehabilitation for pediatric CI patients.
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.
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.
Podcasts
Articles
Pediatric Cochlear Implant Risks, Complications & Counseling
Pediatric Cochlear Implants: Candidacy, Diagnosis, & Mapping
Cochlear Implant Surgery Procedure Techniques & Complications
Contributors
Dr. Marlan Hansen
Dr. John House
Dr. Jacob Hunter
Dr. Anita Jeyakumar
Dr. Christopher Kaufmann
Dr. Prashant Malhotra