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Cochlear Implants in Adults
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
10 sections · 120 slides
Introduction
- Cochlear implant as a neural prosthesis
- Benefits beyond hearing threshold
- Milestones in cochlear implant development
- Cochlear implant utilization in the United States
- The adult referral gap
- Expansion of adult candidacy categories
Indications
- Approved manufacturers in the United States
- Stagnation and expansion of FDA criteria
- Reading the FDA indications table
- FDA indications for cochlear implants in adults: audiometric criteria
- FDA indications for cochlear implants in adults: speech recognition criteria
- Hybrid and electro-acoustic device approvals
- Single-sided deafness and asymmetric loss approvals
Preoperative evaluation
- Absolute contraindications to implantation
- Relative contraindications
- History in the cochlear implant candidate
- Physical examination
- Perioperative antiplatelet and anticoagulant therapy
- Audiologic evaluation and the Minimum Speech Test Battery
- Minimum Speech Test Battery version 3
- Hearing aid benefit as the decisive variable
- Off-label implantation and non-audiometric factors
- Aims of radiographic evaluation
- Obtaining MRI before implantation
- Complementary strengths of CT and MRI
- CT and MRI evaluation of the temporal bone
- Choosing which ear to implant: audiologic factors
- Choosing which ear to implant: anatomic factors
- Rationale for implanting the poorer-hearing ear
- Meningitis risk and the basis for vaccination
- Pneumococcal vaccination before implantation
Device and electrode selection
- Lateral wall and perimodiolar electrode arrays
- Scalar translocation and tip fold-over
- Array length, insertion depth and performance
- Rationale for hearing preservation
- Soft surgical technique
- Adjuncts to hearing preservation
- Full-length versus shortened arrays in residual hearing
Surgical technique
- Sequence of the transmastoid facial recess approach
- Preoperative preparation on the day of surgery
- Evidence for perioperative antibiotics
- Antibiotic choice in practice
- Anaesthesia and facial nerve monitoring
- Planning the postauricular incision and device site
- Historical incision designs
- Soft tissue elevation and receiver pocket
- Fixation of the receiver-stimulator
- Cortical mastoidectomy landmarks
- Cortical mastoidectomy
- The opened facial recess
- Opening the facial recess
- Safe drilling through the facial recess
- Locating the round window from the stapes
- Removing the round window niche
- Round window approach to the scala tympani
- Exposed round window membrane
- Alternative cochlear fenestrations
- Preparation immediately before insertion
- Electrode array entering the cochlea
- Scala tympani position after insertion
- Coiling the excess lead in the mastoid cavity
- Sealing the cochleostomy and facial recess
- Closure of the wound
- Intraoperative confirmation of array position
- Intraoperative device and neural response testing
Postoperative considerations
- Activation and first postoperative visit
- Early activation at five to seven days
- MRI conditionality of current implants
- Implant artifact and tumour surveillance on MRI
- Monopolar electrocautery after implantation
Complications
- Risks discussed during consent
- Facial nerve injury after implantation
- Chorda tympani injury and taste disturbance
- Perilymph fistula and cerebrospinal fluid gusher
- Soft tissue complications
- Skin flap thickness and magnet strength
- Extrusion of the receiver-stimulator fantail
- Electrode migration
- Hard and soft device failure
- Vestibular effects of implantation
- Postoperative facial stimulation
Outcomes
- Historical expectations and measurement
- Variability in speech recognition outcomes
- Predictors of individual outcome
- Groups with lower expected speech outcomes
- Prelingually deafened adults
- Long-deafened ears with contralateral hearing
Special considerations
- Benefits of bilateral implantation
- Deciding on second-side implantation
- Single-sided deafness and asymmetric hearing loss
- Electro-acoustic stimulation in practice
- Effect of implantation on tinnitus
- Labyrinthitis ossificans
- Inner ear enhancement after meningitis
- Labyrinthine ossification on bone-window CT
- Imaging and timing in labyrinthitis ossificans
- Operative options in an ossified cochlea
- Implantation with chronic ear disease
- Implantation in a canal wall down cavity
- Surveillance imaging after subtotal petrosectomy
- Indications for revision surgery
- Technique in revision implantation
Summary
- Key points on candidacy
- Key points on surgery and complications
- Conclusion
- Selected references
- Selected references (continued)
- Selected references (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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