cochlear implant short view

1. COCHLEAR
IMPLANT
DR SATINDER

2. COCHLEAR IMPLANT BENIFITS
 They make spoken language a viable
communication option for those who B/L
severe to profound hearing losses.
 Improve speech perception
 Speech production skills
 Contribute to improved reading outcome for
school aged students.
 Systematic rehabilitation and education
programming are necessary for CIs
recipients.

3. CONTRAINDICATIONS
Absolute C/I deafness due to
lesion in 8th nerve / brainstem and
cochlear aplasia.
Chronic infections middle
ear/mastoid cavity and tympanic
perforations.
If there is total/near total, b/l
cochlear ossicfication.

4. INDICATIONS FOR COCHLEAR IMPLANTS
Bilateral severe to profound H.L. that
is not adequately treated with std.
hearing aids.
Congenital H.L./ prelingual deafness
Acquired H.L./ postlingual deafness
Severe hearing loss that can be aided
and that deteriorates to profound loss
in childhood, adolescence, or
adulthood (prelingual).

5. PREOPERATIVE CONSIDERATIONS
 Collaborative effort involving patients, families,
schools, audiologists, speech/hearing therapists,
and surgeons.
 Candidates must undergo audiologic testing and
speech evaluation.
 Candidates are recommended to undergo a hearing
aid trial to test whether hearing aids are sufficient or
an implant may be more beneficial.
 Infants with hearing impairment should also
undergo a trial with hearing aids to assess potential
benefits of amplification.

6. •MRI and/or CT scanning are needed to
assess anatomy and to evaluate for cochlear,
vestibular, and facial nerve locations, as well
as to confirm the presence of the auditory
nerve (CN VIII).
• Implants for children aged 12 months or
older with profound b/l H.L. and for adults with
similar H.L. who demonstrate limited benefit
from hearing aid use as demonstrated by
speech perception test scores.

7. AIM OF PRE-OP IMAGING
Cochleo-vestiublar anomalies
Evidence of luminal
obstruction
Additional finding that can
complicate surgical/ post-op
recovery.

8. IMAGING
 Detect inner ear
abnormality.
 Tracing course of facial
nerve in complex cong.
malformed cases.
 In case of narrow IAM
absence of the bony
cochlear nerve canal at
the modiolus.
 Detection of high riding
jugular bulb cases.
 Presence of round or oval
window
 Detect labyrinthine
ossification
 Early fibrotic
obstructions.
 Identification of
cochlear N.
 Potency of cochlear
duct
 Large vestibular
aqueduct syndrome
 CNS abnormalities
HRCT MRI

9. Complete labyrinthine ossification.
Axial HRCT showing no visualized
cochlear lumen.
Dehiscent jugular bulb. Note the absence
of a bony plate between the anterior wall of
the jugular bulb and the tympanic cavity on
axial HRCT.

10. Labyrinthitis ossificans. Cochlea on the left is obliterated by bone after meningitis. Scala
tympani of the cochlea on the right was patent, and the patient underwent successful
implantation with complete electrode insertion

11. Cochlear malformations. Neural foramen on the right is absent. Right arrow indicates a
rudimentary vestibule. On the left is a severe cochlear malformation (large arrow). Small
arrow indicates the internal auditory canal

12. APPROACHES
TRANSMASTOID APPROACH
MIDDLE CRANIAL FOSSA
APPROACH
MINIMALLY INVASIVE COCHLEAR
IMPLANT SURGERY

13. FOLLOW-UP/MONITORING
Candidate attend weekly speech
therapy sessions, language
expression, social skills, lip reading
and hearing tactics
Meet with the surgeon in the follow-
up period to address any wound-
healing issues
Prognosis for hearing improvement
and improved quality of life

14. COMPLICATIONS
Flap dehiscence,
Seroma formation,
Implant migration,
Facial nerve stimulation,
Perilymphatic or CSF gusher,
Device failure.
Mennigitis