Cochlear Implants: Patient Information
Cochlear implant
Expectations for surgery
Surgical risks of cochlear implantation
Post-operative considerations
Post-operative instructions
Cochlear implant activation
Sound Processor Replacement Policy

 

Cochlear implant:

A cochlear implant is an electronic device that partially restores hearing in people who have severe hearing loss and who do not benefit from conventional hearing aids.  A processor behind the ear captures and processes sound signals, which are transmitted to a receiver implanted into the skull behind the ear. The receiver relays the information to the inner ear (cochlea). 

A patient needs to commit to the required time and training to become an effective cochlear implant user.

Results vary from person to person and most find that cochlear implant improves both communication and quality of life. Patients often report:

• Improved ability to recognize common environmental sounds
• Improved ability to hear speech without reliance on visual cues
• Improved speech reading ability
• The ability to detect soft sounds
• The ability to locate where sounds are coming from


Expectations for surgery:

The cochlear implant procedure is performed while you are under general anesthesia and takes approximately three hours.  The ear, nose and throat surgeon makes an incision behind the ear and forms a slight depression in the mastoid bone, where the internal device rests. The surgeon then creates a small hole in the cochlea and threads the electrode array along the nerve of hearing.   The incision is closed so that the internal device is beneath the skin.  Most people feel well enough to return home the day of surgery, however, some patients require an overnight stay at the hospital following surgery. 

Generally regular Tylenol or Tylenol #3 (with codeine) is all that is needed for pain control.  You may be provided either or both an antibiotic and oral steroid.  After surgery, you may experience some nausea or dizziness.  


Surgical risks of cochlear implantation:

There are significant risks associated with surgery.  They are infrequent (less than 1%), but very important to consider.

Facial nerve injury
The facial nerve is the nerve that controls the muscles of the face.  In order to insert the cochlear implant electrode, the surgeon needs to remove the bone immediately over the facial nerve.

Dizziness
The vestibular system (your “balance centre”) is located deep inside the ear and is connected to the cochlea (you “hearing centre”).  The vestibular system helps you to keep your balance, and tells you whether you are moving or standing still. 

Meningitis
The cochlea directly communicates with the brain.  The hole needed to insert a cochlear implant presents an opportunity for an infection to access the brain. Because there is a risk of meningitis, your surgeon will ask you to ensure you have received vaccinations against the most common organisms associated with meningitis (Hemophilus influenza and Streptococcus pneumoniae). 

Change in taste in the mouth
The chorda tympani nerve is a nerve that controls taste centres on the front of your tongue.  This nerve travels through the ear, very close to the facial nerve.

Device failure
The cochlear implant is an electronic device and can fail.  If this occurs, a new device can be implanted.

General anesthesia
There are risks associated with getting a general anesthetic.  Surgery under general anesthetic is very common, and is a standard practice for most major surgery.  These risks are dependent on your general health. The anesthetist will discuss these with you before surgery.

Bleeding & wound infection
The surgical area is closed with stitches (a small permanent scar may result) and the head is bandaged, hence slight bleeding may occur post-surgery.  Infection most commonly occurs at the incision site, and can cause pain, fever, inflammation or drainage from the wound.  Patients who experience these side effects after surgery may require additional medical intervention or antibiotic treatment to resolve bleeding and infection complications.


Post-Operative Considerations:

Magnetic Resonance Imaging (MRI) scan
A Cochlear implant contains a magnet located under the skin.  MRI (magnetic resonance imaging) scans involve creating magnetic fields and then use the information to create a “picture”.  Magnets are not permitted in the MRI scanner.  This is because these objects can move.  This can injure the device, surrounding skin or hearing nerve.  Certain cochlear implants are compatible with lower strength scanners.  Before any imaging, it is important to remind your doctors and nurses that you have a cochlear implant.
 
Cautery during surgery
Cautery is a surgical tool used by surgeons to control bleeding during surgery.  Cautery works by using electrical currents.  Because the cochlear implant contains metal, it may attract the electrical current.  Hence, monopolar cautery is not advised for surgery on the head and neck after cochlear implant surgery.  Certain types of cautery (“bipolar” cautery) are acceptable if at least 1cm away from the device. 

Traveling with your cochlear implant
Metal detectors and security scanners in airports will not damage the implant or sound processor. However, individuals with a cochlear implant passing through security metal detectors may activate the detector alarm.  It is advised that patients carry their “Patient Emergency Identification Card” with them at all times. 

Cochlear implant users may also hear a distorted sound caused by the magnetic field around the security scanner door or hand-held scanning wand. Turning off the sound processor before passing through security screening will ensure that those sounds are not too loud or uncomfortable, should they occur.

Have your doctor contact your cochlear implant surgeon to discuss any of these issues. 

Post-Operative Instructions:

Following any surgery your resistance is down, so don't expect to be in full swing. Everyone is an individual with different responses to surgery. Do not hesitate to call your doctor if you have any problems or questions.

  • After discharge from the hospital you may resume most normal activities.
  • Absolutely no heavy lifting (nothing over 25 lbs.) for 6 weeks after surgery.
  • Absolutely no vigorous exercises (jogging, tennis, aerobics) for 6 weeks after surgery. 
  • Do not bend. If you need to bend over to pick up something, bend at your knees.
  • Avoid water over the incision until at least 1 week after surgery.
  • Staples need to be removed within 2 weeks after surgery. You may shampoo your hair after staple removal - carefully.
  • Flying is usually permitted 2 weeks after surgery.
  • If your work is not strenuous, you may return to work 3 to 4 days from the date of surgery. Check with your doctor if your work requires heavy lifting.
  • You may drive if no dizziness is present and you are not taking narcotic pain relievers.
  • You may hear a variety of strange noises in your ear, such as cracking, popping, ringing, etc., and you may sense a feeling of fullness or pressure in your ear. You may also have pain when chewing. This is normal.
  • Do not blow your nose vigorously for 10 days after surgery. After 10 days, you may blow your nose gently, one side at a time, with your mouth open.

Call your doctor's office immediately if you experience any of the following:

For Dr. Darren Leitao:  204-787-3349
For Dr. Jordan Hochman: 204-787-3575

  • Fever (oral temperature above 101.5 degrees Fahrenheit).
  • New weakness or numbness of the face.
  • Pain that is not helped by taking pain medication and is getting worse rather than better. 
  • Severe new headaches.
  • Redness and/or swelling around the incision.
  • Severe vertigo and vomiting.

Should you experience a problem at night or during the weekend, please present to the Health Sciences Centre Emergency Department.


Cochlear Implant Activation:
 
Four to six weeks after surgery, the external components of the device can be programmed and activated. There is no ability to use the device until activation.  The typical cochlear implant fitting schedule includes:

Initial Stimulation – This is when you will be given the external components and your device will be activated. This is usually 4-6 weeks post-surgery. We will do some testing of your internal device and create your first map.

Day 2 – A follow-up to your Initial Stimulation, we will repeat some of the testing on the internal device and go over all the accessories provided in your equipment kit.

Week 1 – Regular follow-up to fine-tune your map.

Week 2 – Regular follow-up to fine-tune your map.

Week 4 – You get a break during your 3rd week of CI use and don’t have to return to the clinic until Week 4, where regular follow-up mapping is done. It may seem repetitive by now, but small adjustments can make big changes with sound quality and speech understanding.

3 month – Regular mapping. Often at this appointment speech perception testing in the sound booth is attempted in order to obtain baseline results to track progress over time.

6 month – Regular mapping, equipment check and speech perception testing in the sound booth.

9 month – This is an optional appointment, for those who feel extra guidance/mapping is needed.

Annual – Once you have reached your annual mark, you will no longer need frequent mapping. You will be contacted for an annual appointment for full mapping and speech perception testing to ensure optimal settings are maintained.  You are free to contact the clinic any time and as often as necessary should there be equipment or sound issues.

For more information on the cochlear implant rehabilitation process, please contact the Central Speech and Hearing Clinic:

Attention: Kelly Boyd
Phone:  204-275-7436
Email:  office@centralspeech.ca
Unit 2 – 1325 Markham Road
Winnipeg, Manitoba R3T 4J6

 

Sound Processor Replacement Policy:
 
There are no up-front costs to Manitoba residents who proceed with cochlear implant surgery as Manitoba Health covers the surgical procedure, internal implant and the first external sound processor.

Adult patients are responsible for the upgrade costs of their sound processor when it requires replacement ($10,000).

Pediatric patients (under 18 years of age) are eligible for funding assistance through the Cochlear Implant Speech Processor Replacement Program, which provides up to 80% of the replacement costs associated with a device upgrade.

Families of pediatric patients interested in the Cochlear Implant Speech Processor Replacement Program can download the application form here.

Contacts:

Dr. Darren Leitao, MD FRCSC
Cochlear Implant Surgeon (Adult and Pediatric)      

Dr. Jordan Hochman, MD FRCSC
Cochlear Implant Surgeon (Adult)         

Justyn Pisa, Au.D. 
Audiologist
Surgical Hearing Implant Coordinator

Kristy Mackie, M.Sc. Aud(C)
Audiologist
Central Speech & Hearing Clinic

Daniela Stangherlin, Au.D. CCC-A
Audiologist
Central Speech & Hearing Clinic

Jacob Sulkers, M. CI.Sc.
Audiologist
Central Speech & Hearing Clinic 

 

 

 

 

Vaccination Forms:


Vaccination Policy for All Patients

Vaccination Form for Physicians

 

Patient Resources:


Cochlear Implant Information for Patients

MRI Policy for Cochlear Implants

Monopolar Cautery for Cochlear Implants

Sound Processory Replacement Policy 

Sound Processor Replacement Application



External Links:


Central Speech and Hearing Association

Canadian Hard of Hearing Association

Society for Manitobans with Disabilities

Manitoba Health Services

Manitoba School for the Deaf