Surgery

Cochlear Implant Surgery

• Report any signs of illness, temperature, or ear drainage that occur within 10 days prior to surgery especially if the patient has ventilation tubes in place.
• Usually we ask patients not to use aspirin, aspirin containing products, fish oil, or vitamin supplement with Vitamin A or C two weeks before surgery as they can act as a blood thinner. However, the patient’s medications will be reviewed at the pre-operative appointment for confirmation.
• The patient should not have anything to eat or drink anything after midnight the day before surgery which is part of the standard pre-operative anesthesia precaution. Any exceptions can be discussed during the pre-operative visit.
• Cochlear implant surgery lasts approximately 2 hours. Recipients usually stay overnight and are typically discharged early the next morning. Patients have a dressing in place over the operated ear that stays in place for 24 – 48 hours. Discomfort is usually mild and well controlled with oral pain medication for several days.
• The patient will wear a hospital gown for the surgery but bring clothes to wear home. A shirt that buttons or zips up the front is optimal.
• Incision care and activity level will be explained before the patient leaves the hospital and a printed instruction sheet will also be provided. Keep the area clean and dry until returning to the doctor to have the stitches removed about 10 days after surgery.

Risk of Surgery

Risks are part of any surgical procedure but those associated with cochlear implantation are not common and can usually be addressed while continuing to use the implant device. Your surgeon will discuss the risks with you in detail during the pre-operative office visits. The most common risks (including but not limited to the following) are:

• Fluid or blood collection over the surgical site will necessitate removal of the fluid collection (which can typically be performed in the office setting).
• Infection of the implant device may require oral or IV antibiotic therapy. Rare cases of infection may require device removal.
• Taste disturbance.
• Facial nerve weakness or paralysis after the surgical procedure on the side of surgery.
• Dizziness (vertigo).
• Soreness, numbness, redness, or break-down of skin in area around internal device.
• Tinnitus or ringing can occur in the implanted ear which is typically transient.
• Perilymphatic fluid leak that may necessitate further surgery.
• Increased risk for meningitis.
• Failure of implanted components possibly requiring removal and replacement.
• Anesthetic risks associated with the heart, lungs, kidneys, liver and brain.

Meningitis Vaccines Information

Bacterial meningitis is a serious infection of the brain and the fluid that surrounds the brain. Bacterial meningitis is a life-threatening infection. Individuals who have a cochlear implant are at increased risk for bacterial meningitis. Although this risk is small, it is important for children and adults with a cochlear implant to be vaccinated against the bacteria that can gain entry into the brain and commonly cause bacterial meningitis. Two types of bacteria have produced the vast majority of cases of meningitis after cochlear implantation: Streptococcus pneumonia “Pneumococcus”) and Haemophilus influenzae type b (“Hib”). Cochlear implant users and their families should be aware that vaccines against pneumococcus and Hib are widely available. These vaccines strengthen the body’s ability to protect against the common causes of bacterial meningitis. Some infections with pneumococcus are now not treatable with routine antibiotics. This is another reason for being sure to get vaccinated.

Meningitis Vaccines

Pneumo Vaccines
There are two types of pneumococcal vaccine, Prevnar® for children being vaccinated when they are less than 2 years of age and Pneumovax® for those being vaccinated when they are over 2 years of age. Prevnar® is part of the routine infant immunization schedule in the United States; therefore all children should have received this vaccine in infancy. It is important to verify that your child has received all doses of their Prevnar® series, and if not, to catch up.

If you or your child undergo cochlear implantation, you should verify which vaccines against pneumococcus you or your child has received and obtain additional doses if you are not fully immunized. Age at the time of vaccination will determine which type of pneumococcal vaccine should be received:

• Children under the age of 2 y: Vaccination with the Prevnar® series followed by Pneumovax® when the child reaches 2 y of age. (Pneumovax® is not effective in children under 2 y.)
• Children 2 to 4 y of age: Complete the Prevnar® series if not fully vaccinated. Vaccinate with Pneumovax® at least 2 mos after the last Prevnar® dose.
• Children 5 y and older and all adults: Initial Pneumovax® vaccination If an adult or child did not receive Pneumovax® before their implant surgery, it is important for them to receive this vaccination now.
• The sooner the vaccine is given the sooner you or your child will be protected. It is never "too late" after surgery to benefit from Pneumovax®.
• Second doses of Pneumovax: If it has been 5 or more yrs since the initial Pneumovax® vaccine, discuss a repeat vaccine with your physician. A second dose of Pneumovax® may provide additional coverage for some individuals, including young children and adults over the age of 65.

Most people receive vaccinations such as Prevnar® and Pneumovax® from primary care providers such as pediatricians, internists, or family physicians.

Further information on the availability of vaccinations is available through general medical clinics sponsored by state and local government and by hospitals. In addition, further information on vaccine availability can be found at www.fda.gov/cdrh/safety/101007-cochlear.html and www.fda.gov/cdrh/medicaldevicesafety/atp/101007-cochlear.html.

Hib Vaccine
Haemophilus influenza type b meningitis is most common among infants and young children. Cochlear implants may increase the risk of Hib meningitis, so it is essential to be vaccinated against Hib disease because bacterial meningitis is life threatening whether you have a cochlear implant or not. Hib vaccine is part of the routine early childhood vaccination series and provides important protection against bacterial meningitis in children with cochlear implants. The Hib vaccine is critical in protecting against meningitis in young children with a cochlear implant. If you received your cochlear implant after age 2 y, or if you are currently older than age 2 y, you do not need to now receive Hib vaccine.

Follow-up Care

Cochlear implant users and their families should also be aware that vaccinations do not eliminate the risk of meningitis. If an ear with a cochlear implant develops a discharge from the ear canal, or produces unusual ear symptoms or a watery nasal discharge, or is diagnosed with a middle ear infection, it is important to have that ear examined by the cochlear implant surgeon or another suitably experienced ear surgeon. Infections in a child or an adult with a cochlear implant should be taken seriously. Untreated middle ear and other infections may spread to produce meningitis or other complications.