Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy
CPT4 code
Name of the Procedure
Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy
Summary
This procedure involves surgically implanting a specialized device into the temporal bone behind the ear. The device includes an osseointegrated implant that connects to a speech processor or cochlear stimulator through the skin. A mastoidectomy, surgical removal of part of the mastoid bone, is performed as part of this process.
Purpose
The procedure is aimed at individuals with severe hearing loss who may not benefit from conventional hearing aids. It helps to improve hearing by directly stimulating the auditory nerve, thereby facilitating better sound perception and speech understanding.
Indications
- Severe or profound sensorineural hearing loss
- Chronic infections preventing the use of conventional hearing aids
- Structural issues with the ear canal that make hearing aids impractical
- Patients who have not had success with other, less invasive treatments
Preparation
- Fasting several hours before the procedure (typically overnight)
- Stopping certain medications as advised by the physician
- Pre-operative hearing tests and imaging studies like CT scans to assess the temporal bone
- Consultation with an audiologist and ENT specialist
Procedure Description
- Anesthesia: Administered general anesthesia.
- Incision: A small incision is made behind the ear to expose the temporal bone.
- Mastoidectomy: The surgeon performs a mastoidectomy to create an appropriate space for the implant.
- Drilling: A precise cavity is drilled into the mastoid bone to fit the osseointegrated implant.
- Implantation: The implant is inserted and secured in place.
- Attachment: A percutaneous attachment is created to allow the speech processor or cochlear stimulator to connect externally.
- Closure: The surgical site is closed with sutures and a dressing is applied.
Duration
The entire procedure typically takes about 2 to 3 hours.
Setting
The procedure is performed in a hospital or specialized surgical center.
Personnel
- ENT Surgeon (Ear, Nose, and Throat Specialist)
- Audiologist
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection at the implant site
- Nerve damage leading to facial weakness or numbness
- Persistent ringing in the ears (tinnitus)
- Dizziness or balance issues
- Device failure or need for revision surgery
- Rare complications such as cerebrospinal fluid leakage
Benefits
- Significant improvement in hearing
- Better quality of life due to enhanced ability to communicate
- Immediate improvement in hearing once the external processor is attached and activated
Recovery
- Initial recovery takes about 1 to 2 weeks, with specific care for the surgical site
- Limited physical activity and avoiding water exposure to the surgical site during the initial healing period
- Follow-up appointments for wound check, and audiologist visits for device fitting and programming
- Full integration of the device and optimization of hearing may take several months
Alternatives
- Traditional hearing aids
- Bone-anchored hearing aids (BAHA)
- Middle ear implants
- No intervention, though this would not address the hearing loss
Patient Experience
- During the procedure, the patient is under general anesthesia and will not feel anything
- Post-operatively, there might be some discomfort or pain managed with prescribed medications
- Patients generally experience an improvement in hearing when the device is activated, though there is an adjustment period as they adapt to the new sounds.