Cochlear device implantation, with or without mastoidectomy
CPT4 code
Name of the Procedure:
Cochlear Device Implantation (with or without Mastoidectomy)
Summary
Cochlear device implantation is a surgical procedure that places a small electronic device in the inner ear to help provide a sense of sound to a person with severe hearing loss. The procedure might include a mastoidectomy, which involves removing part of the mastoid bone to make room for the implant.
Purpose
The procedure addresses severe to profound sensorineural hearing loss, where traditional hearing aids prove ineffective. The goal is to improve hearing and speech understanding, thereby enhancing the patient's quality of life.
Indications
- Severe to profound sensorineural hearing loss in one or both ears
- Limited benefits from hearing aids
- Age-appropriate cognitive ability to use auditory signals
- No medical contraindications for surgery
Preparation
- Fasting for at least 6 hours before the surgery
- Preoperative hearing assessments and imaging studies (e.g., MRI, CT scan)
- Suspension of medications that may increase bleeding, as advised by the doctor
Procedure Description
- Anesthesia: The patient is put under general anesthesia.
- Incision: A small incision is made behind the ear.
- Exposure: The surgeon may perform a mastoidectomy to create a pathway to the cochlea.
- Placement: The internal receiver/stimulator is attached to the skull bone, and electrodes are inserted into the cochlea.
- Closure: The surgical site is closed with stitches, and a dressing is applied.
- Activation: After several weeks, once healed, the external processor is fitted and the device is activated.
Tools used include surgical drills, microscopes, the cochlear implant device, and special electrodes.
Duration
The procedure typically takes 2 to 4 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Otolaryngologist (ENT surgeon)
- Audiologist
- Anesthesiologist
- Surgical nurses
Risks and Complications
- Infection at the surgical site
- Device failure or malfunction
- Nerve damage leading to facial muscle weakness or dizziness
- Risks associated with general anesthesia
- Potential for meningitis, though rare
Benefits
- Significant improvement in the ability to perceive sounds and understand speech
- Better communication abilities
- Enhanced quality of life Benefits may start to be realized within a few weeks to months after activation and therapy.
Recovery
- Initial recovery in the hospital for a few hours to overnight
- Pain management with prescribed medication
- Avoiding strenuous activities and keeping the surgical site dry for several weeks
- Follow-up appointments for wound checks and device activation
- Continuous audiology and speech therapy for optimal use of the device
- Full recovery typically takes 4 to 6 weeks
Alternatives
- Hearing aids: Less invasive but may be less effective for severe hearing loss
- Bone-anchored hearing systems: Another surgical option but not suitable for all types of hearing loss
- Lip reading and sign language: Non-surgical but depend on the environment and the individual’s adaptability
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel anything. Postoperatively, discomfort at the incision site is expected and managed with medication. Once activated, adjusting to the new sounds can be challenging, but consistent use and therapy will improve the experience over time.