Name of the Procedure:

Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy

Summary

This procedure involves the surgical removal of a previously implanted osseointegrated device in the temporal bone and the placement of a new one. This new implant is attached percutaneously to an external speech processor or cochlear stimulator. Additionally, a mastoidectomy, which is the removal of part of the mastoid bone, is performed during this procedure.

Purpose

The purpose of this procedure is to address hearing loss that has not responded well to traditional hearing aids or other medical therapies. The goals are to improve auditory function by directly stimulating the cochlea through the osseointegrated implant and to replace malfunctioning or outdated devices.

Indications

• Severe to profound hearing loss
• Failure of conventional hearing aids to provide adequate auditory gains
• Previously implanted device is malfunctioning or causing complications like infection or pain
• Necessity to upgrade to a more advanced implant system for better auditory outcomes

Preparation

• Preoperative assessment including audiological tests and imaging studies like CT or MRI
• Discussion with the surgical team about the procedure, potential risks, and benefits
• Fasting for at least 8 hours before surgery
• Adjustment or temporary discontinuation of certain medications as advised by the physician
• Preoperative antibiotic prophylaxis may be recommended

Procedure Description

1. Administer general anesthesia to ensure the patient is asleep and pain-free.
2. Make an incision behind the ear to access the temporal bone and the previously placed implant.
3. Carefully remove the existing osseointegrated implant.
4. Perform a mastoidectomy by drilling out part of the mastoid bone to create space for the new implant.
5. Place the new osseointegrated implant into the temporal bone and secure it.
6. Attach the percutaneous abutment that connects the implant to the external speech processor or cochlear stimulator.
7. Close the incision with sutures and apply a sterile dressing.

Duration

The procedure typically takes 2 to 4 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Otolaryngologist (ENT) surgeon
• Surgical nurse
• Anesthesiologist
• Audiologist (for device programming post-surgery)

Risks and Complications

• Infection at the surgical site
• Implant failure or rejection
• Facial nerve injury
• Hearing loss or balance problems
• Anesthesia-related complications
• Postoperative pain or discomfort

Benefits

• Improved hearing and auditory perception
• Enhanced quality of life with better communication abilities
• Immediate feedback from the device once activated and programmed

Recovery

• Hospital stay of 1-2 days for monitoring
• Pain management with prescribed medications
• Keep the surgical site clean and dry
• Avoid strenuous activities for a few weeks
• Follow-up visits for wound care, device activation, and programming
• Full recovery and optimization of the device may take a few months

Alternatives

• Continued use of conventional or bone-conduction hearing aids
• Middle ear implants
• Auditory brainstem implants in cases where cochlear implants are not viable
• Each alternative comes with its own benefits and limitations, to be discussed with the healthcare provider

Patient Experience

• May feel disoriented or dizzy immediately after the procedure
• Mild to moderate pain managed with medication
• Gradual improvement in hearing once the new implant is activated and properly programmed
• Regular follow-up visits to ensure optimal device function and hearing performance