Editing Cochlear implant (section)

==Surgical procedure==

=== Surgical techniques ===
Implantation of children and adults can be done safely with few surgical complications and most individuals will undergo outpatient surgery and go home the same day.<ref>{{cite journal | vauthors = Hoff S, Ryan M, Thomas D, Tournis E, Kenny H, Hajduk J, Young NM | title = Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions | language = en-US | journal = Otology & Neurotology | volume = 40 | issue = 4 | pages = 454–463 | date = April 2019 | pmid = 30870355 | doi = 10.1097/MAO.0000000000002156 | pmc = 6426352 }}</ref><ref>{{Cite web|date=2021-05-28|title=Hearing aids vs cohclear implants: What's the difference?|url=https://www.medicalnewstoday.com/articles/hearing-aids-vs-cochlear-implants|access-date=2021-12-01|website=www.medicalnewstoday.com|language=en}}</ref><ref>{{cite journal |last1=Sivam |first1=Sunthosh K. |last2=Syms |first2=Charles A. |last3=King |first3=Susan M. |last4=Perry |first4=Brian P. |title=Consideration for routine outpatient pediatric cochlear implantation: A retrospective chart review of immediate post-operative complications |journal=International Journal of Pediatric Otorhinolaryngology |date=March 2017 |volume=94 |pages=95–99 |doi=10.1016/j.ijporl.2016.12.018 |pmid=28167021 }}</ref>

Occasionally, the very young, the very old, or patients with a significant number of medical diseases at once may remain for overnight observation in the hospital. The procedure can be performed in an ambulatory surgery center in healthy individuals.<ref>{{cite journal |last1=Joseph |first1=Aimee M. |last2=Lassen |first2=L. Frederick |title=Cochlear implant in an ambulatory surgery center |journal=AANA Journal |date=February 2013 |volume=81 |issue=1 |pages=55–59 |pmid=23513325 }}</ref>

The surgical procedure most often used to implant the device is called [[mastoidectomy]] with facial recess approach (MFRA).<ref name="2015f1000" />

The procedure is usually done under general anesthesia. Complications of the procedure are rare, but include [[mastoiditis]], [[otitis media]] (acute or with effusion), shifting of the implanted device requiring a second procedure, damage to the [[facial nerve]], damage to the [[chorda tympani]], and wound infections.<ref name="2016procRev">{{cite journal | vauthors = Bruijnzeel H, Draaisma K, van Grootel R, Stegeman I, Topsakal V, Grolman W | title = Systematic Review on Surgical Outcomes and Hearing Preservation for Cochlear Implantation in Children and Adults | journal = Otolaryngology–Head and Neck Surgery | volume = 154 | issue = 4 | pages = 586–596 | date = April 2016 | pmid = 26884363 | doi = 10.1177/0194599815627146 | s2cid = 25594951 }}</ref>

Cochlear implantation surgery is considered a clean procedure with an infection rate of less than 3%.<ref>{{cite journal |last1=Vijendren |first1=Ananth |last2=Ajith |first2=Amritha |last3=Borsetto |first3=Daniele |last4=Tysome |first4=James R. |last5=Axon |first5=Patrick R. |last6=Donnelly |first6=Neil P. |last7=Bance |first7=Manohar L. |title=Cochlear Implant Infections and Outcomes: Experience From a Single Large Center |journal=Otology & Neurotology |date=October 2020 |volume=41 |issue=9 |pages=e1105–e1110 |doi=10.1097/MAO.0000000000002772 |pmid=32925845 }}</ref> Guidelines suggest that routine prophylactic antibiotics are not required.<ref>{{cite journal |last1=Woods |first1=R. K. |last2=Dellinger |first2=E. P. |title=Current guidelines for antibiotic prophylaxis of surgical wounds |journal=American Family Physician |date=June 1998 |volume=57 |issue=11 |pages=2731–2740 |pmid=9636336 }}</ref> However, the potential cost of a postoperative infection is high (including the possibility of implant loss); therefore, a single preoperative intravenous injection of antibiotics is recommended.<ref>{{cite journal |last1=Anne |first1=Samantha |last2=Ishman |first2=Stacey L. |last3=Schwartz |first3=Seth |title=A Systematic Review of Perioperative Versus Prophylactic Antibiotics for Cochlear Implantation |journal=Annals of Otology, Rhinology & Laryngology |date=November 2016 |volume=125 |issue=11 |pages=893–899 |doi=10.1177/0003489416660113 |pmid=27443344 }}</ref>

The rate of complications is about 12% for minor complications and 3% for major complications; major complications include infections, facial paralysis, and device failure.

Although up to 20 new cases of post-CI bacterial meningitis occur annually worldwide, data demonstrates a reducing incidence.<ref>{{cite journal |last1=Lalwani |first1=Anil K. |last2=Cohen |first2=Noel L. |title=Does Meningitis After Cochlear Implantation Remain a Concern in 2011? |journal=Otology & Neurotology |date=January 2012 |volume=33 |issue=1 |pages=93–95 |doi=10.1097/MAO.0b013e31823dbb08 |pmid=22143298 }}</ref> To avoid the risk of bacterial meningitis, the CDC recommends that adults and children undergoing CI receive age-appropriate vaccines that generate antibodies to Streptococcus pneumoniae.<ref>{{Cite web|title=Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP)|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm|access-date=2021-12-27|website=www.cdc.gov}}</ref>

The rate of transient facial nerve palsy is estimated to be approximately 1%. Device failure requiring reimplantation is estimated to occur 2.5–6% of the time. Up to one-third of people experience disequilibrium, vertigo, or vestibular weakness lasting more than one week after the procedure; in people under 70 these symptoms generally resolve over weeks to months, but in people over 70 the problems tend to persist.<ref name="2015f1000" />

In the past, cochlear implants were only approved for people who were deaf in both ears; {{as of|2014|lc=y}} a cochlear implant had been used experimentally in some people who had acquired deafness in one ear after they had learned how to speak, and none who were deaf in one ear from birth; clinical studies {{as of|2014|lc=y}} had been too small to draw generalizations.<ref>{{cite journal | vauthors = Tokita J, Dunn C, Hansen MR | title = Cochlear implantation and single-sided deafness | journal = Current Opinion in Otolaryngology & Head and Neck Surgery | volume = 22 | issue = 5 | pages = 353–358 | date = October 2014 | pmid = 25050566 | pmc = 4185341 | doi = 10.1097/moo.0000000000000080 }}</ref>

=== Alternative surgical technique ===
Other approaches, such as going through the [[suprameatal triangle]], are used. A systematic literature review published in 2016 found that studies comparing the two approaches were generally small, not randomized, and retrospective so were not useful for making generalizations; it is not known which approach is safer or more effective.<ref name="2016procRev" />

=== Endoscopic cochlear implantation ===
With the increased utilization of [[endoscopic ear surgery]] as popularized by professor Tarabichi, there have been multiple published reports on the use of endoscopic technique in cochlear implant surgery.<ref>{{cite journal |last1=Rajan |first1=Philip |last2=Teh |first2=Hui Mon |last3=Prepageran |first3=Narayanan |last4=Kamalden |first4=Tengku Izam Tengku |last5=Tang |first5=Ing Ping |title=Endoscopic Cochlear Implant: Literature Review and Current Status |journal=Current Otorhinolaryngology Reports |date=December 2017 |volume=5 |issue=4 |pages=268–274 |doi=10.1007/s40136-017-0164-2 }}</ref> However, this has been motivated by marketing and there is clear indication of increased morbidity associated with this technique as reported by the pioneer of [[endoscopic ear surgery]].<ref>{{cite journal | vauthors = Tarabichi M, Nazhat O, Kassouma J, Najmi M | title = Endoscopic cochlear implantation: Call for caution | journal = The Laryngoscope | volume = 126 | issue = 3 | pages = 689–692 | date = March 2016 | pmid = 26154143 | doi = 10.1002/lary.25462 | s2cid = 24799811 }}</ref>

=== Complications of cochlear implant surgery ===
As cochlear implant surgical techniques have advanced over the last four decades, the global complication rate for CI surgery in both children and adults has decreased from more than 35% in 1991 to less than 10% at present.<ref>{{cite journal |last1=Bhatia |first1=Kunwar |last2=Gibbin |first2=Kevin P. |last3=Nikolopoulos |first3=Thomas P. |last4=OʼDonoghue |first4=Gerard M. |title=Surgical Complications and Their Management in a Series of 300 Consecutive Pediatric Cochlear Implantations |journal=Otology & Neurotology |date=September 2004 |volume=25 |issue=5 |pages=730–739 |doi=10.1097/00129492-200409000-00015 |pmid=15354004 }}</ref><ref>{{cite journal |last1=Venail |first1=Frederic |last2=Sicard |first2=Marielle |last3=Piron |first3=Jean Pierre |last4=Levi |first4=Ann |last5=Artieres |first5=Francoise |last6=Uziel |first6=Alain |last7=Mondain |first7=Michel |title=Reliability and Complications of 500 Consecutive Cochlear Implantations |journal=Archives of Otolaryngology–Head & Neck Surgery |date=15 December 2008 |volume=134 |issue=12 |pages=1276–1281 |doi=10.1001/archoto.2008.504 |pmid=19075122 }}</ref><ref name=":8">{{cite journal |last1=Farinetti |first1=A. |last2=Ben Gharbia |first2=D. |last3=Mancini |first3=J. |last4=Roman |first4=S. |last5=Nicollas |first5=R. |last6=Triglia |first6=J.-M. |title=Cochlear implant complications in 403 patients: Comparative study of adults and children and review of the literature |journal=European Annals of Otorhinolaryngology, Head and Neck Diseases |date=June 2014 |volume=131 |issue=3 |pages=177–182 |doi=10.1016/j.anorl.2013.05.005 |pmid=24889283 |doi-access=free }}</ref> The risk of postoperative facial nerve injury has also decreased over the last several decades to less than 1%, most of which demonstrated complete return of function within six months. The rate of permanent paralysis is approximately 1 per 1,000 surgeries and likely less than that in experienced CI centers.<ref name=":8"/>

The majority of complications following CI surgery are minor requiring only conservative medical management or prolongation of hospital stay. Less than 5% of all complications are major resulting in surgical intervention or readmission to the hospital.<ref name=":8" /> Reported rates of revision cochlear implant surgery vary in adults and children from 3.8% to 8% with the most common indications being device failure, infection, and migration of the implant or electrode.<ref>{{cite journal |last1=Zeitler |first1=Daniel M |last2=Budenz |first2=Cameron L |last3=Roland |first3=John Thomas |title=Revision cochlear implantation |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |date=October 2009 |volume=17 |issue=5 |pages=334–338 |doi=10.1097/MOO.0b013e32832dd6ac |pmid=19502980 }}</ref> Disequilibrium and vertigo after CI surgery can occur but the symptoms tend to be mild and short-lived.<ref>{{cite journal |last1=Buchman |first1=Craig A. |last2=Joy |first2=Jennifer |last3=Hodges |first3=Annelle |last4=Telischi |first4=Fred F. |last5=Balkany |first5=Thomas J. |title=Vestibular Effects of Cochlear Implantation |journal=The Laryngoscope |date=October 2004 |volume=114 |issue=S103 |pages=1–22 |doi=10.1097/00005537-200410001-00001 |pmid=15454752 }}</ref> CI rarely results in significant or persistent adverse effects on the vestibular system when hearing conservation surgical techniques are practiced. Moreover, gait and postural stability may actually improve post-implantation.<ref>{{cite journal |last1=Tsukada |first1=Keita |last2=Moteki |first2=Hideaki |last3=Fukuoka |first3=Hisakuni |last4=Iwasaki |first4=Satoshi |last5=Usami |first5=Shin-ichi |title=Effects of EAS cochlear implantation surgery on vestibular function |journal=Acta Oto-Laryngologica |date=November 2013 |volume=133 |issue=11 |pages=1128–1132 |doi=10.3109/00016489.2013.824110 |pmid=24007563 |pmc=3809927 }}</ref>