Editing Cochlear implant (section)

=== 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>