Before Surgery. All of your questions regarding surgery will be answered by your surgeon during your initial medical evaluation. The implant team encourages you to meet with or contact your surgeon again at any time prior to surgery for any further questions or concerns. The UCSF Prepare Program is designed to prepare the patient for surgery. During these appointments, the patient meets the anesthesiologist, hospital admitting personnel and undergoes any additional medical tests felt to be needed. You may also be required to have a clearance from your primary care physician.

The Surgical Procedure. On the morning of surgery, it is important to arrive on time, and have a contact phone number available to the staff in the event you need to be contacted. Be sure to refrain from all food or drink the morning of surgery. If you eat or drink anything within 6 hours of your surgery, your operation could be delayed or cancelled.

A cochlear implantation surgery takes approximately 2-3 hours in most cases. A small amount of hair is shaved from behind the ear, which is usually not noticeable when the hair is let down. An incision is then made behind the ear, and a pocket is created to allow the receiver-stimulator to sit unobtrusively under the skin and firmly anchored to the skull. A mastoidectomy is then performed, which entails removing the bony septations in the mastoid with a high speed surgical drill and a microscope. This is a very standard ear operation. After some important structures are identified to provide landmarks (such as the incus bone, one of the balance canals), a small opening is made into the middle ear, to provide access to the cochlea. A small hole is then made into the cochlea (the ‘cochleostomy’) to allow insertion of the implant electrode. The implant is then secured to the bone in the pocket previously created, and the electrode gently inserted into the cochlea. The wound is then closed and a mastoid dressing is placed. The patient is generally in recover for 2 hours, and then sent home on the same day. For patients with underlying medical conditions, an overnight stay in the hospital may be recommended.

Possible Complications During or After Surgery. Though the surgery is ordinarily quite safe, there are known, but rare complications that can develop. The most commonly reported complications occur with the skin behind the ear over the implant receiver, which can occasionally break down, leading to an exposed implant. Changes in the way food tastes, due to injury of a nerve in the middle ear, can temporarily occur in approximately 1 in 8 of cases. Rarely this change of taste will be permanent. Injury to the nerve controlling the facial muscles is very rare (<1 in 1000 cases), but if it were to occur, could leave the patient with a permanent weakness of the facial musculature. Other rare complications include leakage of brain fluid (~1%). Approximately 2-3% of patients will require their implant to be removed due to device malfunction or infection. However, in nearly all these cases a new implant can be placed without further difficulty. If the risks of any of these complications are unacceptable to you, you absolutely must discuss this with the surgeon prior to surgery.

Healing and Post-operative Care. Following surgery, the patient returns home. The mastoid dressing is removed by the patient or family member 2 days following surgery. The wound is cared for by cleaning it twice daily with hydrogen peroxide (mixed 50/50 with distilled water), carefully and gently cleaning off the edges of the incision to keep it clean, followed by application of any over-the-counter antibiotic ointment (eg Bacitracin). The patient may shower and wash their hair 3 days following surgery. You will have a post-operative visit approximately 2 weeks after your surgery, that will primarily consist of a wound check and ear exam. No sutures will have to be removed since they are dissolveable.

When to Call your Doctor Following Surgery. In most cases, there are no problems following surgery. After removal of the dressing, you should examine the incision. You should notify your surgeon or the clinic staff if the following is noted:

• The wound looks red and swollen and doesn’t improve over the next 1-2 days, and is painful to touch.
• Fevers >101.5 deg
• Swelling of the skin behind the ear or the feeling of fluid accumulating underneath the skin behind the ear.
• Headaches, light-sensitivity or excessive lethargy following surgery.
• Any questions regarding wound care, or medical concerns about yourself or your child.