What does cochlear implant surgery involve?

Cochlear Implant surgery usually takes from three to four hours. During the operation, a small incision is made behind the ear and the internal device (called the receiver stimulator) is placed under the skin and is secured to your child’s skull. A small opening is then made in the mastoid bone, followed by a tiny hole in the cochlea where the electrode array is inserted into the cochlea. The surgeon then begins to close the incision while the cochlear implant audiologist tests the device to be sure it is working properly before completing the case. Once the audiologist has completed this testing, the incision is completely closed and the surgeon comes out to update the family.

How safe is cochlear implant surgery?

Cochlear Implants are recognized by the American Medical Association (AMA) and the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS), and are also approved by the FDA as an appropriate medical procedure for children. In general, the surgical procedure is not considered dangerous or particularly painful.

As with any surgical procedure, patients and their families should be aware that there are risks associated with anesthesia. In addition, it is common to experience some post operative effects such as inflammation or bleeding at the surgical site or face, numbness or stiffness around the ear, taste disturbance, and dizziness. In most patients, these effects resolve over a short period time.

In a very small percentage of patients the following effects may occur, including injury to or stimulation of the facial nerve, ringing in the ears (tinnitus), neck pain, and fluid leaks from the cochlea (rarely resulting in meningitis). Children with hearing loss and also cochlear implants are at an increased risk for meningitis. Therefore, your child should be up to date with appropriate meningitis vaccinations. Please see the separate letter in this packet detailing meningitis vaccination information. All of this information will again be reviewed with you upon meeting with your child’s surgeon.

How do I prepare my child for cochlear implant surgery?

Our Cochlear Implant Team members can help explain the procedure to your child, and coloring books are available to help him or her understand what will happen step by step. St. Louis Children’s Hospital wants you and your child to feel as relaxed as possible on the day of your child’s operation.

In order to ease anxieties, our Same Day Surgery staff offers a Pre-Admission orientation held every Sunday from 4-5:30 p.m. This orientation familiarizes families and children with the Same Day Surgery suite and procedures. During the orientation a nurse will walk your family through the pre-operative area, show a video of the operating room, and visit the parent’s waiting area. At the end of the tour, the nurse will let your child play with surgery toys and pretend he or she is the doctor. You can also see the patient rooms in which your child will be staying if he or she remains in the hospital overnight following the procedure. To register for the Sunday pre-admission orientation or for more information, call St. Louis Children’s Hospital Answer Line at 314.454.KIDS (5437) or 800.678.KIDS. 

What are the step-by-step procedures for the day of the surgery?

The day of surgery you will register at the Same Day Surgery Suite on the 6th floor of the hospital. After registering, you will be taken to a private room where your child will change into a gown and be examined by the nursing staff, a pediatric anesthesiologist and a resident that is being trained in pediatric cochlear implantation. Once these steps are complete, you will accompany your child to the surgery holding area. Your child will then be taken from the holding area to the operating room by the anesthesiologist. The surgery will last approximately 4 hours. During this time, you may choose to either wait in the Same Day Surgery waiting area or go to the cafeteria on the lower level of the hospital. The Same Day Surgery Staff will notify you when the cochlear implant surgery is complete and your child has been taken to the recovery room. Once your child has fully awakened, you will be called into the recovery room.

Will I be notified of my child’s progress during surgery?

You may request that a nurse give you periodic updates during surgery so that you will know how the surgery is proceeding. After the surgery, your child’s surgeon will inform you of all aspects of your child’s operation. 

How will my child look after surgery?

Your child’s head will be wrapped to protect the incision site. Once the bandage is taken off, the internal part of the implant is not visible after surgery. Your child’s hair may have been shaved in the area where the incision was made during the surgery. Your child may also have some swelling around the site and even on that side of the face. After the incision behind the ear heals and the swelling disappears, a slightly raised bump may remain from the placement of the receiver stimulator itself. This bump is covered by your child’s skin and hair.

Will my child spend the night after surgery?

Many children are able to go home the same day of the surgery; however, many children spend the night in the hospital for observation. If your child does spend the night, the hospital allows one family member to stay overnight in the room with your child. Additional family members are welcome to stay in the lounge area, which is furnished with cots. Once your child is ready to leave the hospital, you will be given instructions on how to care for your child and the incision site. Your surgeon will advise you when you may take off the protective bandage, although most children feel more comfortable with the bandage in place for the first couple days following surgery. You may adjust the bandage’s Velcro fastener for comfort and to change the gauze pads if they become soiled. You may also wash your child’s hair with baby shampoo during this time, including the area over the incision site.

How long is the recovery period?

Children bounce back from implant surgery very quickly. Typically, it is recommended that children stay out of daycare and school for the week following surgery to allow the incision site to begin healing. Children usually return to school after one week, but, physical activity should be limited for 3 weeks. Your surgeon will make more specific recommendations for your child at the post-op follow-up appointment. You will have the opportunity to learn more about the surgery and ask any questions you may have when you and your child meet the surgeon at the pre-op examination.