Surgical Considerations

  • Chapter
  • First Online:
Pediatric Cochlear Implantation

Abstract

The restoration of sound perception with cochlear implantation is one of the more significant advances in medicine in the past 30 years. The bestowment of the 2013 Lasker-DeBakey Clinical Medical Research Award upon scientists Graeme Clarke, Ingeborg Hochmair, and Blake Wilson for their contributions to development of the modern cochlear implant has raised global awareness of the transformative nature of this remarkable technology (Roland and Tobey, Cell 154(6):1175–1177, 2013). The implant technology, processing strategies, and outcomes have significantly improved since the first generation of implants. Many of the basic surgical principles that were developed for cochlear implantation have held up over time. However, evolutions in technique to minimize the incision and enhance patient recovery, as well as newer electrode insertion techniques to enable preservation of cochlear structure and function have taken place. The techniques and principles of cochlear implant surgery are discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 74.89
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
EUR 96.29
Price includes VAT (Germany)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
EUR 139.09
Price includes VAT (Germany)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Adunka OF, Radeloff A, Gstoettner WK, Pillsbury HC, Buchman CA. Scala tympani cochleostomy II: topography and histology. Laryngoscope. 2007;117(12):2195–200.

    Article  PubMed  Google Scholar 

  • Adunka OF, Dillon MT, Adunka MC, King ER, Pillsbury HC, Buchman CA. Hearing preservation and speech perception outcomes with electric-acoustic stimulation after 12 months of listening experience. Laryngoscope. 2013;123(10):2509–15.

    PubMed  Google Scholar 

  • Asp F, Maki-Torkko E, Karltorp E, Harder H, Hergils L, Eskilsson G, et al. Bilateral versus unilateral cochlear implants in children: speech recognition, sound localization, and parental reports. Int J Audiol. 2012;51(11):817–32.

    Article  PubMed  Google Scholar 

  • Balkany T, Gantz BJ, Steenerson RL, Cohen NL. Systematic approach to electrode insertion in the ossified cochlea. Otolaryngol Head Neck Surg. 1996;114(1):4–11.

    Article  CAS  PubMed  Google Scholar 

  • Balkany T, Luntz M, Telischi FF, Hodges AV. Intact canal wall drill-out procedure for implantation of the totally ossified cochlea. Am J Otol. 1997;18(6 Suppl):S58–9.

    CAS  PubMed  Google Scholar 

  • Balkany TJ, Whitley M, Shapira Y, Angeli SI, Brown K, Eter E, et al. The temporalis pocket technique for cochlear implantation: an anatomic and clinical study. Otol Neurotol. 2009;30(7):903–7.

    Article  PubMed  Google Scholar 

  • Barker E, Pringle M. Survey of prophylactic antibiotic use amongst UK cochlear implant surgeons. Cochlear Implants Int. 2008;9(2):82–9.

    Article  PubMed  Google Scholar 

  • Battmer R, Pesch J, Stover T, Lesinski-Schiedat A, Lenarz M, Lenarz T. Elimination of facial nerve stimulation by reimplantation in cochlear implant subjects. Otol Neurotol. 2006;27(7):918–22.

    Article  PubMed  Google Scholar 

  • Beltrame MA, Frau GN, Shanks M, Robinson P, Anderson I. Double posterior labyrinthotomy technique: results in three Med-El patients with common cavity. Otol Neurotol. 2005;26(2):177–82.

    Article  PubMed  Google Scholar 

  • Booth TN, Roland P, Kutz Jr JW, Lee K, Isaacson B. High-resolution 3-D T2-weighted imaging in the diagnosis of labyrinthitis ossificans: emphasis on subtle cochlear involvement. Pediatr Radiol. 2013;43(12):1584–90.

    Article  PubMed  Google Scholar 

  • Boyd PJ. Potential benefits from deeply inserted cochlear implant electrodes. Ear Hear. 2011;32(4):411–27.

    Article  PubMed  Google Scholar 

  • Broomfield SJ, Da Cruz M, Gibson WP. Cochlear implants and magnetic resonance scans: a case report and review. Cochlear Implants Int. 2013;14(1):51–5.

    Article  PubMed  Google Scholar 

  • Buss E, Pillsbury HC, Buchman CA, Pillsbury CH, Clark MS, Haynes DS, et al. Multicenter U.S. bilateral MED-EL cochlear implantation study: speech perception over the first year of use. Ear Hear. 2008;29(1):20–32.

    PubMed  Google Scholar 

  • Carlson ML, Driscoll CL, Gifford RH, Service GJ, Tombers NM, Hughes-Borst BJ, et al. Implications of minimizing trauma during conventional cochlear implantation. Otol Neurotol. 2011;32(6):962–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chen JM, Shipp D, Al-Abidi A, Ng A, Nedzelski JM. Does choosing the “worse” ear for cochlear implantation affect outcome? Otol Neurotol. 2001;22(3):335–9.

    Article  CAS  PubMed  Google Scholar 

  • Chung D, Kim AH, Parisier S, Linstrom C, Alexiades G, Hoffman R, et al. Revision cochlear implant surgery in patients with suspected soft failures. Otol Neurotol. 2010;31(8):1194–8.

    Article  PubMed  Google Scholar 

  • Coelho DH, Waltzman SB, Roland Jr JT. Implanting common cavity malformations using intraoperative fluoroscopy. Otol Neurotol. 2008;29(7):914–9.

    Article  PubMed  Google Scholar 

  • Cohen NL, Waltzman SB. Partial insertion of the nucleus multichannel cochlear implant: technique and results. Am J Otol. 1993;14(4):357–61.

    CAS  PubMed  Google Scholar 

  • Colletti V, Fiorino FG, Carner M, Sacchetto L, Giarbini N. New approach for cochlear implantation: cochleostomy through the middle fossa. Otolaryngol Head Neck Surg. 2000;123(4):467–74.

    Article  CAS  PubMed  Google Scholar 

  • Connell SS, Balkany TJ, Hodges AV, Telischi FF, Angeli SI, Eshraghi AA. Electrode migration after cochlear implantation. Otol Neurotol. 2008;29(2):156–9.

    Article  PubMed  Google Scholar 

  • Crane BT, Gottschalk B, Kraut M, Aygun N, Niparko JK. Magnetic resonance imaging at 1.5 T after cochlear implantation. Otol Neurotol. 2010;31(8):1215–20.

    Article  PubMed  Google Scholar 

  • Dillon MT, Buss E, Pillsbury HC, Adunka OF, Buchman CA, Adunka MC. Effects of hearing aid settings for electric-acoustic stimulation. J Am Acad Audiol. 2014;25(2):133–40.

    Article  PubMed  Google Scholar 

  • Ellul S, Shelton C, Davidson HC, Harnsberger HR. Preoperative cochlear implant imaging: is magnetic resonance imaging enough? Am J Otol. 2000;21(4):528–33.

    CAS  PubMed  Google Scholar 

  • Filipo R, D’Elia C, Covelli E, Bertoli GA, De Seta E, Manganaro F, et al. Haematoma after cochlear implantation: management of a minor complication. Acta Otolaryngol. 2010;130(1):108–13.

    Article  PubMed  Google Scholar 

  • Free RH, Falcioni M, Di Trapani G, Giannuzzi AL, Russo A, Sanna M. The role of subtotal petrosectomy in cochlear implant surgery—a report of 32 cases and review on indications. Otol Neurotol. 2013;34(6):1033–40.

    Article  PubMed  Google Scholar 

  • Frijns JH, Kalkman RK, Briaire JJ. Stimulation of the facial nerve by intracochlear electrodes in otosclerosis: a computer modeling study. Otol Neurotol. 2009;30(8):1168–74.

    Article  PubMed  Google Scholar 

  • Galvin KL, Mok M, Dowell RC, Briggs RJ. 12-month post-operative results for older children using sequential bilateral implants. Ear Hear. 2007;28(2 Suppl):19S–21.

    Article  PubMed  Google Scholar 

  • Gifford RH, Dorman MF, Skarzynski H, Lorens A, Polak M, Driscoll CL, et al. Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments. Ear Hear. 2013;34(4):413–25.

    Article  PubMed  PubMed Central  Google Scholar 

  • Giordano P, Hatzopoulos S, Giarbini N, Prosser S, Petruccelli J, Simoni E, et al. A soft-surgery approach to minimize hearing damage caused by the insertion of a cochlear implant electrode: a guinea pig animal model. Otol Neurotol. 2014;35(8):1440–5.

    Article  PubMed  Google Scholar 

  • Grieco-Calub TM, Litovsky RY. Sound localization skills in children who use bilateral cochlear implants and in children with normal acoustic hearing. Ear Hear. 2010;31(5):645–56.

    PubMed  PubMed Central  Google Scholar 

  • Gulya AJ, Steenerson RL. The scala vestibuli for cochlear implantation. An anatomic study. Arch Otolaryngol Head Neck Surg. 1996;122(2):130–2.

    Article  CAS  PubMed  Google Scholar 

  • Isaacson B, Roland PS, Wright CG. Anatomy of the middle-turn cochleostomy. Laryngoscope. 2008;118(12):2200–4.

    Article  PubMed  Google Scholar 

  • Isaacson B, Booth T, Kutz Jr JW, Lee KH, Roland PS. Labyrinthitis ossificans: how accurate is MRI in predicting cochlear obstruction? Otolaryngol Head Neck Surg. 2009;140(5):692–6.

    Article  PubMed  Google Scholar 

  • Jayawardena J, Kuthubutheen J, Rajan G. Hearing preservation and hearing improvement after reimplantation of pediatric and adult patients with partial deafness: a retrospective case series review. Otol Neurotol. 2012;33(5):740–4.

    Article  PubMed  Google Scholar 

  • Kempf HG, Stover T, Lenarz T. Mastoiditis and acute otitis media in children with cochlear implants: recommendations for medical management. Ann Otol Rhinol Laryngol Suppl. 2000;185:25–7.

    CAS  PubMed  Google Scholar 

  • Kennedy RJ, Shelton C. Ventilation tubes and cochlear implants: what do we do? Otol Neurotol. 2005;26(3):438–41.

    Article  PubMed  Google Scholar 

  • Kopelovich JC, Germiller JA, Laury AM, Shah SS, Pollock AN. Early prediction of postmeningitic hearing loss in children using magnetic resonance imaging. Arch Otolaryngol Head Neck Surg. 2011;137(5):441–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Liening DA, Haupert M, Kartush J. Cochlear implantation and variation of facial nerve anatomy: a case report. Ear Nose Throat J. 1994;73(9):667–9.

    CAS  PubMed  Google Scholar 

  • Litovsky RY, Johnstone PM, Godar S, Agrawal S, Parkinson A, Peters R, et al. Bilateral cochlear implants in children: localization acuity measured with minimum audible angle. Ear Hear. 2006;27(1):43–59.

    Article  PubMed  PubMed Central  Google Scholar 

  • Loizou PC, Hu Y, Litovsky R, Yu G, Peters R, Lake J, et al. Speech recognition by bilateral cochlear implant users in a cocktail-party setting. J Acoust Soc Am. 2009;125(1):372–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Luntz M, Hodges AV, Balkany T, Dolan-Ash S, Schloffman J. Otitis media in children with cochlear implants. Laryngoscope. 1996;106(11):1403–5.

    Article  CAS  PubMed  Google Scholar 

  • McElveen Jr JT, Carrasco VN, Miyamoto RT, Linthicum Jr FH. Cochlear implantation in common cavity malformations using a transmastoid labyrinthotomy approach. Laryngoscope. 1997;107(8):1032–6.

    Article  PubMed  Google Scholar 

  • McRackan TR, Reda FA, Rivas A, Noble JH, Dietrich MS, Dawant BM, et al. Comparison of cochlear implant relevant anatomy in children versus adults. Otol Neurotol. 2012;33(3):328–34.

    Article  PubMed  PubMed Central  Google Scholar 

  • Melton MF, Backous DD. Preventing complications in pediatric cochlear implantation. Curr Opin Otolaryngol Head Neck Surg. 2011;19(5):358–62.

    Article  PubMed  Google Scholar 

  • Migirov L, Wolf M. Magnet removal and reinsertion in a cochlear implant recipient undergoing brain MRI. ORL J Otorhinolaryngol Relat Spec. 2013;75(1):1–5.

    Article  PubMed  Google Scholar 

  • Pakdaman MN, Herrmann BS, Curtin HD, Van Beek-King J, Lee DJ. Cochlear implantation in children with anomalous cochleovestibular anatomy: a systematic review. Otolaryngol Head Neck Surg. 2012;146(2):180–90.

    Article  PubMed  Google Scholar 

  • Parry DA, Booth T, Roland PS. Advantages of magnetic resonance imaging over computed tomography in preoperative evaluation of pediatric cochlear implant candidates. Otol Neurotol. 2005;26(5):976–82.

    Article  PubMed  Google Scholar 

  • Rader T, Fastl H, Baumann U. Speech perception with combined electric-acoustic stimulation and bilateral cochlear implants in a multisource noise field. Ear Hear. 2013;34(3):324–32.

    Article  PubMed  Google Scholar 

  • Richard C, Fayad JN, Doherty J, Linthicum Jr FH. Round window versus cochleostomy technique in cochlear implantation: histologic findings. Otol Neurotol. 2012;33(7):1181–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roland PS, Gstottner W, Adunka O. Method for hearing preservation in cochlear implant surgery. Oper Tech Otolaryngol. 2005;16(2):93–100.

    Article  Google Scholar 

  • Roland PS, Wright CG, Isaacson B. Cochlear implant electrode insertion: the round window revisited. Laryngoscope. 2007;117(8):1397–402.

    Article  PubMed  Google Scholar 

  • Rubin LG, Papsin B, Committee on Infectious Diseases and Section on Otolaryngology-Head and Neck Surgery. Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitis. Pediatrics. 2010;126(2):381–91.

    Article  PubMed  Google Scholar 

  • Venail F, Sicard M, Piron JP, Levi A, Artieres F, Uziel A, et al. Reliability and complications of 500 consecutive cochlear implantations. Arch Otolaryngol Head Neck Surg. 2008;134(12):1276–81.

    Article  PubMed  Google Scholar 

  • Weber RS, Callender DL. Antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery. Ann Otol Rhinol Laryngol Suppl. 1992;155:16–20.

    CAS  PubMed  Google Scholar 

  • Wootten CT, Backous DD, Haynes DS. Management of cerebrospinal fluid leakage from cochleostomy during cochlear implant surgery. Laryngoscope. 2006;116(11):2055–9.

    Article  PubMed  Google Scholar 

  • Ying YL, Lin JW, Oghalai JS, Williamson RA. Cochlear implant electrode misplacement: incidence, evaluation, and management. Laryngoscope. 2013;123(3):757–66.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brandon Isaacson M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Isaacson, B., Roland, P.S. (2016). Surgical Considerations. In: Young, N., Iler Kirk, K. (eds) Pediatric Cochlear Implantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2788-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2788-3_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2787-6

  • Online ISBN: 978-1-4939-2788-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation