Patient education: Cochlear implant in children (The Basics)

What is a cochlear implant? — 

This is a device that is placed, or "implanted," into a part of the inner ear called the "cochlea" (figure 1). It uses electricity to send sounds to the brain, which can improve certain types of hearing loss.

A cochlear implant has 3 main parts (figure 2):

●An external processor – This part is worn on the scalp. It has a microphone to detect sounds. Some devices have another part that is worn on the ear and looks like a hearing aid. The processor attaches to the "receiver" with a magnet. This lets the person remove the processor, such as for sleeping.

●A receiver – This is put under the skin on the scalp near the affected ear. The external processor sends sounds to the receiver, which turns them into electrical signals.

●An electrode – This is put into the cochlea. It takes the signals from the receiver to the cochlea. The cochlea then sends these signals to the brain for the person to "hear" the sounds.

Children with hearing loss in both ears can get an implant in 1 or both ears. Those with hearing loss in only 1 ear can get an implant just in the affected ear. Children of all ages can get cochlear implants, including babies.

For cochlear implant surgery, the surgeon makes a cut ("incision") in the skin behind the ear. This lets them access the cochlea.

What happens before cochlear implant surgery? — 

The doctor or nurse will tell you if your child needs to do anything special to prepare.

Before the procedure, the doctor will do an exam. They might send your child to get tests, such as:

●A CT or MRI – These create pictures of the inside of the ear and skull.

●Hearing tests

The doctor will also ask about your child's "health history." This involves asking about any health problems your child has or had in the past, past surgeries, and any medicines your child takes. Tell them about:

●Any medicines your child is taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your child's medicines, or bring a bag with all their medicines with you.

●Any allergies your child has

●Any bleeding problems your child has – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Any recent ear infections

You will also get information about:

●Eating and drinking before the procedure – Your child will need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or your child might be allowed to have liquids until a short time before the procedure.

●Taking medicine – If your child takes medicines regularly, the doctor or nurse will tell you if they should take them on the day of surgery.

●Lowering the risk of infection – Cochlear implants can increase the chance of getting a serious brain infection called "meningitis." Vaccines can prevent serious or deadly infections. So, it's important for your child to get all the vaccines their doctor recommends.

●Reducing anxiety – It's common for children to feel worried or anxious before surgery. When a person is very worried or stressed before surgery, it can sometimes make their pain worse after surgery. So, it's helpful to try to reduce anxiety, if possible. You can do this by staying calm yourself, reassuring your child, and answering their questions.

●What help your child will need when you go home – Your child might need to stay home from school for a few days while they recover. If your child is young, the doctor or nurse might tell you to sleep in the same room as them the first night at home.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during cochlear implant surgery? — 

When it is time for the procedure:

●Your child will get an "IV," which is a thin tube that goes into a vein. This can be used to give them fluids and medicines.

●Your child will get general anesthesia medicines so they do not feel pain during the procedure. This type makes them unconscious so they can't feel, see, or hear anything during the procedure. They might get a breathing tube to help them breathe.

●Your child might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your child's breathing, blood pressure, and heart rate during the procedure. They will also monitor the nerves on your child's head to make sure they do not get injured.

●The surgeon will shave a small section of hair behind your child's ear. Then, they will make an incision in the skin behind the ear.

●Next, they will make a small hole in the skull using a special drill. This lets them access the cochlea.

●They will put the electrode through the hole and into the cochlea.

●They will make a pocket in the skull bone to hold the receiver in place. They will put the receiver under the skin and into the pocket.

●They will close the incision and cover it with clean bandages.

●Before surgery is over, the audiologist will test the device to make sure it works.

●The procedure usually takes 2 to 4 hours.

If your child is getting a cochlear implant in both ears, the surgeon might do this in 1 procedure or 2 separate procedures.

What happens after cochlear implant surgery? — 

Your child will be taken to a recovery room. The staff will watch them closely as their anesthesia wears off. Some children need to spend at least 1 night in the hospital. Others can go home the same day.

As your child recovers:

●They might feel groggy or confused for a short time. They might also feel nauseous or vomit. The doctor or nurse can give your child medicine to help with this.

●If your child had a breathing tube, they might have a sore throat. This usually gets better quickly.

●The staff will help your child get out of bed and start moving around when your child is ready.

●Your child will get medicine to help with pain, if needed. They might need other medicines, too.

When your child is ready to eat:

●Babies might get fluid in a bottle at first. The nurse will let you know when it is okay to start breastfeeding again.

●Older children will start with clear liquids. Then, they can start eating as they are able. They might feel better if they start with bland foods.

What are the risks of getting a cochlear implant? — 

The doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection, including minor skin infections, or meningitis

●Pain and discomfort

●Dizziness and problems with balance

●Problems with tasting food

●Injury to the inner ear, skull, nerves, or brain

●Problems with the device

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call your child's doctor. Make sure you understand the doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Cochlear implant in children – Discharge instructions (The Basics)
Patient education: Hearing loss in children (The Basics)
Patient education: Audiometry (The Basics)
Patient education: Anesthesia in children (The Basics)
Patient education: Meningitis in children (The Basics)

Patient education: Meningitis in children (Beyond the Basics)