Difference between revisions of "Cochlear implant surgery"
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Cochlear implant surgery is novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve. This surgery has been applied to adults and prelingual children with hearing loss. | Cochlear implant surgery is novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve<ref>{{Cite journal|last=Naples|first=James G.|last2=Ruckenstein|first2=Michael J.|date=2020-02|title=Cochlear Implant|url=https://pubmed.ncbi.nlm.nih.gov/31677740|journal=Otolaryngologic Clinics of North America|volume=53|issue=1|pages=87–102|doi=10.1016/j.otc.2019.09.004|issn=1557-8259|pmid=31677740}}</ref><ref>{{Cite journal|last=Mowry|first=Sarah E.|last2=Woodson|first2=Erika|date=2020-01-01|title=Cochlear Implant Surgery|url=https://pubmed.ncbi.nlm.nih.gov/31556929|journal=JAMA otolaryngology-- head & neck surgery|volume=146|issue=1|pages=92|doi=10.1001/jamaoto.2019.2274|issn=2168-619X|pmid=31556929}}</ref>. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations. | ||
== Preoperative management == | == Preoperative management == | ||
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=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion | |||
* During microscopy, minimize patient movement | |||
* Volatile anesthetics are appropriate despite facial nerve monitoring | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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== Postoperative management == | == Postoperative management == | ||
=== Disposition | === Disposition === | ||
* PACU | |||
* Home-discharge | |||
=== Pain management === | |||
* Oral narcotics | |||
* Multi-modal, non-narcotic medications | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
* PONV | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
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|+ | |+ | ||
! | ! | ||
! | !Posterior | ||
! | Tympanotomy | ||
!Suprameatal | |||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
Revision as of 14:13, 10 July 2021
Cochlear implant surgery
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV |
| Monitors |
Standard; facial nerve monitoring |
| Primary anesthetic considerations | |
| Preoperative |
Patients' hearing is limited |
| Intraoperative |
Facial nerve monitoring (avoid paralytics) |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Cochlear implant surgery is novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve[1][2]. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
- Standard GA setup
- Consider straight connector with accordion to ETT
- Circuit extensions for 180-degree supine position
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- Facial nerve monitoring
- PIV (consider 2nd IV in lower extremity with 180-degree positioning)
Induction and airway management
- GETA
Positioning
- 180-degree turn (head is away from anesthesia team)
- Head positioned away from operating site.
- Surgeons may conduct frequent head position changes intraoperatively
Maintenance and surgical considerations
- Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion
- During microscopy, minimize patient movement
- Volatile anesthetics are appropriate despite facial nerve monitoring
Emergence
Postoperative management
Disposition
- PACU
- Home-discharge
Pain management
- Oral narcotics
- Multi-modal, non-narcotic medications
Potential complications
- PONV
Procedure variants
| Posterior
Tympanotomy |
Suprameatal | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ Naples, James G.; Ruckenstein, Michael J. (2020-02). "Cochlear Implant". Otolaryngologic Clinics of North America. 53 (1): 87–102. doi:10.1016/j.otc.2019.09.004. ISSN 1557-8259. PMID 31677740. Check date values in:
|date=(help) - ↑ Mowry, Sarah E.; Woodson, Erika (2020-01-01). "Cochlear Implant Surgery". JAMA otolaryngology-- head & neck surgery. 146 (1): 92. doi:10.1001/jamaoto.2019.2274. ISSN 2168-619X. PMID 31556929.
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