Challenges in Cochlear Implant Surgery and Post Operative Follow Up

INTRODUCTION: In last quarter of 20th century cochlear implantation gained widespread acceptance all around the world with advancement in technology and surgical experience for rehabilitation of profound to severe bilateral sensory neural hearing loss. Cochlear implant surgery stands high in position because of its ability to restore one of the special senses. Congenital severe to profound hearing loss limits the child ability to develop communication skills by affecting auditory and linguistic development. Cochlear Implantation provides greater access to sound, speech understanding, auditory abilities and linguistic development. Cochlear implant has evolved from single channel electrode to complex multichannel electrode, this provides near normal understanding of speech and in some cases, enjoyment of music. Challenges in cochlear implant surgery starts from pre-operative evaluation of the child. Pre-operative evaluation should include hearing assessment (brainstem evoked response audiometry, oto acoustic emissions, impedance audiometry) radiological assessment (HRCT Temporal bone with cochlear cuts, MRI Brain with internal acoustic meatus screening), general/systemic examination, pediatrician, psychologist, cardiologist, ophthalmologist opinion, evaluation of causes of hearing loss, rule out syndromic causes preoperatively to plan for effective management during surgery or post operatively. Since the introduction of high-risk newborn hearing screening as a routine Pro cedure detection of hearing loss in early life and early rehabilitation with implantation in severe – profound hearing loss has improved more compared to previous decades. Cochlear implant surgery is a technically demanding surgery in which every step of surgery should be precise. As like any other surgery cochlear implant surgery also has its own challenges because of increasing number of surgeries by newer surgeons who are in learning curve. Although number and severity of complications were reduced with experience, avoidance of this challenges during surgery and post-operative period was the main objective for each implant surgeon. Post-operative device programming is difficult in pediatric patients, it is important that the thresholds are accurate and the device set at comfortable levels for optimal functioning of the implant. The purpose of this study is to evaluate the major and minor challenges during surgery and post -operative period & how to overcome all those challenges were highlighted. AIM AND OBJECTIVES: 1. To establish & discuss the intra & post-operative challenges of cochlear implant surgery. 2. Methods to avoid those challenges. 3. Methods to manage those challenges. STUDY DESIGN: Cross sectional study. MATERIALS AND METHODS: All cochlear implant surgeries performed in our institution RGGGH-UIORL between September 2016 – August 2018. Total population of 250 were studied, preoperative evaluation included, HRCT Temporal bone with serial axial and coronal cuts, MRI Brain with internal auditory meatus screening, general, physical, systemic examination and anaesthetic fitness of the patient were studied. Inclusion Criteria: • Children aged between 1-12 years. • Both sexes (female and male). • Bilateral profound sensory-neural hearing loss with no response in BERA. • No appreciable benefit with hearing aid. • No medical or anatomic contraindications. • Motivated parents for cochlear implant surgery & Willingness to comply with follow-up procedure. Exclusion Criteria: • Age below 6 months and above 12 years. • Children with cochlear nerve aplasia and central auditory lesion. • Child with active ear disease. • Children with mental and behavioural disorders. RESULTS: Cochlear implant is a safe hearing rehabilitation surgical technique with less challenges, however the surgeons must be familiar with these challenges in order to prevent minor and major challenges. various challenges are highlighted and techniques evolved in order to overcome those challenges. CONCLUSION: All cochlear implant center should have adequate audiologist backup. The audiologist must specially be trained in neural response telemetry, audio verbal therapy, switch on, mapping and management in trouble shooting