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Cochlear implant

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Cochlear implant

  1. 1. COCHLEAR IMPLANT DR SATINDER
  2. 2. COCHLEAR IMPLANT BENIFITS  They make spoken language a viable communication option for those who B/L severe to profound hearing losses.  Improve speech perception  Speech production skills  Contribute to improved reading outcome for school aged students.  Systematic rehabilitation and education programming are necessary for CIs recipients.
  3. 3. CONTRAINDICATIONS Absolute C/I deafness due to lesion in 8th nerve / brainstem and cochlear aplasia. Chronic infections middle ear/mastoid cavity and tympanic perforations. If there is total/near total, b/l cochlear ossicfication.
  4. 4. INDICATIONS FOR COCHLEAR IMPLANTS Bilateral severe to profound H.L. that is not adequately treated with std. hearing aids. Congenital H.L./ prelingual deafness Acquired H.L./ postlingual deafness Severe hearing loss that can be aided and that deteriorates to profound loss in childhood, adolescence, or adulthood (prelingual).
  5. 5. PREOPERATIVE CONSIDERATIONS  Collaborative effort involving patients, families, schools, audiologists, speech/hearing therapists, and surgeons.  Candidates must undergo audiologic testing and speech evaluation.  Candidates are recommended to undergo a hearing aid trial to test whether hearing aids are sufficient or an implant may be more beneficial.  Infants with hearing impairment should also undergo a trial with hearing aids to assess potential benefits of amplification.
  6. 6. •MRI and/or CT scanning are needed to assess anatomy and to evaluate for cochlear, vestibular, and facial nerve locations, as well as to confirm the presence of the auditory nerve (CN VIII). • Implants for children aged 12 months or older with profound b/l H.L. and for adults with similar H.L. who demonstrate limited benefit from hearing aid use as demonstrated by speech perception test scores.
  7. 7. AIM OF PRE-OP IMAGING Cochleo-vestiublar anomalies Evidence of luminal obstruction Additional finding that can complicate surgical/ post-op recovery.
  8. 8. IMAGING  Detect inner ear abnormality.  Tracing course of facial nerve in complex cong. malformed cases.  In case of narrow IAM absence of the bony cochlear nerve canal at the modiolus.  Detection of high riding jugular bulb cases.  Presence of round or oval window  Detect labyrinthine ossification  Early fibrotic obstructions.  Identification of cochlear N.  Potency of cochlear duct  Large vestibular aqueduct syndrome  CNS abnormalities HRCT MRI
  9. 9. Complete labyrinthine ossification. Axial HRCT showing no visualized cochlear lumen. Dehiscent jugular bulb. Note the absence of a bony plate between the anterior wall of the jugular bulb and the tympanic cavity on axial HRCT.
  10. 10. Labyrinthitis ossificans. Cochlea on the left is obliterated by bone after meningitis. Scala tympani of the cochlea on the right was patent, and the patient underwent successful implantation with complete electrode insertion
  11. 11. Cochlear malformations. Neural foramen on the right is absent. Right arrow indicates a rudimentary vestibule. On the left is a severe cochlear malformation (large arrow). Small arrow indicates the internal auditory canal
  12. 12. APPROACHES TRANSMASTOID APPROACH MIDDLE CRANIAL FOSSA APPROACH MINIMALLY INVASIVE COCHLEAR IMPLANT SURGERY
  13. 13. FOLLOW-UP/MONITORING Candidate attend weekly speech therapy sessions, language expression, social skills, lip reading and hearing tactics Meet with the surgeon in the follow- up period to address any wound- healing issues Prognosis for hearing improvement and improved quality of life
  14. 14. COMPLICATIONS Flap dehiscence, Seroma formation, Implant migration, Facial nerve stimulation, Perilymphatic or CSF gusher, Device failure. Mennigitis
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