minimally invasive approaches do not require hair removal, save time in the operating room, decrease healing time, and are associated with less pain
We use minimally invasive surgical techniques in infants, children, and adults to decrease the pain and swelling after cochlear implant surgery, and miminize the time from surgery to activation to approximately 2 weeks.
ABOVE: 12 month old female infant with the 3-4cm planned surgical incision behind and slightly above the right pinna. The hair is carefully taped away from the ear, and so no hair shaving is required in infants, and in most children. This tiny incision is used for infants and adults undergoing conventional cochlear implant surgery.
We have used this technique in infants as young as 9 months without difficulty. No hair is shaved in infants and most children. The hair is taped away from the ear and the incision. Occasionally, a minimal amount of hair is shaved in some adults with longer or thicker hair, and when a larger cochlear implant is chosen.
Titanium screw fixation - the use of special self-tapping, self-drilling screws - saves 15 minutes or more in the operating room, minimizes trauma to the dura and overlying soft tissue, and results in a very stable, secure placement of the cochlear implant. This also allows the surgery to be performed via a tiny incision behind the ear using carefully placed skin retractors and well-designed muscle flaps.
Average surgery time is 1.5 hours for infants and 2 hours for adults, decreasing the length of general anesthesia, minimizing the exposure of the device and minimizing the infection risk postoperatively. We feel that this enhances the safety of the procedure. Faster surgical times also translates into less retraction of the skin flaps, resulting in less pain, swelling, and hastening of the healing process.
ABOVE: Photos taken on the day of surgery, and 6 days following right-sided minimally invasive cochlear implant surgery in this otherwise healthy 12 month-old female infant.
The upper photo was taken 2 hours after surgery, with the mastoid-pressure dressing in place. The infant recovered quickly and was discharged from the hospital about 4 hours after surgery.
The middle photo shows virtually no proptosis of the right ear following surgery, and the lower photo shows that the dissolvable sutures are beginning to disappear and the tiny insicion has begun healing. There was no tenderness or swelling over the magnet site.
In our experience, tiny surgical incision results in less swelling, pain, and faster healing. Activation can take place 1-2 weeks, rather than 4-6 weeks following cochlear implant surgery.
The photos below show that the device can be place well behind the pinna using a small incision, and that a virtually invisible scar that does not affect the hairline can be achieved at 6 months following surgery.
(the parents of this patient fully consent to the use of these images on this website)