Cochlear implant surgery - Revision history

Jashvin: Maintenance suggestions

2022-10-31T20:14:43Z

Maintenance suggestions

← Older revision		Revision as of 13:14, 31 October 2022
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	* Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion		* Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion
	*During microscopy, minimize patient movement		*During microscopy, minimize patient movement
			**Consider remifentanil infusion
			*Consider TIVA with propofol infusion to aid in preventing PONV
	*Volatile anesthetics are appropriate despite facial nerve monitoring		*Volatile anesthetics are appropriate despite facial nerve monitoring

Nkamdar: procedure variants

2021-07-12T01:28:13Z

procedure variants

← Older revision		Revision as of 18:28, 11 July 2021
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	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|180min
	\|		\|43min
	\|-		\|-
	\|EBL		\|EBL

Nkamdar: Added surgical issues and differences in approaches.

2021-07-12T00:22:26Z

Added surgical issues and differences in approaches.

← Older revision		Revision as of 17:22, 11 July 2021
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	\| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)		\| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)
	\| considerations_postoperative =		\| considerations_postoperative =
	}}'''Cochlear implant surgery''' is a 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\|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\|via=}}</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.		}}'''Cochlear implant surgery''' is a 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\|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\|via=}}</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. Surgical incision is postauricular and that the cochlear implant device sits internally under the skin behind the incision usually. There is no external mechanical component of the device on the surface of the skin that can be seen immediately post-op. A suprameatal approach is reserved for patients with anatomical variations (16%).

	==Preoperative management==		==Preoperative management==
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	===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===		===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===
	*Patients' limited hearing may impair preoperative consultation		*Patients' limited hearing may impair preoperative consultation
			*Investigate genetic/syndromic sources of hearing loss such as neurofibromatosis it's multi-organ pathology

	===Operating room setup===		===Operating room setup===
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	*Head positioned away from operating site.		*Head positioned away from operating site.
	*Surgeons may conduct frequent head position changes intraoperatively		*Surgeons may conduct frequent head position changes intraoperatively
			*Surgeons frequently tilt table for adequate visualization under the microscope. Patients must be carefully strapped to table during these extreme table-tilt angles. Consider 3-4 safety straps during initial positioning

	===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. -->===
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	*PACU		*PACU
	*Home discharge		*Home discharge

			=== Post-op considerations ===

			* Patient hearing is still impaired post-op. Patients must wait weeks before external sound sensor is activated and the patient can hear
			* Glasscock pressure dressing<ref>{{Cite journal\|last=Levy\|first=Joshua M.\|last2=Johnson\|first2=Bradley T.\|last3=Molony\|first3=Timothy B.\|date=2011\|title=Effectiveness of the Glasscock dressing compared to the mastoid pressure dressing in cochlear implantation\|url=https://onlinelibrary.wiley.com/doi/10.1002/lary.22279\|journal=The Laryngoscope\|language=en\|volume=121\|issue=S5\|pages=S323–S323\|doi=10.1002/lary.22279}}</ref> remains on the patient for 2 days post-op
			* Eye and lip sites from facial nerve monitor needles may cause oozing of blood or bruising

	===Pain management===		===Pain management===
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	*PONV		*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<ref name=":0">{{Cite journal\|last=Xu\|first=Bai-Cheng\|last2=Wang\|first2=Su-Yang\|last3=Liu\|first3=Xiao-Wen\|last4=Yang\|first4=Ke-Hu\|last5=Zhu\|first5=Yi-Ming\|last6=Chen\|first6=Xing-Jian\|last7=Du\|first7=Wan\|last8=Li\|first8=Yong\|last9=Chen\|first9=Chi\|last10=Guo\|first10=Yu-Fen\|date=2014\|title=Comparison of Complications of the Suprameatal Approach and Mastoidectomy with Posterior Tympanotomy Approach in Cochlear Implantation: A Meta-Analysis\|url=https://www.karger.com/Article/FullText/358922\|journal=ORL\|language=en\|volume=76\|issue=1\|pages=25–35\|doi=10.1159/000358922\|issn=0301-1569}}</ref>==

	{\| class="wikitable wikitable-horizontal-scroll"		{\| class="wikitable wikitable-horizontal-scroll"
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	\| Unique considerations		\| Unique considerations
	\|		\|
	\|		\|Positioning of the device

			via the external auditory canal
	\|-		\|-
	\|Position		\|Position
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	\|-		\|-
	\|Potential complications		\|Potential complications
	\|		\|Facial nerve damage (1%)<ref name=":0" />
	\|		\|
	\|}		\|}

Chris.Rishel: Reference fix

2021-07-11T21:09:04Z

Reference fix

← Older revision		Revision as of 14:09, 11 July 2021
Line 7:		Line 7:
	\| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)		\| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)
	\| considerations_postoperative =		\| considerations_postoperative =
	}}'''Cochlear implant surgery''' is a 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.		}}'''Cochlear implant surgery''' is a 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\|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\|via=}}</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==

Chris.Rishel: Removed preop systems table

2021-07-11T21:08:41Z

Removed preop systems table

← Older revision		Revision as of 14:08, 11 July 2021
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	===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===		===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===
	~~{\| class="wikitable"~~		*Patients' limited hearing may impair preoperative consultation
	\|+
	~~!System~~
	~~!Considerations~~
	\|-
	~~\|Neurologic~~
	\|Patients' hearing ~~is limited~~
	\|}

	===Operating room setup===		===Operating room setup===

Chris.Rishel: Some formatting, removed unused sections

2021-07-11T21:07:11Z

Some formatting, removed unused sections

Show changes

Nkamdar: Added to body of the document.

2021-07-10T22:13:58Z

Added to body of the document.

← Older revision		Revision as of 15:13, 10 July 2021
Line 9:		Line 9:
	}}		}}

	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<!-~~- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->~~ ===		=== Disposition ===

			* PACU
			* Home-discharge

			=== Pain management ===

	~~=== Pain management<!~~-- ~~Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===~~		* 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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	\|+		\|+
	!		!
	!~~Variant 1~~		!Posterior
	!~~Variant 2~~		Tympanotomy
			!Suprameatal
	\|-		\|-
	\|Unique considerations		\|Unique considerations

Nkamdar at 21:52, 10 July 2021

2021-07-10T21:52:59Z

← Older revision		Revision as of 14:52, 10 July 2021
Line 9:		Line 9:
	}}		}}

	~~Provide~~ a ~~brief summary of this surgical procedure~~ and ~~its indications here~~.		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.

	== Preoperative management ==		== Preoperative management ==

Nkamdar: basic case.

2021-07-10T19:59:22Z

basic case.

← Older revision		Revision as of 12:59, 10 July 2021
Line 1:		Line 1:
	.		{{Infobox surgical procedure
			\| anesthesia_type = General
			\| airway = ETT
			\| lines_access = PIV
			\| monitors = Standard; facial nerve monitoring
			\| considerations_preoperative = Patients' hearing is limited
			\| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)
			\| considerations_postoperative =
			}}

			Provide a brief summary of this surgical procedure and its indications here.

			== Preoperative management ==

			=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
			{\| class="wikitable"
			\|+
			!System
			!Considerations
			\|-
			\|Neurologic
			\|
			\|-
			\|Cardiovascular
			\|
			\|-
			\|Respiratory
			\|
			\|-
			\|Gastrointestinal
			\|
			\|-
			\|Hematologic
			\|
			\|-
			\|Renal
			\|
			\|-
			\|Endocrine
			\|
			\|-
			\|Other
			\|
			\|}

			=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

			=== Operating room setup ===

			* Standard GA setup
			* Consider straight connector with accordion to ETT
			* Circuit extensions for 180-degree supine position

			=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

			=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

			== Intraoperative management ==

			=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

			* Facial nerve monitoring
			* PIV (consider 2nd IV in lower extremity with 180-degree positioning)

			=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

			* 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<!-- 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. --> ===

			=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

			== Postoperative management ==

			=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

			=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

			=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

			== 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). --> ==

			{\| class="wikitable wikitable-horizontal-scroll"
			\|+
			!
			!Variant 1
			!Variant 2
			\|-
			\|Unique considerations
			\|
			\|
			\|-
			\|Position
			\|
			\|
			\|-
			\|Surgical time
			\|
			\|
			\|-
			\|EBL
			\|
			\|
			\|-
			\|Postoperative disposition
			\|
			\|
			\|-
			\|Pain management
			\|
			\|
			\|-
			\|Potential complications
			\|
			\|
			\|}

			== References ==

			[[Category:Surgical procedures]]

Tony.Wang: Page created

2021-05-23T22:57:48Z

Page created

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