Cochlear Implant Post Operative Instructions
DISCHARGE: You will be discharged the same day or the next morning after surgery depending on several factors such as your general medical condition, time of day your surgery is performed and geographical proximity to the hospital.
HEADDRESSING BANDAGE AND WOUND CARE: If you are discharged the same day of surgery, you will be wearing a head-dressing bandage. This bandage is to be removed the morning after surgery. You may then gently clean the operative site with soap and water or hydrogen peroxide and then gently pat it dry. If there is a rubbery adhesive material on the skin and hair along the periphery of the operative site, this may be removed with nail polish remover or alcohol (this adhesive material was used to secure the operative drapes during surgery). Please do not cover the incision with a bandage after removal of the head dressing.
SHAMPOO: Two days after surgery you may shampoo your hair and wash your scalp. Gently pat the incision dry.
MEDICATIONS: You will be given a prescription for an antibiotic to take for seven to ten days and a pain medication to be used as needed. Please do not take aspirin, which may contribute to bleeding. You may take over the counter acetaminophen (Tylenol) before trying the prescribed pain medication.
FOLLOW UP OFFICE VISIT: You will have a return visit in your doctor’s office seven to ten days after your surgery. Please call the office for an appointment at (212) 889-2600.
If there are external stitches to be removed, they will be removed approximately seven to ten days after surgery either in the doctor’s office or if notified otherwise, in the hospital. Children will have absorbable sutures, which will not require removal, but they will still need to be seen in the office on week after surgery.
POST OPERATIVE SYMPTOMS: It is possible that you may have some unsteadiness or dizziness after the surgery. This should diminish over time. You may also have an alteration in the taste on the site of surgery and this also will diminish over time. You may have a ringing or buzzing noise in the ear and this will also diminish over time. If there is swelling, redness, severe pain, drainage from the incision or if you have any questions, please call the doctor’s office.
POST OPERATVE MAPPING OF COCHLEAR IMPLANT: You will be scheduled for your first mapping session to turn on your cochlear implant at your cochlear implant center. The cochlear implant center will schedule this first appointment, which is generally about three to four weeks after surgery. You will have series of mapping sessions over the first year to optimize your function as you are more able to handle increasing auditory information.
CRITICAL LONGTERM INSTRUCTIONS
ELECTROCAUTERY: Electrocautery is an instrument used to control bleeding in the operative field during surgery. There are alternative ways to control bleeding depending on your surgeon’s preference.
In the future, if you have surgery of any kind, please share with your surgeon that monopolar electrocautery must not be used in the head and neck of the cochlear implant patient as induced currents can cause damage to cochlea tissues or permanent damage to the implant. Biopolar electrosurgical instruments may be used on the head and neck patients, however the cautery electrodes must not contact the implant and it should be kept more than one half inch (1cm) from extra-cochlear electrodes and from the implanted receiver stimulator package (behind and above the implanted ear).
DIATHERMY: Therapeutic or medical diathermy (thermo penetration) using electromagnetic radiation (magnetic induction coils or microwave) must not be used. High currents, which may be induced into the electrode lead from these procedures, can cause tissue damage to the cochlea or permanent damage to the implant.
Medical diathermy using ultrasound may be used below the head and neck.
In general, diathermy treatments are used by a variety of healthcare professionals, including physical therapists, nurses, chiropractors, dentists, sports therapists and others. Some healthcare professionals may refer to diathermy as (DP); however, diathermy devices may also be used in a way that causes little or no heating. Diathermy is a treatment that delivers energy to specific areas of the body. These treatments are typically used for the following purposes: to relieve pain, stiffness or muscle spasms, to reduce joint contractures, to reduce swelling and pain after surgery and to promote wound healing.
There is a risk to patients regardless of diathermy target site even when the external cochlear implant device is "on" or "off", and even when a device is removed but the lead electrodes remains implanted. Also, the risk of injury still exists if the diathermy device is used to deliver heat or no heat. Diathermy equipment using microwave inductive heating methods are the most likely to cause damaging heating because the electromagnetic radiation is high. Such devices should not be used on a cochlear implant recipient. Ultrasound diathermy equipment using a different means of heating, is more confined in its energy emission and can therefore be used below the head and neck of cochlear implant recipients.
NEUROSTIMULATION: Do not use neurostimulation directly over the cochlear implant.
MAGNETIC RESONANCE IMAGING (MRI): Magnetic Resonance Imaging (MRI or MR) is contraindicated in patients with cochlear implants except under certain circumstances, which are specific for each manufacturer. Patients with a cochlear implant should not enter a room where an MRI scanner is located. Generally speaking, if the cochlear implant’s magnet is in place, it must be removed surgically before the patient undergoes an MRI procedure.