A cochlear implant is a small electronic device that is surgically implanted in the inner ear to provide a sense of sound for people who have severe to profound hearing loss.

The decision to have a cochlear implant is an important one. It is made only after thorough assessment and consultation between families and a child’s medical team.

What does the operation involve?

The surgeon makes a cut behind the ear and opens the mastoid bone. The facial nerve is identified and an opening to access the cochlea is created and the electrodes of the implant are inserted into the cochlea. The receiver is placed under the skin on top of the bone behind the ear. The skin incision is closed, and dressings and head bandage applied.

The surgery is performed under general anaesthetic. It takes between 2-4 hours depending on complexity and if one or both ears require a cochlear implant. The cochlear implant will be tested immediately after surgery while your child is still under the general anaesthetic. This will confirm if the hearing nerve is being stimulated and if the implant is working.

In most cases your child will only stay overnight in hospital.

Risks of surgery

Serious risks associated with cochlear implant surgery are very rare but can include:

• Inflammation of the brain (meningitis)
• Poorer than predicted outcomes
• Loss of residual hearing
• Disturbance of taste
• Dizziness
• Tinnitus (ringing in the ears)
• Leakage of fluid from the cochlea, perhaps requiring another operation
• Infection, bleeding
• Device movement
• Damage to the facial nerve responsible for closing eyes, smiling and facial expression.
• Anatomical abnormalities and/or ossification of the cochlea (where the tissue is replaced by bone) may prevent insertion, or allow only partial insertion, of the cochlear implant, which may affect subsequent hearing outcomes.

If you have any questions or concerns about your child’s surgery, discuss them with the surgeon.

What to expect after the surgery

• After the surgery, your child will have an intravenous (IV) drip in the back of their hand in case they need any further medication when they are transferred to the hospital ward.
• Your child will have stitches behind their ear that will be covered with a dressing and a bandage will be wrapped around their head. This stops the implant from moving and should be left in place for 1 week.
• After surgery, your child must rest in bed and avoid moving their head. This helps reduce dizziness or nausea.
• Your child may have a nosebleed after surgery as a small amount of blood may pass down the Eustachian tube that connects the ear to the back of the nose. This is common, and there is no need for concern.
• Before they go home, your child will have an X-ray to check the position of the cochlear implant.
• If there are no complications, your child is usually discharged home a day after their surgery.

Post-operative check-up

Your child will have an appointment with the ENT surgeon a week after surgery. The head bandage will be removed at this appointment and the wound and implant checked. After the wound is healed there will be a faint scar.

Care at home

Medication

Your child will generally be on oral antibiotics for one week after surgery. It is important your child takes the whole course.

Pain relief

Pain after the surgery is usually only mild and can be managed with paracetamol (Panadol). Check with your child’s doctor before giving any other medicines. Do not give your child anti-inflammatory medicine such as Aspirin or Nurofen.

Showering or bathing

Use a shower cap to keep your child’s bandage and hair dry while they’re in the shower or bath.

Bandage care

If your child’s bandage comes off at home, it needs to be replaced to minimise the risk of infection. If this occurs bring your child to the Department of Emergency Medicine and ask to have the bandage replaced by an ENT registrar.

When to seek help

See your GP or go to the nearest emergency department if your child:

• has increased pain (some pain is common but should be relieved by paracetamol)
• is bleeding or has any discharge from the bandaged ear
• is dizzy or vomiting
• has a fever (temperature over 38.5°C)
• has redness or swelling around the bandaged ear
• has weakness of the muscles of the face.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Things to remember after cochlear implant surgery

Medical resonance imaging (MRI)

Tell radiographers/radiologists that your child has a cochlear implant if an MRI is being considered.

An MRI is generally not recommended for someone with a cochlear implant as it may cause the implant’s internal magnets to move or cause pain at the implant site.

Some low-strength and lower-body MRI scans can be done with cochlear implant in place.

Temporary removal of the implanted magnet is possible if needed. This would need discussion between the radiologist and your surgeon.

Air travel

Cochlear implants will activate metal detectors. An identification card must be carried. Airport X-ray equipment will not damage cochlear implants or speech processors.

Sport

A direct impact on the site of a cochlear implant can damage the device. Full contact sports, hockey and lacrosse are not recommended. Protective head gear should be worn for bat and ball sports.

Developed by the Ear Nose and Throat and Audiology departments, Queensland Children's Hospital. We acknowledge the input of consumers and carers.

Resource ID:  FS090. Reviewed: March 2024.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.