Risks related to the surgery :

• Cochlear implant surgery involves the same risks as those typically associated with any other surgery under general anesthesia. 

•  Some problems may occur, but they will generally disappear in the weeks following the surgery :

  • ​vertigo.

  • numbness around the ear.

  • worsening of the tinnitus.

  • jaw pain.

  • altered taste. 

•  Some major complications are possible, although very rare :

  • permanent facial paralysis.

  • meningitis.

  • permanent increase in the tinnitus.

  • chronic pain at the implantation site.

  • infection of the ear or incision requiring removal of the implant.

  • permanent balance disorders.

  • residual hearing is usually partially or completely destroyed in the operated ear.

• There is still little known about the long-term effects of electrical stimulation on the auditory nerve.

• A person’s hearing capacity, communication or psychosocial situation may not be improved by this technology.

• The electronics in the device may also malfunction, requiring another surgery to replace the implant. 

• If problems occur, it is very important to call the ENT department at CHU de Québec-UL, L'Hôtel-Dieu de Québec (see contact information in the menu on the right).

The day before the surgery 

• All patients (children and adults) must go to the hospital the day before the surgery for a preoperative visit in Audiology and ENT. If the surgery is scheduled on a Monday, the preoperative visit will take place on the previous Friday.
• ​You will be sent a letter with your appointment location and time. A nurse from the Operating block will contact you about the preoperative examinations (other than Audiology and ENT).

• All patients (children and adults) must have someone accompany them for the surgery.

• For more information about the day of your surgery, call the Operating block at L'Hôtel-Dieu de Québec (see contact details in the menu on the right).
• ​You must be fasting as of midnight the day before the surgery. However, water, apple juice and black coffee (no sugar or milk) are allowed, but only up to 3 hours before the surgery. 

Before the surgery 

• You must report any illness or infection you experience in the days or weeks preceding your surgery to the program office at L'Hôtel-Dieu de Québec (see contact information in the menu on th right).  Appropriate measures will be taken to avoid your surgery being postponed. 
• U.S., Canadian and Québec public health authorities all recommend that cochlear implant recipients receive age-appropriate vaccines for pneumococcus and Haemophilus influenzae. Since 2002, anyone scheduled to undergo cochlear implant surgery has had access to these vaccines free of charge (letter explaining the need for vaccination, see bottom of page).  After receiving the vaccines, the person or their parents must return this questionnaire (see bottom of page) to L'Hôtel-Dieu-de Québec as soon as possible before the surgery.

• Do not take any antiplatelet drugs (Aspirin, Entrophen, Asaphen) for 10 days before the surgery. Tylenol is allowed.

• Don’t forget to book your accommodations and transportation prior to your stay for the surgery and the initial programming (Planning your visit). Ask your rehabilitation workers about the financial assistance available in your region. 
• Children 
  • ​It is recommended to remove young children from daycare and to avoid any contact with potentially infectious persons (e.g., children’s birthday parties) for seven days before the surgery. 

  • Older children can go to school unless there is the possibility of contact with potentially infectious persons (e.g., streptococcus, tonsillitis, etc.).

  • It is important to call the program office if the child develops an ear infection in the month before the surgery or a fever in the 10 days before the surgery. 

  • A child who tends to get repeated ear infections can take antibiotics preventively on a doctor’s orders. 

Cochlear Implantation

• On the day of the surgery, patients must go to the Day centre on the 3^rd floor at the appointed time.
• The surgery is done under general anesthesia and takes approximately two hours. 
• When the surgery is over, the patient will be taken to the recovery room, where they will spend anywhere from a few minutes to an hour.
• Usually, the person is discharged the same day but needs to return to the hospital the next day for a postoperative consultation with the ENT specialist and to have their implant activated by the audiologist. In some cases, the surgeon may recommend that a patient be hospitalized following surgery, depending on their condition.
• The patient will not be able to drive after the surgery, it is therefore strongly recommended they be accompanied.

Special instructions for children

• Parents can accompany their child as far as the Day centre on the 3^rd floor, inside the Operating block, but cannot be present during the surgery.
• Parents must wait in the Day surgery waiting room. They will be called as soon as their child wakes up. 
• If the child needs to be hospitalized, a parent must stay with the child the entire time. 
• It is strongly recommended to bring toys and books to help the child pass the time. 

• Generally, patients do not feel much pain when they first wake up. However, if they are in pain, they will be given pain medication immediately. 
• After the surgery, patients may feel sleepy, nauseated and dizzy.
• Children may be irritable or aggressive with their parents during the recovery period.

• You may experience light bleeding in the nose or throat during the week following surgery. This is normal and should stop in the following days.

• Some postoperative symptoms may occur, including: dizziness, tinnitus, change in taste (refer to information document "From Surgery to Programming" for more details).

Postoperative cares

• All patients have dissolving sutures. Do not remove them, they will fall out on their own over time (this can take a few weeks).

• Wash hair as usual 5 days after surgery, to ensure good hygiene.

• Remove small diachylons behind the ear (recoating bandages) 7-10 days after surgery.

Precautions

• Return to school (or daycare) : allowed after 7 days, but must sit out from recess and gym class.

• Driving a car : wait 1 week after surgery.

• Physical effort and sports activities : wait 1 month after surgery. Avoid blows to the head.

• Avoid blowing your nose too hard the month after surgery. Never block your nose while sneezing.

• Permanents and hair colouring: wait 1 month after surgery.

• Hair clipper: wait 3 months after surgery.

• Flying: Wait 1 month after surgery for recreational flights.

• Water in the ears: wait 1 month after surgery.

• Bathing with head under water: wait 2 months after surgery.

Recommendations and precautions to perform your activities safely with a cochlear implant.

Contraindications

• Examinations and treatments to avoid : electrosurgery, electromagnetic diathermy, electroconvulsive therapy, monopolar electrical cauterization, use of ultrasonic dental scaler.

• Precautions to take with other treatments : 

  • Ultrasound diathermy, TENS (transcutaneous neurostimulator), ionizing radiation therapy, electrolysis and electro-acupuncture : administer only below the shoulders and remove the external part (sound processor).

  • Laser (eye surgery and hair removal) : the beam must never be directed towards or near the implant site.

  • Magnetic resonance (MRI) and radiotherapy : possible only after consulting the surgeon at the Centre québécois d’expertise en implant cochléaire in order to determine the feasibility and necessary precautions to take. Avoid entering a room equipped with an MRI machine.

Emergencies

• In case of an emergency, contact your surgeon at CHU de Québec-Université Laval, Hôtel-Dieu de Québec. Evenings and weekends, contact the ENT physician on call.

1. Activation of the implant the day after surgery :

• You will start hearing sounds with the processor (external part).
• However, speech will probably not be clear at that time.
• Sounds might not be pleasant to hear initially. 
• Some people will need to learn—and others relearn—how to hear with this new device. The person will need to get used to new sounds, an adjustment process that takes time. This requires patience and perseverance on the part of the implant user, who also needs to remember that adjustments will be made during the intensive initial programming.
• To help the patient adapt to the cochlear implant and increase their likelihood of continuing with the process (intensive initial programming and intensive functional rehabilitation), the sound processor must be worn all day, from morning to night, for the two-week recovery period. So as not to hinder progress with the implant, the patient must not wear their hearing aid in the non-operated ear during this period. It is also the patient’s responsibility to follow the audiologist’s recommendations to the letter in terms of program testing.

1. 2-week recovery at home.

1. Intensive initial programming of the cochlear implant (over 3 days at the CHU de Québec with 2 visits to the IRDPQ),

• Adjustment of the external part of the implant.  

1. Intensive functional rehabilitation (RFI) (adults: 8 to 10 weeks, children: 12 weeks)

• Intensive functional rehabilitation (RFI) is necessary to develop and optimize the new hearing provided by the implant. Users in some areas can obtain RFI services from their regional rehabilitation centres. Otherwise, you will receive RFI services in Quebec City, at the CIUSSS de la Capitale-Nationale, IRDPQ.