This surgery is for people with severe to profound sensorineural hearing loss, who struggle despite using conventional hearing aids.

For these patients, a cochlear implant device is a potentially life changing treatment.

The aim of the surgery is to place a cochlear implant receiver under the skin, behind the ear, and insert the attached cochlear implant electrode into the inner ear. When switched on, the device will present sound information to the inner ear at even the lowest volumes.

If you are struggling to hear despite having high power hearing aids then you may be eligible. Within the NHS, ask your audiologist or GP to refer you to an auditory implant centre. Privately, you can directly contact an auditory implant surgeon.

Candidates for this treatment will need to be assessed by a team of dedicated implant experts (classically an implant surgeon, implant audiologist and implant speech and language therapist, but may also include paediatricians, teachers of the deaf and psychologists).

Following the tests and scans, the team will help the patient pick an appropriate implant and plan a bespoke hearing rehabilitation programme around the patient's needs.

If the patient wishes to proceed to surgery, the team will talk the patient through the pre-surgery preparation, what to expect on the day of surgery, surgical recovery, switch-on of implant and essential rehabilitation.

Needle and sticker electrodes are placed on the face and head to provide the surgeon with invaluable information on the position of the important nerves and optimal placement of the electrode array.

A small area of hair needs to be shaved around the ear to reduce the risk of a skin infection. After a dose of antibiotics, the surgery proceeds via an incision placed behind the ear.

The hard bone behind the ear (mastoid bone) is carefully drilled to gain access to the inner ear. The receiver is placed under the muscle behind the ear and the implant electrode is gently inserted into the inner ear, to maximise preservation of natural hearing.

The wound is closed with automatically absorbing stitches and covered with glue.

Cochlear implant surgery has revolutionised hearing health for those with severe-profound hearing loss. It provides sound information at even low volumes to these patients.

The ability to decipher this sound information into meaningful speech depends on several factors: the underlying cause of hearing loss; the duration of hearing loss; previous spoken language development; previous consistent use of hearing aids; the state of the inner ear, and intensity of auditory rehabilitation after procedure.

99% of patients report improvements in their ability to communicate by the 1 year and their global quality of life.

This is a safe procedure performed frequently in specialist hospitals without any serious problems. However, there are potential risks of surgery that you should be aware of:

All surgical procedures have risks of infection, bleeding, pain and scar.

Infection risk is reduced by operative techniques, a dose of antibiotics during the surgery and a meningitis vaccination (provided by your GP at least 2 weeks before surgery – 23 Valent Pneumococcal vaccination).

Severe bleeding is uncommon after this surgery. However, to reduce the risk of bleeding under the skin post-operatively we place a pressure bandage around your head for up to 24 hours, which can be removed by yourself the next morning.

Pain is mild to moderate and we recommend you take regular over-the-counter pain killers (e.g. paracetamol, neurofen) for the first week following surgery.

Numbness over the ear is common and results from skin nerves being cut during the surgical incision. Patients rarely find this an issue in the long term.

Scarring is reduced by meticulous closure using absorbable stitches. Glue will be placed over the incision allowing the patient to wash their hair in the first week after surgery.

Whilst regular acoustic hearing in the operated ear will be surpassed by electrical hearing from your new cochlear implant, there is a risk that residual regular hearing in the operated ear may reduce. To minimise this risk we administer a course of steroids during the surgery. Hearing in the non-operated ear will not be affected by surgery.

Since the hearing and balance systems are anatomically linked, patients frequently report temporary balance disturbances following surgery. Permanent changes in balance is extremely rare and occasionally balance physiotherapy may need to be undertaken, if balance recovery is slow. If your sense of balance is very poor before surgery or you suffer from a severe balance disorder, please discuss this with your surgeon.

The effect of this surgery on tinnitus is unpredictable. Many patients report an improvement in their pre-existing tinnitus, some report no change and rarely patients report deterioration in their tinnitus.

1 in 20 people complain of a metallic taste on the tip of half their tongue following surgery. This is temporary. Permanent change in taste is very rare. If your taste is central to your career (e.g. chef or sommelier) please discuss this with your surgeon.

There is a small but serious risk to the nerve that controls face movements on that side of the face. We use a nerve monitor during surgery to prevent this injury, in addition to pre-operative scans which inform us the anatomy of this nerve. In the few cases where this injury has been reported, the majority are temporary. Permanent damage would require further surgery to restore some function to the muscles of the face.

In some very rare cases, the electrode array’s position within the cochlea is not ideal and will need adjusting to provide the best hearing outcomes. This is extremely rare and is judged by testing during the operation, post-operative X-rays, and hearing outcomes after the device is switched on. Rarely, another operation will be needed to correct this.

In addition, there are some long term risks and considerations. The cochlear implant works by sending an electrical signal to the inner ear. Any part of this device can fail over the course of your life. For example, the insulation around the electrode prevents this signal escaping. Very rarely this process can break down meaning that the electrical signal, that was meant to travel to the inner ear, also activates surrounding nerves, causing facial twitching or pain. In this extremely rare situation we would recommend removing the implant and inserting a new implant.

There is a small but serious risk of leakage of brain fluid. If leakage of brain fluid is noted during the operation we will fix it using cartilage and other grafts harvested from around the ear. However, if it is noted following surgery, you will need to have a second operation to fix this.

This is a major operation undertaken in a specialist hospital operating theatre under a general anaesthetic.

You/your child will be expected to avoid food and liquids in the hours before you arrive (you/your child can eat up to 6 hours and drink water 2 hours before your arrival to hospital). You/your child will be checked into a ward and introduced to the nursing team. Your anaesthetist and surgeon will meet you before surgery: you will have a chance to ask any final questions at this stage. (Although it is recommended that questions are addressed before your surgery date.).

For children, a parent will be allowed to bring their child to the theatre area, where anaesthesia will be started. As the child falls asleep the parent will be escorted back to the ward by the nurse. The operation takes 2 hours per side.

You/your child will wake up with a bandage over your ears and around your head. This bandage stays on until the following morning and can be taken off by yourself/a parent.

Your/your child's hearing aid will no longer be effective, as fluid in the middle ear will stop sound getting to your inner ear. This will persist for a few weeks.

You may be slightly dizzy but this is temporary and should pass quickly.

After 6 hours or so of observations on the ward, you/your chlid will be free to go home accompanied.

People who have surgery must keep their ears dry. Hearing aids may be ineffective in the first few weeks following surgery, as protective fluid builds up around the inner ear. You/your child will be seen 1 week following surgery by the surgical team, who will check the wound is healing well and the implant is in a good position. You/your chlid can have 2 showers in the 1st week after surgery as long as you block your ear hole with cotton wool soaked in Vaseline. People who have surgery traditionally take 1-2 weeks off from work/school depending on the physicality of their daily routines. Your device will be switched on in 2-3 weeks.