Bilateral cochlear implantation

There is rapidly emerging data that clearly show the benefits of bilateral cochlear implantation (CI). For those surgeons who wish to begin bilateral implantation, several important technical differences from traditional implant surgery must be considered. First, the surgeon must determine whether to perform bilateral simultaneous CI (ie, when both implants are placed during the same procedure) or bilateral sequential CI placement of each implant at separate operations. Technical issues that must be considered during sequential implantation include symmetrical placement of the second implant receiver, the avoidance of monopolar cautery during the procedure, and careful preservation of the chorda tympani. Additional considerations during simultaneous implantations include anticipation of increased operating time, including both ears in the preparation, reduced range of neck rotation, bilateral facial nerve monitoring, the use of a headlight, and symmetrical placement of the implants.