Sunday, June 24, 2007

Nichole's Cochlear Implant Surgery 6/22/2007

June 22, 2007 - The Implantation Surgery

We checked into Children's Hospital, Boston around 10:40am. About 1:15pm, they moved us to the Pre-Surgical holding area, where Nichole changed into a Johnny and had an IV started. We met with her surgeon, Dr. Licameli and Dr. Scott. Nichole received a small amount of medication to start feeling sleepy. About 1:50pm I went with Nichole to the operating room. I helped move her to the OR table and talked with her until they put her under. I then took her hearing aids out.

The waiting area at Children's is very nice. They have two liaison nurses who check with the OR every hour and give parents updates. At 5:00pm, the Liaison nurse said they are finishing up and that it should be another 45 minutes. 5:45pm came and went. 6:00pm. 6:15pm. Then at 6:30pm, we were getting nervous. We decided to go check with Nurses on why no update. Dr. Licameli came out as we were heading to the nurse's office. He said “Nichole is doing well, and the implant is perfect. Now let me tell you what went wrong”.

The insertion of the first implant had an issue. Dr. Licameli had completed the implantation. They closed the incision and then our Audiologist (Marilyn) performed the post-implant testing. The signal integrity results were terrible. An X-ray showed that the implant was folded up. The tip, which is very soft and flexible, had folded over on itself when it hit a deformity within Nichole’s cochlea (Mondini Syndrome – see notes at bottom). Dr. Licameli decided that rather than send Nichole on her way and see “how she does” (which Marilyn indicated would be terrible), he opted to remove the first implant and use the backup. They re-opened the incision (had to cut all the stitches), removed the first implant and installed the second one. Dr. Licameli said that during the first implantation, he had removed the guide wire while inserting the electrode array. For the second implant, he left the guide wire in for the whole insertion process, and then removed the guide afterwards. An X-ray of the second implant showed it was well placed, and post-implant testing results were perfect. Nichole will get optimal use from this implant.

At 6:45pm, we joined Nichole in the recovery room. She was still sleepy, and appeared to be in a lot of discomfort. They have her IV morphine for the pain. Around 8:00pm, they released Nichole form recovery and moved her up to 8 West. Nichole started vomiting small amounts of "old" blood (not a great feeling seeing that!). This continued for the next five hours or so. The nurses (who were wonderful) gave Nichole medicine for nausea, but I think she just needed to get rid of all that drainage which had run from her ear to her stomach via the eustachian tube.

Around 6:00am, a resident came in and removed the bandage. Everything looked fine. Two other doctors came in at 8:00am to check on Nichole. They made sure her facial nerves were not effected by having her make a bunch of different faces. Whew. Then Nichole mentioned her tongue was numb.
They said that the numbness in Nichole’s tongue would fade over the course of a few weeks. There is a major nerve near the implant site that forks into two branches. One branch is the main facial nerve, while the other is the taste/sensation nerve to the back of the tongue. They needed to drill a hole in the skull between these two branches. They try to err on the side of the tongue nerve so that the facial nerve is not damaged. All testing of Nichole’s face muscles show no impact to the face nerve. Nichole mentioned her neck was sore on the right side (the implant side). The doctor indicated it was just stiff from being in one position during the surgery and would ease with time.

Nichole was discharged around 1:30pm. The pain med they prescribed is quite strong, making her a bit wobbly, and sleepy. We headed home (with a stop in the North End for some Regina's Pizza to bring home for Nichole's sister and brother. While Nichole is supposed to be on a "soft food" diet, we caved to her desire for a slice. Nichole basically rested the balance of the weekend.


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