Cochlear Implant surgery is a three-hour procedure with an overnight stay in the hospital. It is considered outpatient surgery. An incision is made behind the ear and an opening is made in the bone so that the electrode array can be inserted into the inner ear. The incision is closed and the patient goes to the recovery room for about an hour, then to a hospital room for an overnight stay. The patient usually goes home the following morning. 
 
Risks of surgery include:

• The risks associated with being anesthetized for 3 hours.
• Injury to the facial nerve causing paralysis of one side of the face. Worldwide incidence of permanent facial paralysis following cochlear implantation is 2%. The function of the facial nerve is monitored during the surgery in every case. This monitoring helps the surgeon avoid injury to the nerve.
• Infection at the surgical site.
• Temporary loss of taste sensation. This usually recovers in about two months.
• Failure of the cochlear implant device to work after it is implanted.
• Failure to provide benefit. A small number of patients report that they receive no benefit from the device. The rigorous candidacy evaluation process minimizes this possibility.
• Nausea or dizziness after surgery. Usually this goes away after one day, but for some people it can last several days. If this is the case, a longer hospital stay may be required.
• Disappointment in the benefit obtained from the cochlear implant. Each patient and their family members are counseled so that their expectations are realistic.   

Programming the cochlear implant

One month after surgery patients return for the “hook-up.” On the first day of activation, the headpiece is placed on the patient’s head and the speech processor is connected to a computer. The speech processor is programmed by the computer to provide effective stimulation for the patient. This is customized for each patient so that they hear important sounds and do not hear uncomfortable sounds. Most people are disappointed on the first day. Voices do not sound normal. They are reported as sounding mechanical or warbled, (like voices under water), garbled, scratchy or raspy, like a man’s voice or like a child’s voice or any combination of these. It can take up to six months to fully adjust to a cochlear implant.

Full programming or mapping of the implant takes about eight appointments during the first three months following hook-up, with follow-up appointments at three months, six months and annually thereafter for adults, semi-annually thereafter for children.