This section (and the previous one on Activity Guidelines) is reproduced here courtesy of the British Cochlear Implant Group (BCIG) which represents the professionals working in the field of implants. It is available from BCIG here. These Guidelines are dated June 2008
Please note that whilst the NCIUA uses it best endeavours to provide accurate information, the Association does not provide medical advice and has no responsibility for these notes.
These guidelines have been produced by the BCIG with input from the major UK suppliers of cochlear implants and members of several UK cochlear implant teams. The information listed here aims to provide realistic guidance to cochlear implant users to enable them to gain the maximum benefit from their implants and to minimise potential problems, but is given as general guidance, parts of which may not be applicable to all cochlear implant users. All cochlear implant users should read and understand the instructions given by the manufacturer / supplier of their cochlear implant and should take advice from their clinician on their own particular circumstances. But do remember that most people with cochlear implants are able to lead normal lives as long as they take a few sensible precautions. Although this information may seem daunting, in most cases the risks are very small!
General medical advice for cochlear implant users
1. Meningitis
You are advised to follow the guidance of the Department of Health, which at the time of writing (June 2008) is that everyone who has a cochlear implant (or is about to receive one) should be vaccinated against pneumococcal meningitis. Further details are available from your cochlear implant centre.
2. Ear infections
Ear infections in the implanted ear must be treated as an emergency by the Cochlear Implant Centre or GP so that antibiotics can be prescribed. If the GP arranges the treatment, it is important to inform the cochlear implant centre as soon as possible.
3. Cremation
At present it is not necessary for a cochlear implant to be removed prior to cremation because it will not explode. But some crematoriums do require all implantable devices to be removed. Parts of the implant may remain after cremation.
If new implants are available in the future which have batteries contained in the internal device, then it WILL be necessary for the implant to be removed prior to cremation.
Advice about specific treatments
The following information is intended as general guidance. The Cochlear Implant ID card gives a summary of the advice for the specific manufacturer and device, and the user should carry this at all times. A copy should also be kept at home and, for children, an additional copy must be kept in the school records. Extra copies of the cards can be obtained from the cochlear implant centre. People with cochlear implants may also wish to wear ‘MedicAlert’ bracelets or pendants (details can be supplied by your cochlear implant centre).
Please remember that the effects of a number of procedures are unknown. If you are in doubt you must consult the implanting surgical team.
Treatments that must NEVER be carried out on people with cochlear implants
1. Electro surgery
Monopolar electrosurgical instruments must never be used in the head and neck region. Bipolar electrosurgical instruments must never be used within 2cm of the implant. Note that this includes dental surgery.
2. Therapeutic diathermy
Therapeutic diathermy is an optional treatment for purposes such as pain relief, reducing joint contractures, reducing pain and swelling after surgery, and promoting wound healing.
There is potentially a very serious risk to health for implant users from short wave diathermy and microwave diathermy and these should NEVER be used.
Note that these treatments are used by a variety of professionals, including physiotherapists, nurses, chiropractors, dentists and sports therapists. They may refer to it as ‘deep heat’ or similar.
Ultrasound diathermy is acceptable below the head and neck.
3. Neurostimulation
Neurostimulation must not be used directly over the cochlear implant as it could lead to damage to the cochlea tissue or to the implant.
4. Electro-convulsive therapy
Electro-convulsive therapy must never be used on a cochlear implant patient.
6. Use of electrical and electronic medical devices
Devices which cause electric current to flow through the head and / or neck should never be used. If you are considering using equipment that could involve electrical current passing through other parts of the body, you should check with your cochlear implant centre first.
Treatments that can SOMETIMES be carried out on people with cochlear implants
1. MRI
MRI must be approached with extreme caution. A person with a cochlear implant must never have an MRI scan without first seeking the advice of the medically responsible person from their cochlear implant team, who should also contact the implant manufacturer. An MRI machine has the potential to damage the implant, or cause potentially harmful effects due to the magnetic and electrical properties of the internal implant (the effects can not be avoided by simply taking off the speech processor). For these reasons, a person with a cochlear implant should also not be near an MRI machine, whether it is in use or not.
Nuclear Magnetic Resonance (NMR) machines, which are sometimes used in research facilities and universities, are similar to MRI machines, so also should not be approached.
Some cochlear implants can be compatible with certain types of MRI procedure. Others can be made temporarily compatible by a minor surgical procedure. Some may not be compatible.
The surgical team who carried out the cochlear implant operation must be contacted before any MRI procedure is carried out.
2. Ultrasound
The use of ultrasonic diagnostic equipment and ultrasonic tooth cleaners is not thought to pose any significant risk of damage to the implant but ultrasound should not be applied directly over the site of the implant and you should remove the external parts of the implant when ultrasound is in use.
3. TENS machines (as used for pain relief)
TENS machines should not be used on the head. For treatment of neck problems and before embarking on any course of physiotherapy electrotherapeutic treatment you should refer to the Implant Centre before proceeding.
4. X rays
X rays can be undertaken but the speech processor should be switched off and kept well away from all X ray equipment.
5. Gamma cameras
External equipment must be removed.
6. Electrolysis
Electrolysis must not be carried out within 1cm of any part of the cochlear implant. (Note that the eyebrows could possibly be close to some of the internal parts). The external equipment should be removed during the process.
7. Devices for electronic pain therapy (including pain relief pens)
These devices may cause damage to the implant if they are used on the head or neck. They may be used below the neck.
8. Radiotherapy (e.g. cobalt units or linear accelerators)
The cochlear implant is only at risk of failure if it is exposed to the direct beam. Scattered radiation is unlikely to cause any damage. As a precaution the external equipment should be removed and kept outside the treatment room. It is advisable to leave the equipment off for 2 hours after the treatment. The Cochlear Implant team should be informed of any cochlear implant users undergoing radiotherapy.
9. Ultrasound diathermy
This is acceptable below the head and neck.
10. Dental treatments
Dental probes, i.e. electrical pulp testers, can be used on people with cochlear implants. See section above for information about ultrasonic tooth cleaners.
Treatments that CAN be carried out on people with cochlear implants
Treatments that are known to be safe for cochlear implant users include:
*laser hair removal
*laser treatment for cataracts.
*use of body mass index scales
*use of digital body fat scales
*electric head lice combs are safe under normal operating conditions
*bone density scans
*DEXA scans