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Patient Resources

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Improve your hearing success after cochlear implantation surgery with these tips and resources from the Johns Hopkins Cochlear Implant Center.

 

Cochlear Implants and MRI

  • What to do if you need a MRI at Johns Hopkins Hospital after you have had a cochlear implant:

    • You and the clinician ordering the MRI must determine if the benefit of having a MRI outweighs the risk to you and your cochlear implant. Generally, you should avoid having an MRI unless your clinician has determined that the MRI is critical to a diagnosis that cannot be made using other imaging means. Your clinician should fax the order for the MRI and any authorization required by insurance to Johns Hopkins Radiology scheduling at fax # 443-451-6986. Once those documents have been received, you will be contacted with a time for the study. Failure to follow this approach will likely result in your MRI being cancelled.

    • MRIs to be done at Johns Hopkins Hospital for cochlear implant users must be scheduled when one of the Johns Hopkins Neurotology Fellows is available to apply a binding (head bandage) prior to the MRI. Time has been set aside for Monday through Friday mornings for the binding to be done between 7am and 9 am. This was set up to minimize disruption in the surgical training of our fellows.

    • You can reach Barbara Gottschalk by email at bgottsc1@jhmi.edu or by telephone at 410-955-6554 to discuss the MRI procedure if you still have questions after reading the information below.

    To minimize confusion and delays on the day of the MRI, we strongly recommend that you:

    1. Ensure that you know the exact model of your cochlear implant(s), and bring documentation of that information on the day of the scan. What matters in this case is the model of the implant itself, not the external devices that are part of a cochlear implant system. All manufacturers recommend that all external parts of a user’s cochlear implant system be removed prior to entering an MRI suite.

    2. Review the relevant manufacturer website below before scheduling an MRI, and print a copy of the information there to give to the MRI technologist and/or radiologist on the day of your scan.

    3. Notify the MRI scheduling agent that you have a cochlear implant and ask that the agent specifically notify the MRI tech and radiologist that they should review the manufacturer’s website prior to the day of the planned MRI. You can suggest that they search “Johns Hopkins Cochlear Implant MRI” to reach our website, then follow the links to the manufacturer’s site.

  • Advanced Bionics

    The Advanced Bionics HiRes Ultra3D requires no bandage; however, MRI technicians and radiologists may be unfamiliar with this device, so you should anticipate and try to minimize day-of-study confusion and delays by ensuring that the MRI facility reviews the website above before your MRI is performed. If your implant is this model and you have no other implants, then we suggest that you notify the MRI scheduling agent that you have an MRI-compatible cochlear implant and ask that the agent specifically notify the MRI tech and radiologist that they should review the above website prior to the day of the planned MRI. You should then print and bring a copy of the above website instructions and its attached documents to the MRI facility on the day of the study.

    Despite similar names, the Advanced Bionics HiRes 90KHiRes 90K Advantage, and HiRes Ultra are not the same as the HiRes Ultra3D. They all require bandaging and following the scheduling procedures described above.

    MRI is contraindicated for the AB Clarion C1 and CII.

    MedEl:

    The MedEl Synchrony (Mi1200) cochlear implant has a reorienting magnet that makes it more MRI-compatible than other MedEl implants (Concert Mi1000SonataPulsarC40+) and all other cochlear implants other than the Advanced Bionics HiRes Ultra3D; however, Med-El recommends bandaging prior to MRI for all Med-El cochlear implants, including the Synchrony.

    Cochlear Ltd:

Commonly Asked Questions About Cochlear Implant Binding

  • The interaction of the MRI with your device magnet may cause: pain, intolerance of imaging study, cochlear implant movement despite the binding, reversal of magnet polarity, magnet or device extrusion (coming out of the skin), device failure, need for additional surgery, possibly including replacement of the cochlear implant. Most of these risks are rare. More commonly, patients experience mild-moderate discomfort and warmth at the site of the device magnet.

  • CT scans usually require no special precautions for a patient with a cochlear implant and provide very good images for bones, the lungs, blood vessels and the gastrointestinal tract, and ultrasound is a good approach for some cases, but MRI is often the best technology for imaging tumors, joints and other soft tissues. In some cases, the best alternative to MRI may be observation or surgical exploration of the site in question.

  • Most cochlear implants made since 2019 are made to permit MRI scanning without magnet removal, but most older cochlear implants have a magnet that at least requires either a head bandage/binder (to keep the magnet from flipping) or, when that fails, a surgery to remove the magnet before the MRI and then to reinsert the magnet after. Magnet removal and replacement can be done as a sterile procedure in the clinic or operating room. However, every time this is done there is a risk of infection, failure of the skin to heal, and loss of the implant. We use the binding protocol to avoid those risks.

  • If this is your first MRI with your cochlear implant in place, you will be provided a small disc for the binding. If you have had a previous MRI, please bring your disc(s) to future studies. For magnet localization, please bring your external processor. Remember that before entering the MRI suite, you will have to remove your external processor and leave it outside.

  • Some patients are unable to tolerate the wrapping or imaging due to discomfort and/or claustrophobia. We recommend that patients take an over the counter analgesic like ibuprofen or acetaminophen to minimize any pain. If you think you may require an anti-anxiety medication, you should obtain that in advance from the clinician/provider ordering the MRI scan. The person doing the binding will not be able to provide this prescription, and you may have to reschedule the study if you do not have the medication available.

Vaccine Information for Cochlear Implant Candidates

Vaccine Information for Cochlear Implant Candidates

All cochlear implant users and all patients anticipating cochlear implantation should receive pneumococcal vaccination to reduce the risk of ear infections that can lead to pneumococcal meningitis.  

Pneumococcal vaccination protects against Streptococcus pneumoniae (commonly referred to as pneumococcus), the bacteria most commonly responsible for meningitis after cochlear implant surgery.  Although extremely rare, bacterial meningitis can be fatal and has been reported worldwide in 200 patients with cochlear implants since 1980. We therefore take this matter very seriously.  To minimize the risk of infection, we require all cochlear implant uses and candidates to receive age-appropriate pneumococcal vaccination and to provide us with proof of vaccination. We take these precautions in accordance with guidelines established by the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) and state health departments. 

In early 2022, the CDC updated pneumococcal vaccination recommendations for adult cochlear implant patients to reflect approval of two new vaccines, called PCV20 and PCV15. The 2022 CDC guidelines for pneumococcal vaccination and cochlear implantation are: 

2022 CDC Guidelines

CDC recommends pneumococcal vaccination for all children, including those with cochlear implants. 

Children younger than 2 years old with cochlear implants should receive PCV13 according to the Childhood Immunization Schedule. If an older child with cochlear implants did not get the recommended shots as an infant and young child, they may need to receive PCV13. Children 2 years or older with cochlear implants should also receive PPSV23. Talk to your child’s doctor about when your child should get these vaccines. 

Children should get all recommended shots of pneumococcal vaccines at least 2 weeks before cochlear implant surgery. This will provide maximum protection both during and after surgery. Children already up to date with pneumococcal vaccination do not need extra shots before surgery. 

CDC recommends pneumococcal vaccination for adults with cochlear implants. 

All adults with cochlear implants who have never received pneumococcal vaccines should receive 1 shot of PCV15 or PCV20. If PCV15 is used, it should be followed by 1 shot of PPSV23. Talk to your doctor about when you should get these vaccines. 

Adults should get all recommended shots of pneumococcal vaccines at least 2 weeks before cochlear implant surgery. This will provide maximum protection both during and after surgery. Adults already up to date with pneumococcal vaccination do not need extra shots before surgery. 

CDC recommends pneumococcal vaccination for people who have had pneumococcal meningitis in the past. 

A past case of pneumococcal meningitis does not provide enough protection against getting this form of meningitis again. For this reason, people should receive pneumococcal vaccines according to CDC’s recommended schedules regardless of if they have had pneumococcal meningitis. 

For children, the new (2022) guidelines are the same as the old (2021) guidelines, because PCV15 and PCV20 are not yet approved for children.  

For adults, the new (2022) guidelines are simpler than before, because only one vaccine is required. For adults who have not already received any pneumococcal vaccine, we recommend a single dose of PCV20, which you can receive at one of your JHCIC visits or at a pharmacy or your primary care provider’s office.  

Cochlear implant users and candidates who already completed all pneumococcal vaccinations recommended by the 2021 Johns Hopkins Cochlear Implant Center guidelines should not need PCV20 or PCV15. The old (2021) recommendations, which are still current for children are: 

Old (2021) JHCIC Pneumococcal Vaccination Guidelines 

  • Young Children (younger than 2y) – A full schedule of Prevnar 13 vaccines should be administered as routinely required in the U.S. 
  • Young Children (older than 2y) – One dose of PPV23 or Pneumovax should be given at age 2 years. If the last dose of Prevnar 13 is given after age 2 years, then Pneumovax should be administered 8 weeks later. 
  • Adults (age 19y and older) who have NOT had any prior pneumococcal vaccinations now need one dose of Prevnar 13 followed 8 weeks later by PPV23 or Pneumovax.  A Pneumovax booster is required at age 65 years. 
  • Adults (age 19y and older) who have had prior vaccination only with Pneumovax, now also need one dose of Prevnar 13 to be given 1 year of more after their Pneumovax shot. A Pneumovax booster is required at age 65 years. 
  • Adults over 65 need one dose of Prevnar 13 to be given at least 1 year after Pneumovax.  If no pneumococcal vaccines given yet, get Prevnar 13 then Pneumovax 8 weeks later. 
  • Cochlear implant candidates must have completed at least part of the immunization requirements prior to surgery. Full compliance with the full immunization schedule must be documented as soon as possible. 

We ask that the patient’s primary care physician sign a Proof of Pneumococcal Vaccination Form and return it to us via MyChart or fax 410-367-2365 to Barbara Gottschalk MSN CRNP at the Johns Hopkins Cochlear Implant Center. To avoid canceling your surgery or discovering a problem too late to fix it, please send you vaccination confirmation as soon as possible and at least 3 weeks before a planned cochlear implant surgery date.  

To avoid confusion, adults who plan to receive pneumococcal vaccination should specifically request PCV20, and parents of children who need pneumococcal vaccination should specifically request “pneumococcal vaccination according to CDC guidelines cochlear implant users”. If you ask a non-JHCIC provider for “a meningitis vaccine”, you may receive the wrong vaccine. For more information, please visit the CDC’s website on Use of Vaccines to Prevent Meningitis in Persons with Cochlear Implants

If you have any questions, please contact:  

Updated: April 2022 

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