Innovation for CI surgery and habilitation in the COVID era: the MERF, Tamil Nadu experience


  • Sreenivas Kamath Kasaragod Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
  • K. Shilpa Nair Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
  • Kiran Natarajan Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
  • Raghunandhan Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
  • Mohan Kameswaran Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
  • Ranjith Rajeswaran Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India



Cochlear implantation, Challenges, Complications, COVID pandemic


Background: Cochlear implantation (CI) is a safe and effective procedure for management of severe-profound hearing loss. Complications are uncommon, but when present, should be identified and managed appropriately. The CI and its habilitation services were halted during this time period. Through this article we have tried to showcase how our institute resumed the CI surgeries and managed its complications as well as how we tackled the problems faced in auditory habilitation of CI candidates.

Methods: This was a retrospective review of the challenges in cochlear implantation and its complications during the COVID pandemic. A safe management plan was formulated. All patients were thoroughly evaluated and complications were classified as minor or major and were managed medically or surgically, based on its severity. Postoperative auditory habilitation challenges were also tackled with innovative approaches to habilitation.  

Results: A stringent protocol was followed during the pandemic. Wound infection, biofilm, device failure were the complications encountered. All challenges and complications were dealt with by an experienced CI surgeon appropriately with successful outcomes.

Conclusions: During the pandemic, it was essential to deal with all the challenges in CI and its complications taking all necessary precautions. Complications of CI, although not common required prompt and effective management for optimal outcomes.


Chang D, Xu H, Rebaza A, Sharma L, Dela CCS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med. 2020;8(3):e13.

Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020;382(12):1177-9.

Dham R, Arumugam SV, Dharmarajan S, Sunil Mathews, Paramasivan VK, Kameswaran M. Interrupted cochlear implant habilitation due to COVID-19 pandemic-ways and means to overcome this. Int J Pediatr Otorhinolaryngol. 2020;138:110327.

Vaid N, Vaze V, Gokhale N, Kothadiya A. Cochlear Implant Surgery During the Covid Pandemic Lockdown-The KEM Hospital, Pune Experience. Indian J Otolaryngol Head Neck Surg. 2022;74(1):433-6.

Indian Speech and Hearing Association. Telepractice guidelines for audiology and speech, language pathology services in India, 2020. Available at: Accessed on 15 January 2022.

Rajeswaran R, Tavora-Vieira D, Mertens G, Dillon M, Narayan S, Kameswaran M, et al. Audiological practice and COVID-19: recommendations that audiological centers can use to maintain the safety and quality of service-expert opinion. Eur Arch Otorhinolaryngol. 2022;279(3):1251-6.

Smith L, Tønning TL, Josvassen JL, Mikkelsen JH, Nissen L, Dieleman E, et al. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants Int. 2018;19(1):38-45.

Arumugam SV, Thirugnanam S, Paramasivan VK, Pradananga RB, Nithya, Kameswaran M. Satellite habilitation centres following cochlear implantation - Are they the way ahead in improving outcomes in developing countries? Int J Pediatr Otorhinolaryngol. 2021;144:110606.

Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period. Ann Surg. 2020;272(1):27-9.

Tarkan Ö, Tuncer Ü, Özdemir S, Sürmelioğlu Ö, Çetik F, Kıroğlu M, et al. Surgical and medical management for complications in 475 consecutive pediatric cochlear implantations. Int J Pediatr Otorhinolaryngol. 2013;77(4):473-9.

Bush ML, Thompson R, Irungu C, Ayugi J. The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review. Otol Neurotol. 2016;37(10):1466-74.

Chaudhary T, Kanodia A, Verma H, Singh CA, Mishra AK, Sikka K. A Pilot Study Comparing Teletherapy with the Conventional Face-to-Face Therapy for Speech-Language Disorders. Indian J Otolaryngol Head Neck Surg. 2021;73(3):366-70.

Verma H, Mishra R, Panda NK. Outcome measures following tele-rehabilitation and conventional face to face rehabilitation in paediatric cochlear implant users during COVID-19 pandemic: A pilot study in a tertiary care setup. J Otol. 2022;17(1):31-8.






Original Research Articles