Two-stage surgical management of delayed otalgia in single-channel cochlear implant users.

Complication rates after cochlear implantation, which have been reported in up to 12.2% of cases, are categorized as major or minor depending on the severity of the complication or the level of intervention required. The majority of documented cases involve the flaps, electrodes and the facial nerve (Cohen et al., 1988; Cohen and Hoffman, 1991; Hoffman and Cohen, 1995). There have been no reported instances of delayed otalgia. We present two cases of delayed otalgia and imbalance after single-channel device implantation: a 30-year-old female 21 years after surgery (patient 1) and a 41-year-old female 19 years after cochlear implantation (patient 2). Symptom duration ranged from four to 24 months. Both presented for second opinions with dull, persistent otalgia around their internal receivers and imbalance. Patient 1 described a sensation of ‘free falling’, while patient 2 had right-sided ‘teetering’; neither had spinning vertigo. Both devices failed within two years of placement. In spite of normal physical examinations, both were initially managed with antibiotics and non-steroidal anti-inflammatory medications for symptomatic relief. After referral, otologic examination revealed point tenderness at receiver sites without signs of infection or device migration. Computed tomography of the temporal bones was normal, without indication of soft tissue infection or osteomyelitis. Both opted for removal of the original device, followed by a period of observation for symptom changes, and reimplantation with a multichannel device. Although no abnormalities were found during the removal, the otalgia immediately resolved in both patients. Follow-up is 15 months for patient 1 (implanted with a Clarion CII device, contra-laterally) and four months for patient 2 (implanted with a Nucleus 24 Contour device, ipsilaterally). Patient 2 also had a large C-shaped incision from the original implantation. We were able to complete the revision through a 2.5 cm post-auricular incision. Both are currently without complaints. Patient 2, in particular, is doing well without flap complications.