Work

Three decades of cochlear implant failure and multiple reimplantation: a retrospective cohort study

Year: 2026

Type: article

Abstract: Introduction Cochlear implantation (CI) is a highly reliable intervention for sensorineural hearing loss; however, device failure may occur, limiting patient benefit unless revision surgery is performed. This study evaluated the long-term institutional prevalence and causes of CI failure, and assessed complications, audiological and speech outcomes, and their associated factors following multiple revision surgeries. Materials and methods A retrospective cohort study identified 91 failed CI cases among 3,777 CIs performed at a single tertiary referral center between January 1993 and November 2024. Audiological and speech outcomes, including Pure Tone Average (PTA), Speech Reception Threshold (SRT), Speech Discrimination Score (SDS), Categories of Auditory Performance (CAP), and Speech Intelligibility Rating (SIR), were analyzed using Mixed Models for Repeated Measures (MMRM) with restricted maximum likelihood (REML) estimation. Results The overall prevalence of CI failure was 2.41%, occurring predominantly in pediatric patients (96.7%). Hard device failure was the most common cause (68.8%), followed by medical (15.0%), soft (13.8%), and surgical (2.5%) failures. Revision surgery was performed once in 80 cases, twice in 8 patients, and three times in 2 cases. Reimplantation successfully preserved audiological performance across successive revisions, while CAP and SIR scores demonstrated significant additional improvement after the first revision compared with the initial implantation ( p = 0.037 and p < 0.001, respectively). Reimplantation using the same electrode model was associated with better SDS after the first revision ( p = 0.035), and better SRT ( p = 0.022) and SIR ( p = 0.001) after the second revision. An interval of >3 years between surgeries was associated with significantly higher post-revision SIR scores after both the first ( p = 0.040) and second ( p = 0.004) revisions. Conclusion CI failure had a prevalence of 2.41% over more than three decades. Reimplantation is a salvage procedure that successfully restores auditory function after device failure, allowing for continuous language development. Electrode selection and revision strategy should remain tailored to each case.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1941723