Abstract
We had a case of 75-year old man with a history of progressive hearing loss on both side who implanted with a Nucleus 24 Contour Advance in the right ear. After 4 years from implantation, the patient started to complaint of right facial twitching when his cochlear implant was active. Despite undergoing numerous alterations in his implant programming, facial nerve stimulation (FNS) persisted. After increasing the pulse width and changing the stimulation mode, there was no facial nerve stimulation. However there was a deterioration in hearing and speech understanding. CT of the temporal bone showed good position of the implant electrodes und cochleomeatal scintigraphy (CMS) showed a highly positive activity with suspicion of otosclerosis, although the medical history was negative for otosclerosis. The FNS was managed with cochlea reimplantation and advanced programming techniques. FNS in cochlear implant patients may be managed through reimplantation and advanced programming techniques.
Highlights
Facial nerve stimulation is a well known complication of cochlear implants
CT of the temporal bone showed good position of the implant electrodes und cochleomeatal scintigraphy (CMS) showed a highly positive activity with suspicion of otosclerosis, the medical history was negative for otosclerosis
facial nerve stimulation (FNS) in cochlear implant patients may be managed through reimplantation and advanced programming techniques
Summary
Facial nerve stimulation is a well known complication of cochlear implants. The reason for this adverse effect is not known and there are many theories that attempt to explain this problem. The programming system of the cochlear implant system can be used to reduce the facial nerve stimulation This can be done by lowering the current amplitude by widening the pulse width or by switching off the electrodes which stimulate the facial nerve. This may result in decreasing performance with cochlear implant and decrease in speech understanding. Failure to resolve this problem with programming may lead to the indication to removal of the implant assuming a soft failure which cannot be proven by telemetry This is because too many electrode need to be switched off which influences the speech performance
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