Poster 105: Chronic headaches after unilateral cochlear implant placement: a case report.

Abstract

Setting: Outpatient rehabilitation clinic. Patient: A 46-year-old woman with medical history of migraines and sensorineural hearing loss. Case Description: The patient, who was treated with left cochlear implant placement on December 2000, was referred to our pain management outpatient clinic in August 2001 with chronic left-sided headache since the surgery. On initial evaluation, she reported having constant fluctuating left facial and temporal vibrating headaches rated 8/10 on the visual analog scale (VAS) for pain, along with disabling left ear tinnitus and difficulty sleeping. She was initially treated with 5mg of zolpidem orally at bedtime and 7.5mg of hydrocodone and 750mg of acetaminophen orally every 6 hours as needed for pain but with no relief. The patient received several trials of multiple narcotic medications and tricyclic antidepressants until December 2001. She began receiving an 80mg dose of oxycodone orally every 8 hours. In August 2002, 50mg of nortriptyline orally at bedtime was added. Assessment/Results: Monthly follow-up for 6 months. Her pain rating improved to 3/10 on the VAS, the vibration dysesthesia decreased significantly, and her sleep, quality of life, and wellness markedly improved. Discussion: This is the first case report in the literature on chronic disabling headache after cochlear implant surgery, designated cochlear implant pain syndrome. Conclusion: Cochlear implants are now widely use in the pediatric and adult population with sensorineural hearing loss. It was only in 1984 that the US Food and Drug Administration approved the implants for use in adults. The reported surgical complications are wound infection and breakdown (most common), along with less frequent facial paralysis, cerebrospinal leak, meningitis, and device-related complications. Clinicians should be aware that headache symptoms in these patients can be related to cochlear implant placement.