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Peer-reviewedCC BYFrontiers in surgery

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

  • Luluh Alsughayer1
  • Nezar Hamed1
  • Thamer Alzahrani2
  • Abdullah Alsarar3
  • Rahma Sweedy4
  • Turky AlHarbi5
  • Wafaa S. Taishan6
  • Afrah Alshalan7
  • Farid Alzhrani1
7 affiliations
  1. 1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University , ,
  2. 2Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Centre , ,
  3. 3College of Medicine, Imam Mohammed Ibn Saud Islamic University , ,
  4. 4Egyptian Ministry of Health (MOH) , ,
  5. 5Audiology-Speech Language Pathology, Sultan Bin Abdulaziz Humanitarian City , ,
  6. 6Department of Otolaryngology, Makkah Health Cluster , ,
  7. 7Department of Otolaryngology, Head & Neck Surgery, College of Medicine, Jouf University , , ,
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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.

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Cite

BibTeXRIS
BibTeX
@article{alsughayer2026three,
  title = {{Three decades of cochlear implant failure and multiple reimplantation: a retrospective cohort study}},
  author = {Luluh Alsughayer and Nezar Hamed and Thamer Alzahrani and Abdullah Alsarar and Rahma Sweedy and Turky AlHarbi and Wafaa S. Taishan and Afrah Alshalan and Farid Alzhrani},
  journal = {Frontiers in surgery},
  year = {2026},
  month = oct,
  doi = {10.3389/fsurg.2026.1941723},
  url = {https://europepmc.org/article/PMC/PMC13727629},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Three decades of cochlear implant failure and multiple reimplantation: a retrospective cohort study
AU  - Luluh Alsughayer
AU  - Nezar Hamed
AU  - Thamer Alzahrani
AU  - Abdullah Alsarar
AU  - Rahma Sweedy
AU  - Turky AlHarbi
AU  - Wafaa S. Taishan
AU  - Afrah Alshalan
AU  - Farid Alzhrani
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in surgery
DO  - 10.3389/fsurg.2026.1941723
UR  - https://europepmc.org/article/PMC/PMC13727629
AB  - 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.
SN  - 2296-875X
ER  -