Evaluating Patient Motivation Behind Device Removal in Cochlear Implant Patients.

Objective: To assess indications behind cochlear implant (CI) removal without subsequent re-implantation.

Patients: Patients who underwent CI explantation between January 2013 and December 2022.

Interventions: Explantation of CI device without ipsilateral re-implantation.

Main outcome measures: Indications for and audiometric testing before CI explantation.

Results: Within a cohort of 743 CI patients, 35 patients (5%) underwent implant revision. A total of 16 patients (2%) underwent explantation without ipsilateral re-implantation (mean age of 51 yr [SD, 23]), and 19 (3%) underwent explantation followed by re-implantation (mean age of 51 yr [SD, 18]). The average time between CI insertion and removal was 56 months (SD, 72). Six explantations (6 of 16 [37.5%]) were due to infectious complications: 2 (13%) did not undergo re-implantation given severe life-threatening comorbidities, 1 (6%) underwent simultaneous contralateral implantation, 1 (6%) experienced insurance barriers preventing re-implantation, and 2 (13%) were lost to follow-up. Ten patients (10 of 16 [62.5%]) underwent device removal for noninfectious indications, including 6 (38%) with non-audiologic symptoms attributed to CI, 3 (19%) who required repeated MRIs and desired avoidance of peri-imaging procedures, and 1 (6%) who had poor audiometric outcomes due to cochlear ossification. Patients who were not re-implanted performed worse on AzBio (35% versus 59%; p = 0.10) and CNC testing (27% versus. 70%; p = 0.02) after initial successful implantation compared with those who did undergo re-implantation.

Conclusions: Patients undergo explantation for a variety of reasons, with ill-defined symptoms being the motive in over half of the cases. These desires are compounded by poor postoperative audiometric performance, which likely hinders the patient's desire to undergo re-implantation.