title: Pain-only complaint about cochlear implant device: A five-patient pediatric experience.
abstract: OBJECTIVE
  To present the case histories and management of five pediatric patients who experienced pain at the receiver-stimulator site, but no other indication that the device was failing. Patients were from a sole-surgeon pediatric practice (600 + implant surgeries before June 2013; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices).
  
  
  METHODS
  The University Institutional Review Board-approved review of sole-surgeon pediatric case series.
  
  
  RESULTS
  The onset of pain ranged from 2 to 16 years post implantation. Pain, not amenable to conventional medical therapy, was present regardless of whether or not the external appliance was 'on', or even being worn on the head. Four of the five patients were bilaterally implanted, but pain was only at one receiver-stimulator package. Clinical management ultimately included revision surgery in all five cases, with immediate resolution of the pain in four. For those four, the replacement cochlear implant (CI) performed well; the other patient fears pain if her replacement device is used, but continues enjoying her contralateral implant. At analysis by the company, two of five explanted devices exhibited problems: loss of hermeticity; insulation failure.
  
  
  CONCLUSIONS
  Though infrequently reported, pain-only complaint by a CI user is a challenging dilemma.
  
  
  CONCLUSIONS
  Pain may be the sole clinical manifestation of cochlear implant device failure. We offer a flowchart for the care of CI patients with pain, encourage a worldwide registry of such cases, and offer ideas to try to understand better the problem.
authors.forename: Norman Wendell
authors.initials: NW
authors.lastname: Todd
authors.forename: Jolie C
authors.initials: JC
authors.lastname: Fainberg
authors.forename: CeIsha Chinwe
authors.initials: CC
authors.lastname: Ukatu
authors.forename: Claudia Y
authors.initials: CY
authors.lastname: Venable
authors.forename: Phil
authors.initials: P
authors.lastname: Segel
mesh_terms: D002648:Child; D019929:Cochlear Implantation / Q000009:adverse effects*; D003054:Cochlear Implants / Q000009:adverse effects*; D005260:Female; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation
keywords: Cochlear implant; Pain; Soft failure