Conversion disorder: a missed diagnosis leading to cochlear reimplantation

To report a case of a patient presenting with presumed cochlear implant (CI) device failure that underwent revision surgery and was ultimately diagnosed with conversion disorder.

Clinical capsule report.

Tertiary academic referral center.

A pediatric patient with Waardenburg syndrome underwent unilateral CI at the age of 6 years for bilateral profound sensorineural hearing loss. During the following 2 years, the patient experienced subjective symptoms of device malfunction including abnormal sounds and intermittent loss of signal despite external component exchange. The patient subsequently underwent revision surgery only to have persistent intermittent complaints. Given the severity of the symptoms, the patient underwent a second reimplantation procedure. Extensive device testing by our institutional implant program and the manufacturer failed to reveal any causal device defects.

Given the ongoing but inconsistent subjective complaints and normal device testing, the patient was referred for psychiatric consultation to evaluate for a nonorganic underlying cause. The patient was subsequently diagnosed with conversion disorder and successfully managed with ongoing psychiatric counseling and close follow-up with our CI program.

This represents the first report of a patient presenting with symptoms of device failure, who underwent revision surgery and was ultimately found to have conversion disorder. Although rare, conversion disorder should be considered in the differential diagnosis of patients presenting with symptoms of device malfunction and normal integrity testing particularly among those with significant psychosocial stressors or a history of psychiatric illness. Thorough device testing and in-depth psychological evaluation is required for diagnosis, and close multidisciplinary follow-up with the CI team and psychiatrist is crucial.