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Updated: Oct 24, 2025

Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
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Risk Factors for Facial Nerve and Other Nonauditory Side Effects Following Cochlear Implantation.

Fadwa Alnafjan1, Zubair Hasan2, Halit Sanli3

  • 1Macquarie University.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|August 16, 2021
PubMed
Summary

Facial nerve stimulation during cochlear implant surgery can lead to nonauditory side effects like pain and vestibular issues. Identifying at-risk patients through intraoperative measures and hearing loss etiology can help tailor CI programming.

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Audiology

Background:

  • Cochlear implantation (CI) is a common treatment for severe to profound hearing loss.
  • Nonauditory side effects (NASx) following CI surgery can impact patient quality of life.
  • Intraoperative facial nerve stimulation (FNS) is a known complication during CI surgery.

Purpose of the Study:

  • To characterize patients experiencing nonauditory side effects (NASx) after cochlear implant (CI) surgery.
  • To identify risk factors associated with the development of NASx post-CI activation.
  • To inform surgical and audiological management strategies for at-risk patients.

Main Methods:

  • Retrospective case review of 123 multichannel CI recipients with intraoperative FNS.
  • Utilized intraoperative electrical auditory brainstem responses (eABR) during CI surgery.
  • Analyzed the incidence and types of NASx, including pain and vestibular dysfunction.

Main Results:

  • 34% of patients with intraoperative FNS experienced facial nerve stimulation upon CI activation.
  • Pain (22%) and vestibular dysfunction (4%) were the most common NASx, often co-occurring with facial nerve stimulation.
  • Etiology of hearing loss was significantly related to FNS at initial activation, particularly for acquired hearing loss of undetermined or toxic etiology.

Conclusions:

  • A significant proportion of patients with intraoperative FNS develop NASx post-CI activation.
  • Intraoperative eABR and specific hearing loss etiologies are potential risk factors for NASx.
  • These findings can aid in identifying at-risk patients and modifying CI program planning to mitigate NASx.