Perilymphatic Fistula and Vestibular Dysfunction Requiring Cochlear Implant Programming Intervention: A Case Study

Cochlear implants (CIs) are effective interventions for treating severe-to-profound sensorineural hearing loss. In patients with complex inner ear anatomy due to conditions such as incomplete partition type II (IP-II) and enlarged vestibular aqueduct, they present unique challenges, increasing the risk of surgical and postoperative complications, including facial nerve stimulation (FNS), cerebrospinal fluid leaks, and vestibular dysfunction. The 32 year-old subject of this case study presented with IP-II and experienced persistent FNS, dizziness, and declining CI performance despite an initial revision surgery and appropriate programming strategies of her processor. Interdisciplinary collaboration between audiology, neurotology, and speech-language pathology helped to identify and address contributing factors to the patient's symptoms. After strategic programming adjustments, including pulse width modification and electrode management in conjunction with aural rehabilitation sessions, the patient's speech perception scores and CI quality of life metrics improved markedly over time, as did her confidence and engagement in social and professional settings. This case highlights a challenging example of CI performance issues in the setting of IP-II and aims to examine how CI programming, in response to anatomical and surgical difficulties, affects patient outcomes in cases involving inner ear malformations.