Refractory severe facial nerve cross-stimulation and loss of auditory sensation after ten years of uneventful cochlear implant use. A rare and challenging case.

Facial nerve stimulation after cochlear implantation has been well described. When the implant is first activated it is usually possible to 'programme out' the unwanted cross-stimulation. We report an exceptional case of delayed facial nerve stimulation and auditory failure after ten years of uncomplicated implant use. This sudden change proved refractory to reprogramming strategies. The patient refused contralateral implantation as he felt there was residual aided hearing. The implant was removed and replaced. Integrity testing of the explanted device showed it to be functioning normally. Severe facial nerve cross-stimulation persisted and the patient failed to regain his previous auditory sensation. Subsequently, despite extensive investigation and a trial of fluoride therapy, after a third implant he has performed equally badly leading to non-use.