Titanium Allergy: An Uncommon Cause of Pain in Cochlear Implant Recipients

Objective: To describe the clinical presentation and course of 2 cochlear implant (CI) recipients with a titanium allergy. Patients: A 66-year-old female and a 41-year-old female both underwent unilateral cochlear implantation, immediately after which they experienced otalgia that persisted and negatively impacted their ability to wear their CI external processor. Intervention(s): Patch testing for cochlear implant allergy was performed. Surgical explantation of the CI with the exposed titanium to remove the allergen was recommended, with a subsequent surgery offered with implantation of a CI fully encased in silicone after resolution of otalgia. Main outcome measure(s): Clinical resolution of otalgia, including the ability to use a cochlear implant without discomfort. Results: Both CI patients were confirmed to have a titanium allergy through patch testing. One patient experienced complete resolution of otalgia, while the second patient continued to have otalgia for at least 6 months following CI explantation. The first patient was subsequently implanted with a different CI in which the titanium components were fully encased in silicone and has remained pain-free and able to use her CI on an everyday basis 2 years post-implantation. Conclusions: A high index of suspicion for patient allergy to cochlear implants is warranted in CI recipients presenting with otherwise unexplained and persistent otalgia following CI surgery, and even more so in those with a prior history of hypersensitivity reactions.