Evolving trends in cochlear implant reimplantation: An analysis of causes and outcomes at a tertiary referral cohort

Abstract Purpose This study aimed to characterize evolving causes and outcomes of cochlear implant (CI) revision surgeries in the post-2012 era, a period marked by improved device reliability and changing patient expectations. Methods We retrospectively reviewed 1,449 CI procedures performed at a tertiary referral center between 2012 and 2024, identifying 48 revision surgeries. Cases were categorized by implantation site (in-house vs. referral) and classified by revision indication. Device survival was evaluated with Kaplan–Meier and competing risks analyses. Auditory outcomes and electrode positioning were assessed before and after revision. Results The in-house revision rate was 1.9%, with a 7-year cumulative device survival of 96.1%. Functional performance concerns (n = 20) emerged as the leading cause of revision, exceeding infection/flap problems (n = 19) and device failure (n = 6). Referral patients more often underwent elective reimplantation for performance optimization, frequently converting from lateral wall to modiolar-hugging arrays. These revisions consistently achieved superior modiolar proximity and significant gains in speech perception, with postoperative imaging confirming successful reinsertion trajectories despite fibrous tracts. Infection remained the predominant early complication, while functional revisions increased gradually over time. Conclusion Revision cochlear implantation in the modern era reflects both reduced device failures and the rise of patient-driven revisions for functional optimization. Strategic electrode selection and pursuit of bilateral symmetry can yield meaningful auditory improvements. These findings underscore the evolving role of revision surgery in enhancing CI outcomes, highlighting the importance of individualized decision-making in contemporary practice.