Recurrent Cochlear Implant Electrode Exposure in a Smoker With Prior Canal Wall Mastoidectomy: A Case Report.

Cochlear implantation (CI) is an established and effective surgical intervention for patients with severe to profound sensorineural hearing loss. The procedure involves placement of an internal receiver-stimulator in a postauricular subperiosteal pocket with an electrode advanced through the mastoid and facial recess into the cochlea. Long-term device function depends on secure fixation and durable soft tissue coverage over both the implant and extracochlear electrode segment to prevent skin breakdown, infection, and electrode exposure. Although electrode exposure is uncommon, it represents a serious complication that can compromise implant integrity and frequently necessitates revision surgery or explantation. Patients with prior history of canal wall down (CWD) mastoidectomy are at increased risk of this complication given the altered mastoid anatomy, reduced soft tissue bulk, and compromised vascular supply. In addition, a history of chronic tobacco use further exacerbates these risks by inducing vasoconstriction, reducing tissue oxygenation, and impairing collagen synthesis increasing the likelihood of postoperative skin breakdown. We present a case of recurrent CI electrode exposure in an elderly patient with a remote history of CWD mastoidectomy and chronic tobacco use, highlighting the compounded impact of these factors on postoperative healing and device viability.