A 9-year-old cochlear-implant user develops intermittent painful stimulation, declining speech scores and aversion to the device. Integrity testing is repeatedly normal; mapping changes and replacement external equipment have failed. Imaging shows no migration. What is the most appropriate conclusion and next step?
Suspected soft failure requires a structured exclusion process and multidisciplinary counselling; normal electrical integrity does not trump consistent clinical deterioration.
A. Discuss explantation and reimplantation for suspected soft failure: A reproducible clinical decline despite normal integrity testing and systematic exclusion of external, mapping and positional causes is the classic setting for soft failure; revision is a multidisciplinary, preference-sensitive decision.
B. Deactivate the implant permanently and rely on contralateral amplification: This avoids symptoms but abandons potentially restorable binaural access without resolving the failed internal device.
C. Repeat remapping and external-component substitution for another year: Those troubleshooting steps have already failed; continued delay prolongs auditory deprivation and distress.
D. Use cortical auditory evoked potentials to overrule the clinical pattern if responses are present: Objective responses may contribute but cannot prove stable day-to-day device function or exclude soft failure.
E. Reimplant only after an integrity test becomes abnormal: Waiting for a hard-failure signature is unnecessary when a robust exclusion process demonstrates clinical soft failure.
If replacing the external processor completely resolved pain and restored stable speech performance, the internal implant should be monitored rather than revised.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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