A unique presentation of Bell's palsy in a pediatric cochlear implant patient

Objective: To describe a rare case of idiopathic delayed facial nerve palsy following cochlear implantation (CI) in a pediatric patient with a history of device extrusion, facial nerve stimulation, and cholesteatoma. Methods: Retrospective chart review of a case of a 14-year-old female with bilateral severe-to-profound sensorineural hearing loss who underwent initial cochlear implantation at ages 3 and 4. Ten years later, she experienced bilateral CI failure and had left-sided electrode extrusion through the external auditory canal (EAC). She underwent multiple CI-related surgeries, including right explantation/reimplantation and left-sided explantation with EAC reconstruction and cholesteatoma removal, followed by interval reimplantation 6 months later. Results: After left-sided reimplantation, the patient developed facial nerve stimulation necessitating deactivation of eight electrodes. Subsequently, she experienced delayed-onset complete facial nerve palsy, which was managed with high-dose corticosteroids, antivirals, and revision exploratory surgery to ensure proper electrode placement and absence of cholesteatoma. Her facial function gradually improved following medical management. Conclusion: Delayed-onset facial paralysis in this case was ultimately diagnosed as Bell's Palsy, an extremely rare complication following pediatric cochlear implantation. This case highlights the importance of a comprehensive approach to evaluation and management of facial nerve dysfunction in post-CI patients.