Should Cochlear Implant Contraindicate Transcranial Stimulation? A Case Study with Safety Implications

Electrical stimulation in proximity to a cochlear implant (CI) is contraindicated due to the potential risk of damaging the implant and thermal insult to the inner ear. Yet, during surgical procedures that pose a risk to the nervous system, the use of transcranial electrical stimulation for neuromonitoring is crucial for assessing the integrity of the motor pathways and preventing neurological insults. The current paper depicts a case of a patient with CI undergoing two consecutive surgeries for scoliosis correction, revealing a suspected pending neurological insult in the second operation. An audiological and electrical examination after each operation demonstrated preserved auditory function and normal functioning of the CI, respectively. The current case is consistent with previous reports reviewed in the paper, showing no CI failures nor hearing deterioration following transcranial electrical stimulation for neuromonitoring and electroconvulsive therapy. In light of this accumulating evidence, there is an urgent need for manufacturers and regulatory bodies to proactively undertake a comprehensive review of this declared contraindication. Subsequently, an updated data-driven risk analysis is essential to weigh the consequences of preventing the contraindicated tools and treatments, as well as their potential benefits to these patients. Laryngoscope, 135:1493-1495, 2025.