Case Report Cochlear Implantation in Neurological Patients: Case Report and Literature Survey Maurizio Barbara, MD, PhD ; Valerio Margani, MD; Rocco Costanzo, MD; Marco Salvetti, MD, PhD; Alessandro Bozzao, MD, PhD; Simonetta Monini, MD; Edoardo Covelli, MD PhD Cochlear implant (CI) is a reliable solution to restore hearing in people with severe-to-profound hearing loss. The device is made up of internal and external components linked transcutaneously through a magnet that may rise specific issues in people who must undergo brain magnetic resonance (MRI) due to neurological diseases. The description of a case of a CI implantee needing MRI has given us the opportunity to highlight the differences that can be encountered among different neuropathies, either acute or chronic, with the aim of shedding some light for finding a common protocol when facing this important and fre- quent clinical issue. In particular, the removal of the magnet prior to performing an MRI exam is mandatory for brain diseases ipsilateral to the implanted side, whereas for contralateral side lesions it is less important when using apposite bandage kits. Key Words: Cochlear implantation, MRI safety, magnet removal, artefact, neurological disease. Laryngoscope, 00:1–5, 2020 INTRODUCTION Cochlear implantation (CI) is nowadays considered a reliable option for rehabilitating the majority of people affected by profound deafness. One of the main issues that could be encountered by CI recipients is represented by the need for a magnetic resonance imaging (MRI) scan. The most frequent MRI-related issues regard pain during exam- ination due to the torque force applied on the device, as well as demagnetization of the device, which could jeopardize further coupling with the external CI component. The presence of the magnet may cause susceptibility artefacts due to the magnetization of materials in a con- stant magnetic field, known as B0, which creates its own locally varying magnetic field that superposes onto the homogeneous B0 field, introducing an error into the imag- ing assumptions and therefore impairing quality and clin- ical utility of the exam itself. 1 Todt et al. found that for a diagnostic visual assess- ment of the internal auditory canal and the labyrinth at 3 tesla (T), a more horizontal and posterior position of the magnet relative to the nasion-ear angle is recommended. 2 Newer magnet technologies provide safe access to MRI at 1.5 T and 3.0 T with magnet in place and no head wrap. Med-El Synchrony (Med-El Innsbruck, Austria) and Cochlear Nucleus Profile Plus (Cochlear Ltd, Mel- bourne, Australia) contain a diametrically bipolar self- aligning magnet that nearly eliminates magnetic torque. Advanced Bionics HiRes Ultra 3D (Advanced Bionics Fig. 1. MRI-safe spacer in site after magnet removal in the reported case. MRI = magnetic resonance imaging. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.] From the NESMOS Department (M.B., V.M., S.M., E.C.), ENT Clinic, Sapienza University, Rome, Italy; IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (R.C., M.S., A.B.), Pozzilli, Italy; NESMOS Department, Neurology Unit, Sapienza University (R.C., M.S.), Rome, Italy; and the NESMOS Department, Neuroradiology Unit, Sapienza University (A.B.), Rome, Italy. Editor’s Note: This Manuscript was accepted for publication on April 6, 2020. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Maurizio Barbara, MD, PhD, Department of Otolaryngology, Sant’Andrea Hospital, via di Grottarossa 1035-1039, Roma 00189, Italy. E-mail: maurizio.barbara@uniroma1.it DOI: 10.1002/lary.28704 Laryngoscope 00: 2020 Barbara et al.: CI and MRI-Related Artifacts 1 The Laryngoscope © 2020 The American Laryngological, Rhinological and Otological Society, Inc.