From Sound to Silence - Cerebellar Abscesses and Herniation Due to Cochlear Implant Infection With Escherichia coli and Bacteroides fragilis

Sep 30, 2026

Uploaded by Eliana

Cochlear implantation is a widely used, low-incidence intervention for sensorineural hearing loss, yet a rare and serious complication can follow infection. The report presents the first described case of cerebellar abscesses with herniation attributed to cochlear implant infection, involving a 57-year-old man with recurrent implant infections. After multiple debridements and implant removal while retaining the electrode array, two right-sided cerebellar abscesses formed and progressed to mass-effect herniation, requiring urgent neurosurgical care and extensive antimicrobial therapy. Prompt multidisciplinary intervention supported significant clinical improvement and emphasizes early recognition and aggressive infection control.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Case Reports in Infectious Diseases

Case Presentation (Brief Summary, Figure 1)

Initial Surgery and Postoperative Infections (2022-2023)

First Neurological Event (Summer 2024)

Presentation and Initial Findings (Fall 2024)

Wiley Case Reports in Infectious Diseases Volume 2026, Article ID 5645503, 7 pages [https://doi.org/10.1155/crdi/5645503](https://doi.org/10.1155/crdi/5645503) Case Report From Sound to Silence: Cerebellar Abscesses and Herniation Due to Cochlear Implant Infection With Escherichia coli and Bacteroides fragilis Celine Molfetta , Ruchi Biswas, Marc Pickard, Tanzila Salim, and Carlos Nuñez Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, USA Correspondence should be addressed to Celine Molfetta; [celine.molfetta.cm@gmail.com](celine.molfetta.cm@gmail.com) Received 24 March 2025; Revised 30 October 2025; Accepted 9 December 2025 Academic Editor: Dawei Cui Copyright © 2026 Celine Molfetta et al. Case Reports in Infectious Diseases published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Cochlear implantation (CI) is a safe and well-established intervention for sensorineural hearing loss, with a low incidence of severe postoperative infections. We present the frst reported case of cerebellar abscess and herniation due to CI infection. Tis unique case involves a 57-year-old man with recurrent cochlear implant infections, necessitating multiple debridements and eventual removal ofthe implant body while retaining the electrode array. Tis ultimately led to the formation of two right-sided cerebellar abscesses. His course was further complicated by cerebellar herniation due to mass efect, requiring urgent neurosurgical intervention and extensive antimicrobial therapy. Despite the grave prognosis, timely intervention led to signifcant clinical improvement. Tis case highlights the pathophysiology, implicated organisms, and management of cerebellar abscesses following CI/explantation, underscoring the importance of early recognition, aggressive infection control, and multidisciplinary management in this rare but serious complication. 1. Introduction Cochlear implantation (CI) remains the mainstay of intervention for sensorineural hearing impairment in children and adults, with a low 4% estimated incidence of postoperative infection. Tough rare, studies report a 3% rate of major adverse infectious complications necessitating surgical intervention [1] . Infection is commonly a result of impaired wound healing (Staphylococcus aureus most frequently reported perioperatively), acute otitis media, and chronic ear pathology. Te majority of postoperative infections present with a time lag, commonly meningitis, tinnitus, cerebrospinal fuid (CSF) otorrhea, and rarely, abscess formation [1, 2] . Reported cases include retroauricular and subperiostal abscess formation, highlighting infltration of local structures [3] . Eggink et al. suggest that otogenic infections may extend directly through the compromised dural plate, or through the labyrinth and cochlear aqueduct [4] . Despite this, intracranial, specifcally cerebellar, extension is exceedingly rare. Treatment includes site irrigation, systemic antibiotics, surgical debridement, and possible contralateral CI [2] . Cerebellar abscess formation is extremely rare, with an estimated prevalence of 0.3–0.9 per 100,000 population per year, with high morbidity/mortality. It is commonly secondary to acute mastoiditis or acute otitis media [5] . Symptoms include fever, nausea, vomiting, gait ataxia, dysmetria, nystagmus, vertigo, headache, seizure, altered mentation, or weakness. Cerebellar abscesses causing mass efect may have grim impending consequences, such asherniation. Alarm symptoms and signs include papilledema, pupillary asymmetry, posturing, respiratory distress/arrest, and other neurological defcits, dependent upon afected anatomic structures [6] . 2 Case Reports in Infectious Diseases Here, we present the rare, frst-reported case of cerebellar absces

FAQs

What complication is reported after cochlear implant infection?

The case describes cerebellar abscess formation followed by cerebellar herniation due to mass effect.

What organisms are implicated in the cochlear implant infection?

Escherichia coli and Bacteroides fragilis are implicated, along with other pathogens mentioned in prior hardware infections.

How was the patient managed after progression to neurological deterioration?

Management included urgent neurosurgical intervention and extensive antimicrobial therapy after implant removal and treatment escalation.

Sep 30, 2026

Uploaded by Eliana