The clinical story began with symptoms that might easily have been mistaken for a routine ear problem. The young woman developed a headache, pain in the affected ear, and visible inflammation of the skin over the site where her cochlear implant had been placed. For most patients, such complaints would prompt a search for common bacterial culprits, typically organisms that colonize the skin or the external ear canal. But this patient’s medical history and her home environment pointed her care team toward a far less expected diagnosis, one that would only emerge after an extensive diagnostic work-up.

CHARGE syndrome is a rare genetic condition whose name is an acronym summarizing its hallmark features: coloboma of the eye, heart defects, choanal atresia, retardation of growth and development, genitourinary abnormalities, and ear abnormalities. The ear anomalies associated with the syndrome are among its most consistent features, and they frequently produce severe sensorineural hearing loss. Cochlear implants, which bypass damaged inner ear structures by converting sound into electrical signals delivered directly to the auditory nerve, are therefore a common and often transformative intervention for patients with CHARGE syndrome. Yet the same anatomical complexity that makes implantation necessary also makes these patients surgically challenging, with altered temporal bone anatomy and an increased likelihood of perioperative and postoperative complications.

When the teenager arrived with headache, ear pain and cellulitis over her implant site, her physicians pursued an aggressive and systematic evaluation. Imaging of the temporal bone with computed tomography using intravenous contrast allowed the team to assess the bony structures surrounding the implant and to look for evidence of bone involvement. Blood cultures were obtained to determine whether bacteria had entered the bloodstream, and cultures of the wound itself were sent to identify the organism responsible for the local infection. The results were striking: cultures grew Pasteurella multocida, and the imaging findings confirmed osteomyelitis, an infection of the bone adjacent to the implant. Blood cultures demonstrated a transient bacteremia, indicating that the organism had at least briefly circulated beyond the site of the wound.

Pasteurella multocida is a gram-negative coccobacillus, a small, rounded rod-shaped bacterium that occupies a distinctive ecological niche. It lives as part of the normal oral flora of many domestic animals, with cats being the most common carriers, and it is notorious among clinicians for producing rapidly developing cellulitis after bites and scratches. In typical zoonotic infections, the bacterium is introduced directly into the skin through a break in the epidermis, causing redness, swelling and pain within hours to days of the injury. What makes this case exceptional is the presumed route of inoculation and the destination of the infection: rather than a simple skin infection, the organism apparently colonized the surgical site of an implanted medical device and then invaded the underlying bone, a pattern of disease that has rarely been described in association with cochlear implants.

The exposure history proved to be the key that unlocked the diagnosis. The patient’s family had recently welcomed a new kitten into the home, and the teenager had sustained numerous excoriations, superficial scratches that break the skin, from the animal’s playful claws. In a patient with a permanently implanted device beneath the skin of the scalp and mastoid region, even minor scratches over the implant site can provide a pathway for oral bacteria from a pet to reach the device and the surrounding tissue. The authors of the report emphasize that a thorough exposure history, including questions about animal contact, should be part of the standard evaluation of any pediatric patient presenting with headache, ear pain and cellulitis, particularly when complicating factors such as a cochlear implant are present, so that zoonotic organisms are included in the differential diagnosis from the outset.

Management of the infection required both surgical and medical strategies, reflecting the seriousness of a device-related bone infection. The cochlear implant itself had to be removed, a difficult decision in any patient for whom the device represents their primary connection to the hearing world, but one that is often unavoidable when infection involves the implanted hardware. Biofilm formation, in which bacteria adhere to artificial surfaces and encase themselves in a protective matrix, makes device infections nearly impossible to eradicate with antibiotics alone. In addition to the explantation, the patient received four weeks of antibiotic therapy targeted at Pasteurella multocida, a duration consistent with the treatment of osteomyelitis, where prolonged therapy is needed to eliminate bacteria residing within bone tissue.

The clinical course was further complicated by the development of facial nerve palsy, a weakness of the facial muscles caused by dysfunction of the facial nerve, which runs through the temporal bone in close proximity to the structures involved in cochlear implantation. Inflammation and infection within this confined bony space can compress or irritate the nerve, producing facial drooping and difficulty closing the eye on the affected side. The patient was treated with corticosteroids, the standard approach to reduce inflammation around the nerve, and the report documents this complication as part of the cascade of events set in motion by the infection. The episode underscores how infections of the temporal bone can threaten not only hearing but also the cranial nerves that control facial movement.

Beyond its microbiological novelty, the case carries a broader message about the care of medically complex patients. The authors highlight the importance of a multidisciplinary team in managing patients with intricate medical and surgical histories. In this single admission, expertise was required from otolaryngology, which managed the implant and the temporal bone; from pediatric infectious diseases, which selected and monitored the antibiotic regimen; and from pathology and laboratory medicine, which identified the organism through culture. The patient herself consented to the publication of her case, having been an adult at the time of her care, and the authors express their appreciation for her willingness to share her experience so that other clinicians might recognize similar presentations more quickly.

For the wider community of cochlear implant recipients and their families, the report offers practical lessons without cause for alarm. Device infections remain uncommon, and Pasteurella multocida is an unusual cause even among those that do occur. But the case illustrates a simple preventive principle: minor wounds over an implant site deserve attention, and households with implanted medical devices should be mindful of scratches from pets, particularly cats. For clinicians, the message is equally direct. When a patient with an implanted device presents with unexplained cellulitis, headache and ear pain, asking about animal exposure may reveal the diagnosis that routine thinking would miss, and early recognition of zoonotic pathogens can spare patients the prolonged and invasive course that this teenager endured.

Subject of Research: A case report of Pasteurella multocida cochlear implant infection in a teenager with CHARGE syndrome

Article Title: Cochlear implant infection in a teenager with CHARGE syndrome: a case report

Article References: Pereira, N. M., Tarun, S., Johnson, C. L., Neu, N., Green, D. A., Wang, R., & Golub, J. S. (2026). Cochlear implant infection in a teenager with CHARGE syndrome: a case report. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07624-6

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07624-6

Keywords: Pasteurella multocida, CHARGE syndrome, cochlear implant, zoonotic infection, osteomyelitis, bacteremia, facial nerve palsy, pediatric infectious disease, cat scratch, multidisciplinary care, antibiotic therapy, case report