The purpose of this session is to help cochlear implant surgeons and clinicians become more familiar with challenging clinical scenarios and how to best manage these challenges. The session will focus on clinical decision making, and pre-, intra-, and post-operative management. Clinicians will have a stronger understanding of cochlear implantation and trouble-shooting problems. Topics will include but are not limited to: 1) Difficult anatomy – congenital malformations, CHARGE syndrome, in the setting of chronic ear disease, post-meningitis and the ossifying cochlea, and otosclerosis. 2) Cochlear implant candidacy in the developmentally delayed child or adult with dementia. 3) Managing complications, such as device failure, infections, and facial nerve stimulation.