Background <p>A notable complication in cochlear implant (CI) users is Anomalous Facial Nerve Stimulation (AFNS), an unintended stimulation of the facial nerve causing sound-triggered involuntary facial movements. Reported in about 5.6% of users (range 0.68–43%), AFNS risk factors include otologic conditions like otosclerosis or cochlear malformations and device factors such as high stimulation levels.</p> <p>Initial management involves conservative programming adjustments to minimize current spread. If unsuccessful, deactivating offending electrodes is necessary. While often effective, these interventions can occasionally lead to a decline in auditory performance, sometimes resulting in device discontinuation or even explantation. This requires careful clinical consideration to balance optimal hearing outcomes with patient comfort.</p> Case presentation <p>Two clinical cases of CI users with severe-to-profound sensorineural hearing loss are described. The first case, a 57-year-old woman suffering chronic otitis media since childhood, required explantation because of severe AFNS and reimplantation with a device delivering using multi-mode grounding (MMG) stimulation with anodic monophasic pulses (AMP). The AFNS was controlled, and she returned to using CI with acceptable functional gain. The second case, a 27-year-old woman with bilateral otospongiosis, exhibited intraoperative facial nerve stimulation during bipolar monophasic testing, but this was prevented postoperatively using MMG-AMP.</p> Conclusions <p>CI reimplantation with MMG-AMP was effective in managing severe AFNS when conservative measures failed to resolve it. This electrical stimulation pattern should be a viable option for CI candidates with AFNS risk factors (otosclerosis, inner ear malformations, FN dehiscence, cochlear obliteration/ossification) or for those who have an indication for cochlear reimplantation due to severe AFNS. Further studies are required to better explore the use of MMG-AMP in a larger number of subjects.</p>