Various factors must be taken into consideration when planning a cochlear implantation procedure in atypical scenarios, which may require special future consideration (e.g., long-term imaging needs) or that are characterized by audiological complexity. Amongst these cases, there are patients with intractable Meniere’s disease, petrous bone cholesteatoma or patients that previously underwent a brainstem implantation. These complex cases demand individualized planning and careful multidisciplinary evaluation. In addition to surgical difficulties, CI following a previous auditory brainstem implant (ABI) introduces neuroplasticity-related challenges, requiring cortical reorganization and patient adaptation to new auditory input. A few examples are reported, as managed in an otological tertiary referral center.