The cochlear implant intervention is the standard of care for the rehabilitation of severe to profound hearing loss in children. Growing case numbers are associated with increasing prevalence of conditions that may require surgical revision to maintain electrical hearing and language acquisition. Scalp complications can be avoided by observing core surgical principles, which also reduces the risk of wound infections. Providers of cochlear implant care should also become familiar with the indications for revision surgery, including the work-up and appropriate technique for electrode re-insertion. A summary of the literature reveals varied outcomes depending on indication, ranging from diminished speech performance to significant gains after revision surgery. Patient selection must be carefully considered to minimize additional delays in language development. The decision for revision surgery is straightforward in cases of documented speech perception decline, device failure and infection. In cases of failure to progress, however, the outcome may be reduced or unchanged. © 2010.