Follow-up of cochlear implantation (CI) in complex otologic cases, particularly those treated with subtotal petrosectomy (SP), requires a tailored multidisciplinary approach. In addition to standard audiological and electrophysiological assessments, periodic radiological imaging (CT and MRI) may be necessary depending on age, surgical technique, and preoperative pathology. Complications specific to SP include retroauricular extrusion, breakdown of the blind sac closure, cable exposure, and residual cholesteatoma development. Re-aeration of the cavity, while usually asymptomatic, may in rare cases lead to serious consequences. Understanding these risks and implementing appropriate radiological and surgical strategies are essential for long-term success and patient safety.