Pain on the head behind the ear is most likely to be due to an external cause, given that the skin has the most pain receptors. It is not unusual for people to screw in the magnet to ensure that the coil does not fall off easily. However, this can gradually produce a pressure point especially if the magnet actually touches the skin beneath. The skin of the elderly is particularly delicate especially if there is also little hair cover. Excessive pressure from the magnet and the coil, which do not change position, constrict the microscopic blood flow in the skin. In chronic cases, a small portion of skin dies off and a pressure sore develops, sometimes in the elderly without even causing pain. At this stage, bacteria entering the wound can cause an infection which can spread to the implant itself. At switch-on your audiologist would have instructed you to ensure that the magnet strength needs to be adjusted so that the coil stays in place without falling off, but without touching the skin. This is achieved by having a magnet that holds well without going past the last thread on the rim underneath. The magnet in the coil comes in various strengths, so that it is tailored to your individual need. Over time, depending on changes to your skin and hair, the strength may need to be adjusted. At your annual implant check-ups your audiologist will inspect the skin under the coil, making sure that the skin is healthy. Please take some time today to ask someone to check your head. If an indentation from the coil or magnet can be felt, it is possibly too strong. Adjusting the magnet by slightly unscrewing it will probably be sufficient, but also placing a protective barrier, such as a layer of moleskin (Scholl footcare product at chemists), may provide added protection for an elderly skin. Although the most likely cause of pain behind the ear is physical pressure, it is still possible that it might be due to a more serious issue. If the pain on the head also includes a fever and spreads into the ear, it may be a middle ear infection, which needs urgent attention from your family doctor and surgeon to ensure it does not spread to the implant and inner ear.