diff --git a/homeassistant/components/nina/config_flow.py b/homeassistant/components/nina/config_flow.py
index e6ebedb42082..6844db9c437e 100644
--- a/homeassistant/components/nina/config_flow.py
+++ b/homeassistant/components/nina/config_flow.py
@@ -13,7 +13,11 @@ from homeassistant.config_entries import (
 )
 from homeassistant.core import callback
 from homeassistant.data_entry_flow import section
-from homeassistant.helpers import config_validation as cv, entity_registry as er
+from homeassistant.helpers import (
+    config_validation as cv,
+    device_registry as dr,
+    entity_registry as er,
+)
 from homeassistant.helpers.aiohttp_client import async_get_clientsession
 from homeassistant.helpers.typing import VolDictType
 
@@ -245,6 +249,7 @@ class OptionsFlowHandler(OptionsFlowWithReload):
                 )
 
                 await self.remove_unused_entities(user_input)
+                await self.remove_unused_devices(user_input)
 
                 self.hass.config_entries.async_update_entry(
                     self.config_entry, data=user_input
@@ -264,6 +269,20 @@ class OptionsFlowHandler(OptionsFlowWithReload):
             errors=errors,
         )
 
+    async def remove_unused_devices(self, user_input: dict[str, Any]) -> None:
+        """Remove devices from regions that are not selected."""
+        device_registry = dr.async_get(self.hass)
+
+        removed_regions = set(self.data[CONF_REGIONS]) - set(user_input[CONF_REGIONS])
+
+        for region in removed_regions:
+            if device := device_registry.async_get_device(
+                identifiers={(DOMAIN, region)}
+            ):
+                device_registry.async_update_device(
+                    device.id, remove_config_entry_id=self.config_entry.entry_id
+                )
+
     async def remove_unused_entities(self, user_input: dict[str, Any]) -> None:
         """Remove entities which are not used anymore."""
         entity_registry = er.async_get(self.hass)
diff --git a/tests/components/nina/conftest.py b/tests/components/nina/conftest.py
index 8113eca50baa..9ccd88383337 100644
--- a/tests/components/nina/conftest.py
+++ b/tests/components/nina/conftest.py
@@ -14,6 +14,7 @@ from .const import (
     DUMMY_CONFIG_ENTRY,
     DUMMY_CONFIG_ENTRY_AREA_FILTERS,
     DUMMY_CONFIG_ENTRY_DEFAULT_FILTERS,
+    DUMMY_CONFIG_ENTRY_MULTIPLE_REGIONS,
 )
 
 from tests.common import (
@@ -80,6 +81,22 @@ def mock_config_entry_area_filter(hass: HomeAssistant) -> MockConfigEntry:
     return config_entry
 
 
+@pytest.fixture
+def mock_config_entry_multiple_regions(hass: HomeAssistant) -> MockConfigEntry:
+    """Provide a common mock config entry with an area filter."""
+    config_entry = MockConfigEntry(
+        domain=DOMAIN,
+        title="NINA",
+        data=deepcopy(DUMMY_CONFIG_ENTRY_MULTIPLE_REGIONS),
+        version=1,
+        minor_version=3,
+    )
+
+    config_entry.add_to_hass(hass)
+
+    return config_entry
+
+
 @pytest.fixture
 def mock_nina_class(nina_region_codes: dict[str, str]) -> Generator[AsyncMock]:
     """Fixture to mock the NINA class."""
diff --git a/tests/components/nina/const.py b/tests/components/nina/const.py
index bdf0f601e1ed..3aaba8b31666 100644
--- a/tests/components/nina/const.py
+++ b/tests/components/nina/const.py
@@ -55,3 +55,12 @@ DUMMY_CONFIG_ENTRY_AREA_FILTERS: dict[str, Any] = {
         CONF_AREA_FILTER: ".*nagold.*",
     },
 }
+
+DUMMY_CONFIG_ENTRY_MULTIPLE_REGIONS: dict[str, Any] = {
+    CONF_MESSAGE_SLOTS: 5,
+    CONF_REGIONS: {"083350000000": "Aach, Stadt", "010590000000": "Test, Stadt"},
+    CONF_FILTERS: {
+        CONF_HEADLINE_FILTER: "/(?!)/",
+        CONF_AREA_FILTER: ".*nagold.*",
+    },
+}
diff --git a/tests/components/nina/test_config_flow.py b/tests/components/nina/test_config_flow.py
index 0a2f1801940b..d504d636347c 100644
--- a/tests/components/nina/test_config_flow.py
+++ b/tests/components/nina/test_config_flow.py
@@ -25,7 +25,7 @@ from homeassistant.components.nina.const import (
 from homeassistant.config_entries import SOURCE_USER
 from homeassistant.core import HomeAssistant
 from homeassistant.data_entry_flow import FlowResultType
-from homeassistant.helpers import entity_registry as er
+from homeassistant.helpers import device_registry as dr, entity_registry as er
 
 from . import setup_platform
 from .const import DUMMY_USER_INPUT
@@ -327,3 +327,52 @@ async def test_options_flow_entity_removal(
     )
 
     assert len(entries) == new_slot_count * entities_per_slot
+
+
+async def test_options_flow_device_removal(
+    hass: HomeAssistant,
+    device_registry: dr.DeviceRegistry,
+    mock_config_entry_multiple_regions: MockConfigEntry,
+    mock_nina_class: AsyncMock,
+    nina_warnings: list[Warning],
+) -> None:
+    """Test if old devices are removed."""
+    await setup_platform(
+        hass, mock_config_entry_multiple_regions, mock_nina_class, nina_warnings
+    )
+
+    old_devices = dr.async_entries_for_config_entry(
+        device_registry, mock_config_entry_multiple_regions.entry_id
+    )
+
+    assert len(old_devices) == len(
+        mock_config_entry_multiple_regions.data.get(CONF_REGIONS, [])
+    )
+
+    result = await hass.config_entries.options.async_init(
+        mock_config_entry_multiple_regions.entry_id
+    )
+
+    result = await hass.config_entries.options.async_configure(
+        result["flow_id"],
+        user_input={
+            CONF_MESSAGE_SLOTS: 5,
+            CONST_REGION_A_TO_D: ["095760000000_0"],
+            CONST_REGION_E_TO_H: [],
+            CONST_REGION_I_TO_L: [],
+            CONST_REGION_M_TO_Q: [],
+            CONST_REGION_R_TO_U: [],
+            CONST_REGION_V_TO_Z: [],
+            CONF_FILTERS: {},
+        },
+    )
+
+    assert result["type"] is FlowResultType.CREATE_ENTRY
+
+    devices = dr.async_entries_for_config_entry(
+        device_registry, mock_config_entry_multiple_regions.entry_id
+    )
+
+    assert not any(
+        old_device.id in (device.id for device in devices) for old_device in old_devices
+    )