Hearing loss is one of the most prevalent sensory conditions worldwide, affecting over 1.5 billion people and is one of the main causes of disability. For individuals with severe to profound hearing loss, cochlear implants (CIs) are one of the most effective rehabilitation options as they can significantly improve speech comprehension, language development, quality of life and social inclusion. Despite their clinical value, however, access to CIs remains highly unequal between and within countries, with implantation rates disproportionately favoring wealthier nations and people with a higher socioeconomic status. Grounded in a human rights approach, this article develops a conceptual and policy-based reflection supported by a targeted review of scientific literature and international legal standards. From this standpoint, access to CIs must be recognized as an enforceable fundamental right. This recognition implies clear international obligations for states to translate their human rights commitments into tangible, inclusive national policies. Furthermore, this perspective emphasizes the ethical responsibility to ensure the real accessibility, affordability and adaptability of cochlear implants, overcoming barriers related to socioeconomic disparities, geography, race and systemic inequalities. This perspective article highlights the urgent need for comprehensive public policies based on international human rights law to ensure equitable access to cochlear implants, advocating a rights-based approach as a necessary strategy to achieve social justice, dignity and full social participation for people with hearing disabilities.
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Cochlear implants provide a treatment option for adults with severe to profound sensorineural hearing loss (SNHL). However, their long-term impact on mental health were understudied. This study explored the long-term effect of cochlear implants on the incidence of psychiatric disorders in adults with bilateral severe to profound SNHL, and examined the subgroup differences in these outcomes. Data for this cohort study were analyzed on January 12, 2024, from the TriNetX electronic records database. Adults with bilateral severe to profound SNHL who received a cochlear implant were compared with matched peers who did not. The primary outcome was the combined incidence of anxiety, depression, and insomnia, within one to three-years after baseline. Each psychiatric disorder was examined separately as a secondary outcome. This study included 8,964 adults in each group. The cochlear implant group demonstrated a significant lower risk of psychiatric disorders compared to the non-implanted group. Reductions were also observed for depression, insomnia, and anxiety, with effects consistent across the follow-up period and subgroups. Cochlear implantation was associated with a lower long-term incidence of psychiatric disorders among adults with bilateral severe to profound SNHL.
To identify barriers that audiologists face in adopting telemedicine in adult cochlear implant care, and to determine what is needed to overcome these barriers. Prospective mixed-methods anonymous online survey of cochlear implant audiologists working with adults in the United Kingdom. Thirty-one complete responses were received in August - September 2024. Eighty-seven percent (27) had used remote care tools in their care of adults with cochlear implants. Twenty-nine percent (9) had never used remote care tools or used them rarely; no respondents used them daily. Sixty-eight percent of respondents reported frequent technical issues with remote care tools. Respondents were split equally when asked if remote care is less effective than in-person care, but 81% felt that the gold standard of clinical care is in-person care. Barriers to remote care could be overcome by improvements and enhancements to the cochlear implant manufacturers' tools, and easier and fuller integration into patient pathways and systems. The main barriers to audiologists using remote care were frequent technical problems and the perception that the gold standard of clinical care was in-person care. When telemedicine offers a seamless, accessible, person-centred care experience, perceptions about the gold standard of care may change.
To explore how families support and adapt to their child's language development following cochlear implantation in Saudi Arabia. Although international research has explored these factors, fewer qualitative studies have examined how family dynamics, parental self-efficacy, and perceptions of professional services intersect in shaping parents' interpretations of their children's linguistic outcomes in the Saudi context. Eighteen parents (10 mothers and 8 fathers) of children with cochlear implants aged 2-12 years in Riyadh participated in semi-structured Arabic interviews. The parents' ages ranged from 27 to 45 years, and their educational backgrounds varied from high school to postgraduate degrees. Transcripts were analyzed thematically following Braun and Clarke's six-phase framework. Four themes emerged family support and engagement, parental self-efficacy and language strategies, perceptions of professional services, and early intervention. Parents emphasized consistent home practice, sibling involvement, and culturally appropriate communication routines but reported challenges related to limited access and coordination of services. Findings highlight the need for family-centered, culturally responsive rehabilitation programs that strengthen parental confidence and ensure timely intervention to optimize language outcomes for children with cochlear implants.
This study aims to investigate the language and listening development of children with cochlear implants (CI) in the Gulf Cooperation Council (GCC) region over 24 months. It seeks to identify factors influencing progress and the impact of challenges on CI outcomes, focusing on children without additional disabilities. The project design is explorative, with a descriptive, longitudinal, ambispective analysis conducted across six hospitals in four GCC countries. Qualified speech and language therapists evaluated children diagnosed with prelingual severe to profound bilateral sensorineural hearing loss who received CIs between 2018 and 2024. The Integrated Scales of Development (ISD) assessed progress in six developmental domains at five intervals (T0-T4). Data also included demographics, prior hearing aid use, and parental education. The results indicated significant improvements across all six developmental domains over the 24-month period, with median scores increasing consistently. Statistical analysis revealed a strong linear trend in development (P = 0.000). Children who received CIs earlier showed better outcomes, whereas prior hearing aid use did not significantly affect results. Parental education levels had no impact on developmental outcomes. The study underscores the importance of early cochlear implantation and ongoing auditory-focused intervention for enhancing listening and spoken language skills in children with CIs in the GCC. Despite significant progress, children did not fully match their hearing peers within the 24-month timeframe, suggesting the need for extended support.
Cochlear Nerve Deficiency, particularly Hypoplastic Auditory Nerve (HAN), creates uncertainty regarding Cochlear Implant (CI) outcomes. This study evaluated the utility of Transtympanic Electrically Evoked Auditory Brainstem Response (TT-EABR) in managing HAN cases. Twenty-two children with MRI-confirmed HAN were assessed using TT-EABR to guide ear selection for CI vs Auditory Brainstem Implantation (ABI) candidacy. Consequently, 13 children received CIs (HAN -CI group). Their auditory and speech outcomes -measured via CAP, SIR, and MAIS/IT-MAIS at baseline and 12 months post-implantation (with Auditory-Verbal Therapy) -were compared against an age-matched control group of 13 children with normal auditory nerves. The HAN -CI group demonstrated significant improvements from baseline to 12 months in CAP (p=0.001), SIR (p=0.005), and MAIS/IT-MAIS (p=0.001) scores. Remarkably, no statistically significant differences were found between the HAN and control groups for CAP (p=0.93), SIR (p=0.70), and MAIS/IT-MAIS (p=0.97). Favorable outcomes correlated with Kumar-Dutt Type A and B TT-EABR responses, with Type A yielding the best results. While historical data associates HAN with poor outcomes, this study highlights that precise preoperative TT-EABR assessment and ear selection can lead to outcomes comparable to non-anomalous cases. TT-EABR is a pivotal prognostic tool, crucial for ear selection and managing parental expectations. Preoperative TT-EABR is essential for tailored clinical management and successful CI intervention in selected HAN cases.
Background and Aims: Accuracy in speech perception in bilingual children is influenced by two phonological systems. This study compares phonological development in bilingual Urdu-English (UE) children with CIs with their hearing-age-matched peers with normal hearing (NH), by investigating whether bilingualism or any spectral limitations of CI impact perception of UE phonemes. Method and Procedures: Children (n = 57) aged 3; 0-6; 11 years (28 CI, 29 NH) were assessed for speech perception using a custom-designed UE Speech Perception Test (UE-SPT), in quiet and noise (+5 dB SNR). Responses were analysed using confusion matrices, across phonological parameters of place, manner, and voicing to determine error patterns. Outcomes and Results: Significant deficits in CI children were found across all features, with voicing discrimination showing the largest errors (effect sizes d > 6), exacerbated by noise, especially for Urdu aspirated stops. CIs mastered only 8.3% Urdu-aspirated consonants at 6; 11 years compared to 91.7% mastered by NH peers, indicating critical language-specific vulnerabilities. Backing and substitutions errors were particularly seen in CI's speech, whilst manner was preserved. Conclusion and Implications: UE bilingual phonological complexity compounded by inadequate speech processing abilities in CIs challenges them, underscoring urgent need for targeted speech therapy interventions focusing voicing contrasts and aspirated consonants, as well as environmental accommodations that reduce noise interference and enhance listening through CI, to optimise educational outcomes. This research contributes vital clinical guidance for supporting bilingual children with cochlear implants, addressing both environmental, technological and linguistic challenges.
The objective of this cross-sectional study was to compare the auditory memory scores obtained using the verbal and picture-pointing response modes in children with cochlear implants and implant-age matched typically developing children. The short-term auditory memory test consisting of word sequences ranging from two-word sequences to five-word sequences was developed and administered to 53 children using unilateral cochlear implants and 53 typically developing children matched in terms of implant age and gender. The implant age of the children ranged from 2 years 8 months to 7 years 9 months, and the mean age of implantation was 3 years 5 months. Each participant was tested twice, once using a verbal response task and once using a picture-pointing response task in two different sessions. The total auditory memory scores were significantly higher (P < 0.05) for the picture-pointing task as compared to the verbal recall task, especially when the memory task placed a high auditory demand and cognitive load on the children. The total auditory memory scores obtained using both the response tasks were lower in children using cochlear implants as compared to implant-age matched typically developing children (P < 0.05). The present findings indicate that the type of response task affects the performance on the short-term auditory memory test in children using cochlear implants and typically developing children, with the picture-pointing response task yielding better scores than the verbal response.
We had two sets of objectives. First, to assess the effects of an online music program on the expressive vocabulary of children with cochlear implants (CIs) and on maternal stress. Second, to explore associations between children's vocabulary, maternal stress, and the quality of children's acoustic environment, measured as daily exposure to speech in quiet. Sixteen children with CIs (M = 17.63 months, SD = 6.39) and their mothers participated weekly in a 12-week online music program (CI-T), and 16 children with CIs (M = 18.46 months, SD = 6.02) and their mothers served as controls (CI-C). The program started three months after CI activation. Both groups were assessed at three (T1), six (T2), and twelve (T3) months after CI activation. We collected measures of children's vocabulary (using the MacArthur-Bates Cognitive Development Inventories; MB-CDI), maternal stress (using the Parenting Stress Index; PSI), and children's daily exposure to speech in quiet (from the datalogging of children's devices). Friedman non-parametric tests examined within-group differences in children's vocabulary and in mothers' stress across time points. Spearman correlations (both groups combined) explored associations between changes in vocabulary, maternal stress, and the datalogging at T1, T2, and T3. The CI-T group showed significant vocabulary gains between T1 and T2, and between T2 and T3 [χ²(2) = 20.5, p < .001]. The CI-C group significantly improved only between T2 and T3 [χ²(2) = 19.60, p < .001]. Maternal stress decreased significantly in the CI-T group between T1 and T2 [χ²(2) = 8.22, p = .02], but not in the CI-C group (all ps > .05). In both groups, we found significant associations between increases in children's expressive vocabulary and maternal stress (e.g. between children's vocabulary increases between T1 and T2, and mothers' scores on the 'Parent-Child Dysfunctional Interaction' subscale at T1; r = -.40, p = .03); between increases in children's expressive vocabulary and daily exposure to speech in quiet (e.g. between children's vocabulary increases between T1 and T2 and the datalogging 'Speech' scene at T2; r = .47, p = .03); and between maternal stress and daily exposure to speech in quiet (e.g. between mothers' scores on the 'Parent Distress' subscale at T2 and the datalogging 'Speech' scene at T2; r = -.56, p = .01). Online music-based interventions could benefit children with CIs and their mothers, alongside longer exposure to speech in quiet.
Hearing-related quality of life is a crucial outcome for adults with cochlear implants. The Cochlear Implant Quality of Life (CIQOL)-35 Profile is a patient-reported outcome measure originally developed in English. In a previous study, this instrument was cross-culturally adapted into German to address the need for standardized assessment tools in German-speaking regions. To ensure the adapted instrument meets psychometric criteria, validation is required. The German adaptation of the CIQOL-35 Profile was validated through an online survey including questions on demographics, the German CIQOL-35 Profile, and the German Nijmegen Cochlear Implant Questionnaire (NCIQ). The collected data were analyzed for reliability and validity. A total of 204 adults (aged 19-87 years) with bilateral hearing loss completed the online survey. Cronbach's α between 0.84 and 0.91 demonstrates good internal consistency for all subscales of the CIQOL-35 Profile and the global outcome. Moderate to strong correlations (rs = 0.55-0.85) between the CIQOL and NCIQ indicate good convergent validity. Confirmatory factor analysis established construct validity for the German CIQOL instruments. These findings confirm that the adapted German version of the CIQOL instruments is a reliable and valid measure for assessing hearing-related quality of life in adults with cochlear implants and demonstrates higher validity than the NCIQ. The availability of the CIQOL in multiple languages facilitates international comparability of research results and increases clinical application. Implementing quality of life instruments in clinical practice enables a more comprehensive evaluation of patient outcomes and may help identify patient needs that may be addressed in therapy and rehabilitation.
Dementia is a major global health problem with increasing prevalence. Hearing loss has been identified as the most modifiable risk factor for dementia. The Age-Related Cognition and Hearing (ARCH) study is a 3-year prospective, controlled, observational comparative cohort study comparing cochlear implants (Implants) and hearing aids (HAs) for reducing cognitive decline associated with age-related hearing loss (ARHL), based on patient-reported real-world outcomes of auditory function, cognitive performance, listening environment, social interaction and psychosocial well-being. Upon its completion in 2029, the ARCH study is expected to yield significant evidence regarding the comparative effects of two primary hearing interventions-Implants and HAs, to delay and ameliorate cognitive decline associated with ARHL. 210 older adults are divided into six study subgroups (N=35) with: (1) moderate to profound hearing loss or age-typical normal hearing, (2) use of Implants or HAs and (3) mild cognitive impairment (MCI) or normal cognition. Listeners in the HA groups have hearing loss that is consistent with Implant candidacy and qualification through Centers for Medicare & Medicaid Services in the USA. The primary study outcome is a 3-year change in real-time patient-reported outcomes collected while participants are in their natural listening environments using ecological momentary assessment (EMA) methodologies. Secondary outcomes include lab-based audiometric and neuropsychological testing, and patient-reported outcomes of social isolation, loneliness, depression, anxiety and quality of life.Cross-sectional analyses will use factor analysis to reduce EMA items into domains, followed by regression and mixed-effects models to test group differences and identify specific EMA items driving those effects. Machine-learning approaches will complement these models by predicting outcomes, identifying key variables and uncovering data-driven patterns. Longitudinal mixed-effects models will assess how EMA factor scores and cognition change over time and whether real-world EMA experiences mediate cognitive trajectories. Additional analyses will compare real-time EMA responses with retrospective patient-reported outcome measures and laboratory-based cognitive and auditory assessments, with sample size adjusted for up to 10% attrition. All study procedures follow institutional review board requirements and the Declaration of Helsinki at the University of Iowa (IRB# 202403385), with informed consent processes tailored to ensure understanding among participants with MCI. Study findings will be disseminated through a multi-tiered strategy aimed at maximising scientific, clinical and public health impact. Peer-reviewed manuscripts will be submitted to leading journals in audiology, geriatrics, cognitive ageing and public health, with interim and final results presented at national and international conferences and professional society meetings.
Early cochlear implantation during the critical period of neuroplasticity leads to better auditory and language outcomes but presents unique anesthetic challenges in infants. This study retrospectively examined anesthesia-related events throughout the full diagnostic and surgical process over a 10-year period, focusing on pediatic population undervent cochlear implantation - especially under the age of 18 month. Data from 175 children under age 3 were analized who received cochlear implants between 2014 and 2024. Anesthesia-related events during audiological tests (BERA/ASSR), imaging (CT/MRI), and surgery were recorded. Collected variables were demographics, comorbidities, ASA and Mallampati scores, anesthetic techniques, procedure durations, complications, and ICU admissions. A subgroup analysis was conducted for patients implanted before 18 months. Of the 175 patients, 35 (20.2%) received implants before 18 months and 8 (4.6%) before 12 months. Anesthesia-related complications occurred in 14 cases (8.1%) in the study population, with laryngospasm during extubation being the most frequent (n = 8); all resolved without reintubation. Difficult intubation was noted in 3 patients, mainly those with craniofacial anomalies. Four children required postoperative ICU care. No complications were observed during diagnostic procedures. No significant association was found between complication rates and age, ASA status, or Mallampati score. Cochlear implantation, even in infants under one year, is safe with appropriate anesthesia and experienced teams. Complications were rare and manageable. Recognizing anesthesia risks helps optimize care and reassure parents, supporting timely intervention within the neuroplastic window.
Langerhans cell histiocytosis (LCH) is a rare disorder that may involve the temporal bone and, in rare cases, result in sensorineural hearing loss. This report highlights the importance of close radiological surveillance and timely cochlear implantation in the setting of progressive otic capsule ossification. A 21-year-old male presented with a five-year history of progressive bilateral hearing loss, tinnitus, vertigo and imbalance. Following multidisciplinary team (MDT) discussion, cochlear implantation was deferred until completion of chemotherapy. Repeat CT imaging demonstrated progressive cochlear ossification involving the otic capsules. A repeat discussion followed, which led to an expedited cochlear implantation. The left side was implanted first due to lesser ossification, achieving full electrode insertion. Sequential implantation of the contralateral ear was performed four months later. However, insertion was limited due to advanced ossification. The second implantation was technically more challenging, with only partial electrode insertion possible due to advanced ossification. We advocate for close surveillance in the case of LCH to monitor for signs of otic capsule ossification. This case demonstrates that cochlear ossification in LCH may progress rapidly, narrowing the window for optimal implantation. Early cochlear implantation should be strongly considered in such cases.
BACKGROUND: Cochlear implants (CIs) have made it possible to significantly improve hearing in people with profound hearing loss. Although, cochlear implants are considered a safe procedure, this minimally invasive surgery has an overall complication rate of 12.5%. With Gusher (cerebrospinal fluid outflow) considered a common intraoperative complication of cochlear implants. METHODS: In this retrospective study, clinical files of patients with severe to profound sensorineural hearing loss who had undergone cochlear implantation were retrospectively reviewed. We calculated the incidence and risk factors of gusher and management options used . Statistical analysis included non-parametric tests and multivariate ordinal logistic regression to explore predictors of CSF leak intensity. RESULTS: 1050 patients with profound hearing loss who underwent CI, 21 of whom had an intraoperative cerebrospinal fluid (CSF) leak, i.e. 2%, with a mean age of 3.5 years, and a sex ratio of 0.62, i.e. 62% female and 38% male. 43% of patients with gusher had structural abnormalities on their CT scan. Dilatation of the vestibule and vestibular aqueduct, as well as Mondini dysplasia, were the most common anomalies in Gusher patients. Younger implantation age was the only factor associated with higher CSF leak intensity in univariate analysis, but no independent predictors were identified in multivariate analysis. CONCLUSIONS: Advancements in surgical techniques, radiological assessments, and technological innovation have significantly reduced cochlear implant–related complications, leading to a decreased risk of cerebrospinal fluid leakage incidents.
Incomplete Partition type II (IP-II), or Mondini dysplasia, accounts for half of congenital cochlear malformations and results in profound sensorineural hearing loss. Cochlear implantation restores hearing in patients with IP-II however low numbers mean reporting of auditory performance outcomes is limited. Here we review English language articles between 2010 and 2025 reporting hearing outcomes following cochlear implantation in individuals IP-II. Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR) and parental reports of cochlear implantation in 731 individuals, across 20 studies, with a follow-up of 1-3 years, met the inclusion criteria. Findings suggest that auditory perception and speech develop more slowly in people with IP-II compared to controls but there was no difference between groups by 1-2 years post-implantation. Most patients with IP-II have better hearing with a cochlear implant than before. However, there is limited evidence that this is comparable to those with normal middle ear anatomy. Findings were typically derived from questionnaires with small cohorts and short follow-up. Patient counselling for people IP-II should identify that prediction of hearing outcomes is uncertain. Informed prognostication of timing of surgery and hearing outcomes after cochlear implantation in IP-II needs further study with long-term follow-up including surgical and hearing outcome measures.
To evaluate the contribution of electrode insertion live monitoring, offered by the Nucleus® SmartNav system, in cochlear implantation surgery since correct and precise electrode placement can assure better preservation of the cochlear structure. A prospective cohort study was conducted on 66 patients, with normal cochlear anatomy, operated for unilateral cochlear implantation. Once the surgeon started inserting the electrodes under SmartNav monitoring, the progression of the electrode array and its position were assessed, and the angular insertion depth, placement time and speed of insertion were measured. The mean insertion speed was 0.49 mm/s, which corresponds to a total insertion time of 40.81 s for the used CI522 electrode. The benefit of training was highlighted by comparing the mean values of insertion speed between the initial half of procedures and the final half performed by the same surgeon, indicating a reduction of 0.10 mm/s (20%). The mean angular insertion depth was 401.71° (251-572), while, when compared with the preoperative CT scan measures of the cochlear diameter, only a moderately negative correlation was found (r = - 0.51). Also, two cases of Tip Fold-over were detected with immediate correct replacement of the electrode. Cochlear implantation with live monitoring by the SmartNav system offers the main advantage of controlling the surgeon's insertion speed, which he can modulate to achieve the softest atraumatic insertion, with a positive training effect resulting in reduced speed over time. Additionally, it demonstrated its effectiveness in detecting tip fold-overs in a safer way than radiologic imaging.
To present a case series of patients with Chudley - McCullough syndrome (CMS) and provide audiometric outcomes pre - and post - cochlear implantation. A retrospective case series was written based on six patients with CMS and hearing loss. Patients were treated in a tertiary-care medical center for their hearing loss with hearing aid fitting and cochlear implantation. Audiometric outcomes pre- and post-cochlear implantation were analyzed. Three out of six patients were diagnosed with auditory neuropathy spectrum disorder (ANSD), one patient was suspected of ANSD, and in two patients, the presence of ANSD could neither be confirmed nor excluded. All patients were fitted with hearing aids, and all had limited benefit. In most cases, hearing deteriorated rapidly and eventually, all patients received a cochlear implant (CI), unilateral or bilateral. In general, aided thresholds with CIs were satisfactory. However, speech recognition varied widely between patients and was, on average, worse compared to patients with sensorineural hearing loss without CMS. CMS was often diagnosed relatively late during childhood, and sometimes hearing loss was the first apparent symptom. Hearing loss was found to be progressive, often not detected shortly after birth and often complicated by ANSD. Cochlear implantation emerged as the optimal treatment, demonstrating superiority over hearing aid rehabilitation to improve hearing performance. Auditory and speech-language development outcomes remained poorer than in children with CI and without CMS. Based on these results, we advocate considering cochlear implantation early for children who have CMS and hearing loss.
Background/Objectives: Cochlear implants (CIs) and other implantable hearing devices are crucial to treat hearing loss. The aim of this study was to analyze the temporal trends of implantation for hearing devices in Italy between 2001 and 2023, with stratification by age. Methods: This population-based study explored Hospital Discharge Records and used codes from the International Classification of Diseases, 9th revision-Clinical Modification (ICD9-CM) to identify cochlear and non-cochlear implants. Patients were partitioned into six age classes: <1, 1-2, 3-17, 18-65, 66-80, and >80; and time series for counts and incidence rates (IRs) per 1,000,000 inhabitants with confidence intervals (CI95%) were explored overall and by age class. Trends were assessed by incidence rate ratio and Cox-Stuart test with a significance threshold for p-values at 0.05. Results: 22,850 (83.6%) records for cochlear and 4476 (16.4%) for non-cochlear implants were extracted. Cochlear implants volume shifted from 537 procedures in 2001 to 1595 in 2023 (p < 0.01), while IR increased (p < 0.01) from 9.4 (CI95%: 9.7, 10.3) in 2001 to 27 (CI95%: 25.7, 28.4) in 2023. The volumes of implanted CIs increased in children and adults. Volumes for non-cochlear implants increased between 2001 and 2010, from 62 to 254, and remained stable afterwards. IR shifted from 1.1 (CI95%: 0.8, 1.4) in 2001 to 4.1 (CI95%: 3.6, 4.7) in 2023. Conclusions: Those trends highlight the importance of monitoring efficacy and safety of hearing devices, and the establishment of the Italian Implantable Hearing Device Registry at the Italian National Institute of Health is a first step in such a direction.
Menière's disease is a chronic inner ear disorder characterized by recurrent vertigo attacks, tinnitus, and fluctuating hearing loss, which may progress to severe sensorineural hearing impairment in a subset of patients. Since 2015, international consensus criteria distinguish between definite and probable disease. Current therapeutic strategies follow a stepwise approach, ranging from non-ablative to ablative interventions. Cochlear implantation (CI) has emerged as an effective option for auditory rehabilitation and has also shown beneficial effects on vertigo and tinnitus. Combined strategies with endolymphatic sac surgery are discussed, while labyrinthectomy with simultaneous CI represents a highly effective yet irreversible intervention. Particular challenges arise in bilateral cases, where radiological endotyping (e.g., hypoplastic vestibular aqueduct type) may improve future treatment planning. Evidence demonstrates that CI is feasible after ablative procedures as well as in unilateral Menière's disease with hearing preservation, resulting in significant improvements in quality of life. Systematic reviews confirm the safety and efficacy of CI, establishing its central role in the management of advanced disease stages. Early developments of vestibulocochlear implants (VCI) additionally open perspectives for combined auditory and vestibular rehabilitation, although clinical application remains experimental. Der Morbus Menière ist eine chronische Innenohrerkrankung mit rezidivierenden Schwindelattacken, Tinnitus und Hörverlust, die bei einem Teil der Patienten zu hochgradiger Schallempfindungsschwerhörigkeit führt. Die Diagnostik erfolgt seit 2015 anhand international konsentierter Kriterien, welche zwischen definitivem und wahrscheinlichem Morbus Menière unterscheiden. Therapeutisch wird ein stufenweises Vorgehen empfohlen, das von nicht-ablativen bis hin zu ablativen Verfahren reicht. Cochleaimplantate (CI) haben sich als effektive Option zur Hörrehabilitation etabliert und zeigen zudem günstige Effekte auf Schwindel- und Tinnitussymptomatik. Kombinationsstrategien mit Saccuschirurgie werden diskutiert, während die Labyrinthektomie mit simultaner CI-Implantation eine hochwirksame, jedoch irreversible Maßnahme darstellt. Besondere Herausforderungen bestehen bei bilateralen Verläufen, bei denen radiologische Endotypisierungen (z. B. hypoplastischer Typus des vestibulären Aquädukts) künftig die Therapieplanung präzisieren könnten. Studien belegen, dass die CI-Versorgung sowohl nach ablativen Eingriffen als auch bei einseitigem Morbus Menière mit Erhalt von Restgehör möglich ist und zu einer signifikanten Verbesserung der Lebensqualität führt. Systematische Übersichten bestätigen die hohe Wirksamkeit und Sicherheit der CI-Therapie, wodurch sie eine zentrale Rolle in der Versorgung fortgeschrittener Erkrankungsverläufe einnimmt. Erste Ansätze zur Entwicklung vestibulocochleärer Implantate (VCI) eröffnen zudem die Perspektive einer kombinierten auditiven und vestibulären Rehabilitation, befinden sich jedoch noch im experimentellen Stadium.