Cochlear implants have become an important tool for the treatment of individuals with hearing impairment. A preoperative approach consisting of a multidisciplinary team that fully assesses each cochlear implant candidate will allow the selection of those patients likely to benefit. Cochlear implant technology continues to evolve including electrode design, receiver/stimulator design, and speech-processing modalities. Novel surgical techniques have enhanced the safety of cochlear implantation and have provided access to a growing number of patients. Children with congenital inner ear malformations and those with cochlear ossification are able to benefit from implantation.