ObjectiveTo determine whether choosing the “better” ear or the “worse” ear for cochlear implantation impacts performance outcome.DesignRetrospective cohort study.SettingUniversity teaching hospital–cochlear implant program.MethodsTwo groups of cochlear implantees were selected and matched based on clinical parameters, including duration of deafness/age at implantation, implant types, and processing strategies. Nineteen patients received an implant in his or her “better” ear of the two that had been amplified. An equal number of patients received an implant in the “worse” ear— an ear that was not amplified or was chosen to avoid causing oscillopsia; or if the patient was not willing to relinquish his or her hearing aid in the “better” ear based on subjective or objective criteria. Standard speech perception testing was performed.ResultsThe average open-set speech perception responses at 1 year after implantation were as follows: word recognition score 40.4% and sentence recognition score 81% in the aided subjects (better ears); word recognition score 41.5% and sentence recognition score 84.5% in the unaided group (worse ears).ConclusionNo differences were found between the two groups of implantees. Choosing the “worse” ear for implantation did not appear to have a negative impact on performance outcome in this match-paired study.