Cochlear implantation is one of the fastest-growing ENT procedures in India. Here are straight answers to the questions you actually face in clinic. Who qualifies for a cochlear implant? Adults: Bilateral severe-to-profound sensorineural hearing loss (≥70 dB HL) with speech discrimination ≤50% on open-set sentences even with well-fitted hearing aids. Children: Profound loss (≥90 dB HL) from age 12 months. Earlier implantation (before 18 months) gives significantly better speech outcomes. Is the ADIP scheme still active for cochlear implants? Yes. The Government of India's Assistance to Disabled Persons (ADIP) scheme covers the device and surgery cost for children below 5 years from families with monthly income under ₹20,000. Your patient needs a disability certificate and referral to an empanelled centre. State schemes like Kerala's Sruthi Tharangam run parallel programs. Bilateral vs unilateral — what should you recommend? Bilateral implantation gives better sound localisation and performance in noise. For paediatric patients with no cost constraint, bilateral is now the standard of care internationally. In India, sequential bilateral (second side done within 2 years) is a pragmatic middle ground given costs. What is the typical surgical duration and complications rate? 90–120 minutes under general anaesthesia. Major complication rate is under 2% at high-volume centres. Most common issues: device failure (0.3–0.5%), facial nerve palsy (transient, <1%), and meningitis risk (mitigated by Pneumococcal vaccination pre-implant). How soon can patients expect speech improvement? Device activation happens 4–6 weeks post-op. Children implanted under 2 years reach age-appropriate speech in 2–3 years of rehab. Adult post-lingual patients show 70–80% open-set sentence recognition within 12 months. Rehab compliance is the single biggest predictor of outcome. MRI compatibility — what to tell patients? All current generation devices (Cochlear, MED-EL, Advanced Bionics) are MRI-conditional at 1.5T with the external processor removed and a head bandage. MED-EL offers 3T conditional implants. Always document the exact device model in records — imaging centres need this.