In case you missed it! CI2026 Recap

Each year, the American Cochlear Implant Alliance (ACI Alliance) conference brings together clinicians, surgeons, researchers, and advocates to share the latest evidence and collaborate on advancing patient care.

In May, the CI2026 conference convened in Chicago, Illinois, providing a forum for thought leaders across the field to present emerging research and explore strategies to improve outcomes and access to cochlear implantation.

During the meeting, Cochlear hosted two symposia focused on key areas shaping the future of cochlear implant care. The first symposium, titled “Maximizing Hearing Potential through Evidence-Based Practices and Innovation” explored the scientific foundation that drives superior patient outcomes from surgical technique to adaptive technology and was moderated by Dr. Brian Kaplan. Expert presentations connected cochlea health, electrode positioning, evolving technology, and long-term hearing potential through three strategic pillars:

Start Strong: Optimize the electrode-neural interface (ENI) through anatomy-aligned electrode design with surgical placement
Keep Advancing: Use smart implant technology to sustain and enhance outcomes
Today and Always: Deliver lifelong value through innovation and trusted partnership

Our esteemed panel consisted of leading experts representing academic and clinical centers across the United States:

Akira Ishiyama, MD – UCLA

Amit Walia, MD – Washington University St. Louis

Mana Espahbodi, MD – University of Utah

René Gifford, PhD – Hearts for Hearing

START STRONG: Building the Foundation at Implantation

Decisions at the time of implantation establish the foundation for long-term outcomes. In particular, electrode design and placement play a critical role in shaping the electrode-neural interface (ENI), which underpins hearing performance.

Our Slim Modiolar electrode design was highlighted for its intent to both:

Provide the closest connection to spiral ganglion neurons, improving stimulation efficiency, and
Protect cochlear structures through atraumatic insertion.

Anatomical Rationale for Perimodiolar

Dr. Akira Ishiyama provided detailed temporal bone research that reinforced why perimodiolar positioning aligns with cochlear biology.

Spiral ganglion neurons terminate before the full length of the cochlear duct (approximately 695°)¹, meaning deeper insertions may not provide additional neural benefit.
Scala tympani volume correlates with hearing preservation—lower electrode volume (Slim Modiolar) may improve outcomes.²

These findings reinforce the concept that working in alignment with cochlear anatomy—rather than simply maximizing insertion depth—may support both structural preservation and functional outcomes.

Controlling Variables: The Role of Electrode Position

Data from Washington University³ presented by Dr. Amit Walia demonstrated that while measures of cochlea health account for a significant portion of outcome variability, electrode position remains an independent contributor to performance, with perimodiolar placement outperforming predicted outcomes even after controlling for cochlea health.

Complementary intrapatient data from the University of Utah⁴presented by Dr. Mana Espahbodi—where patients served as their own controls—showed higher CNC word scores with perimodiolar electrodes compared to lateral wall arrays, with no meaningful differences in other clinical variables. These findings suggest that when patient factors are held constant, electrode placement itself can meaningfully impact speech perception outcomes.

KEEP ADVANCING: Smart Implants are the new standard of care: the Cochlear® Nucleus® Nexa™ System

While a strong surgical foundation is critical, the symposium emphasized that patient needs and technology continue to evolve over time. Advanced implant platforms, like the Nucleus® Nexa® System, designed to adapt over the lifespan of the device may play an increasingly important role in sustaining outcomes.

Emerging clinical workflows reflect this evolution. For example, early activation—sometimes within days of surgery—was discussed by Dr. René Gifford as a growing clinical practice supported by improvements in surgical technique and device capabilities. Additionally, remote programming and activation pathways were highlighted as potential solutions to reduce patient burden and improve access to care. Remote early activation can be achieved by writing a Population Mean map to the internal device in the operating room and allowing the patient to activate their device via Smart Sync once the dressing is removed.

Nexa ENI Research Platform

Jan Janssen discussed Nexa ENI Research Platform, emphasizing how the Cochlear® NEXOS Chipset enables novel research opportunities that were previously impossible. Research initiatives include novel or enhanced objective measures for assessing neural health, and precision diagnostics that provide detailed understanding of patient-specific cochlear function.

The fundamental innovation of the Nucleus® Nexa^TM architecture is that continuous evolution occurs through firmware updates delivered inside the implant itself, not just through external processor upgrades. This approach ensures that patients implanted today are prepared for innovations that will emerge throughout their lifetime with the device, truly embodying the Keep Advancing pillar of maximizing hearing potential through sustained technological progress.

TODAY AND ALWAYS: Trusted Partner for Life: Experience, Responsibility and Innovation

The final theme, presented by Jan Janssen, focused on the broader concept of innovation as a long-term, evidence-driven process rather than a single breakthrough. Throughout our history, we’ve approached every advancement with clear commitments: experience grounded in evidence, responsibility that prioritizes safety and reliability, and continuous innovation serving patients across their lifetime. This is what it means to be a trusted partner for life—supporting all your patients’ journeys today and always.

Longitudinal clinical studies, including global studies of next-generation implant concepts, reflect a sustained commitment to improving outcomes over decades.

Our Saturday Breakfast Symposium titled “Optimizing Outcomes for Every Patient Through Evidence-Based Hearing Care” focused on how evidence-based approaches and real-world data are transforming cochlear implant care across the patient journey—from activation through long-term maintenance, and was moderated by Dr. Terry Zwolan. We were joined by phenomenal panel of experts:

Yue Zhang, PhD – Cochlear North America

Allison Biever, AuD – Rocky Mountain Ear Center

Jourdan Holder, AuD, PhD – Hearts for Hearing

Mary Rose Goldstein, AuD – Center for Neurosciences

A central theme was the evolution of care pathways to improve access and streamline protocols while maintaining or enhancing patient outcomes. Survey data demonstrated a trend toward earlier activation after surgery and fewer required follow-up visits, reflecting advancements in surgical techniques, technology, and care models.⁵ Telehealth adoption has also increased, supporting more flexible and patient-centered care delivery.

Dr. Allison Biever presented on the activation phase of Cochlear’s Care Model. Early activation was highlighted as a key opportunity to accelerate outcomes.⁶ Clinical data and case series showed that same-day or next-day activation produces comparable speech perception outcomes to traditional timelines, with high patient satisfaction and reduced burden (e.g., fewer visits and faster access to sound).

Dr. Biever’s presentation also emphasized Population Mean-based programming, which is increasingly adopted as a primary method at activation. This approach significantly reduces fitting time while maintaining equivalent performance outcomes compared to traditional behavioral mapping.

During her presentation on the optimization phase, Dr. Jourdan Holder reinforced three evidence-based pillars:

Verifying audibility (targeting ~20–25 dB HL)
Using objective measures (e.g., eSRTs) for programming
Promoting consistent daily device use (~12 hours/day)

Finally, Dr. Mary Rose Goldstein discussed how the maintenance phase is shifting toward streamlined, data-driven models. Real-world evidence shows MAP stability over time and supports reduced visit frequency, supplemented by remote monitoring tools (e.g., Remote Check^ꝉ), which maintain outcomes while improving clinic capacity and access.

Overall, integrating early activation, objective programming, and remote care enables more streamlined, scalable, and personalized CI management without compromising clinical outcomes.

It was an outstanding conference featuring an impressive breadth of innovative research—far more than could be fully captured in a single post. We hope to see you next May in San Diego! CI2027 San Diego – American Cochlear Implant Alliance

*Cross‑study comparisons are limited by differences in study design, populations, and endpoints.

^ꝉ Remote Check for Nucleus sound processors is approved for all ages, however certain tests are not suitable for ages below 6. Remote Check does not replace clinical care and does not involve remote programming of the sound processor. Remote Assist for Nucleus sound processors is approved for ages 6 and older. Remote Check and Remote Assist features are only visible and accessible if they are enabled by a clinician. Clinicians should consider the suitability of the feature before enabling Remote Check and Remote Assist. Only available at clinics that have enrolled in Remote Care.

Danielian, A., Ishiyama, G., Lopez, I. A., & Ishiyama, A. (2020). Morphometric linear and angular measurements of the human cochlea in implant patients using 3-dimensional reconstruction. Hearing research, 386, 107874. https://doi.org/10.1016/j.heares.2019.107874
Canfarotta, M. W., Dillon, M. T., Selleck, A. M., & Brown, K. D. (2025). Scala Tympani Volume Influences Initial 6-Month Hearing Preservation With Lateral Wall Electrode Arrays. The Laryngoscope, 135(5), 1781–1787. https://doi.org/10.1002/lary.31917
Walia, A., Shew, M. A., Smetak, M., Ortmann, A., Durakovic, N., Jiramongkolchai, P., Lefler, S., Herzog, J. A., & Buchman, C. A. (2026). Perimodiolar Electrode Locations Outperform Lateral Wall Arrays When Controlling for Cochlear Health and Speech Processing Strategy. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 47(2), 257–265. https://doi.org/10.1097/MAO.0000000000004699
Ewer, N., Espahbodi, M., Durham, A. R., Johnson, K., Gurgel, R. K., & Patel, N. S. (2026). A Unique Perspective: Intrapatient Comparison of Perimodiolar and Lateral Wall Cochlear Implant Electrodes. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 47(5), 678–683. https://doi.org/10.1097/MAO.0000000000004860
Zwolan, Terry A.; Holcomb, Meredith; Buck, Barbara; Adkins, Weston1; Snapp, Hillary; Prentiss, Sandra. A Survey of Current Audiology Practice in Adult Cochlear Implant Programs and Its Impact on Access to Care. Ear & Hearing 47(1):p 137-145, January/February 2026. | DOI: 10.1097/AUD.0000000000001703
Patro, A., Lindquist, N. R., Holder, J. T., Freeman, M. H., Gifford, R. H., Tawfik, K. O., O’Malley, M. R., Bennett, M. L., Haynes, D. S., & Perkins, E. L. (2024). Improved Postoperative Speech Recognition and Processor Use With Early Cochlear Implant Activation. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 45(4), 386–391. https://doi.org/10.1097/MAO.0000000000004150