Cochlear implants have been used for the treatment of severe or profound sensorineural deafness for 40 to 50 years, and have been performed in China for more than 20 years. Currently, cochlear implants are recognized as the most effective treatment for severe or profound sensorineural deafness and are one of the most successful programs in bionic medicine. With the continuous research on auditory implant medicine and the in-depth understanding of the law of auditory-speech development, cochlear implant medicine currently has the following major clinical development trends in China. Cochlear implant specialization and teamwork Cochlear implantation is not just a simple step of surgery, but involves pre-operative diagnosis, specialized otology surgery, post-operative commissioning, evaluation and rehabilitation of hearing and speech, and even education and psychological counseling, etc. The personnel involved include audiologists, otologists, neurologists, psychologists, speech rehabilitators, educators and social workers. Therefore, cochlear implantation is both a highly specialized and multidisciplinary medical procedure. Because of the highly specialized and multidisciplinary nature of this work, there is a trend toward the establishment of team-based, specialized cochlear implant teams in order to better carry out this work. A multidisciplinary clinic for cochlear implantation involves a joint consultation between an ear surgeon, an audiologist, a psychologist, as well as radiologists and pediatric neurologists each time to develop the most rational auditory implantation plan for the patient. This allows for closer assistance and communication between the staff of the different specialties and fields involved to provide better medical, rehabilitation and educational services for the patient. Many cochlear implant centers abroad are such teams, and China is bound to move in this direction as well. 2. Bilateral cochlear implants Audiological studies have proven that binaural listening has the following advantages: binaural listening can improve hearing by 5 to 10 dB; better localization of sound sources and perception of stereo sound; improved speech recognition in noisy environments; better auditory memory with binaural listening than monaural, especially short-term memory; and improved communication and social skills for patients in daily life. Many studies have shown that unilateral cochlear implant recipients require more attention and integration of more sensory systems when listening, and that bilaterally deaf patients benefit more from bilateral cochlear implants than from unilateral implants. Bilateral cochlear implants have been tried since 1988, and in the early 1990s, the primary goal of bilateral cochlear implants shifted to the desire to provide binaural gain, improve speech comprehension in noisy environments, and obtain a better signal-to-noise ratio. More recently, there has been a mainstream trend toward bilateral simultaneous cochlear implantation, replacing the previous bilateral implantation of sequential cochlear implants. Many studies have concluded that the benefit of bilateral cochlear implants for patients is “to ensure optimal hearing performance after implantation”. By eliminating the cephalic shadow effect, the binaural sum effect, the binaural squelch effect, the binaural time difference and the energy spectrum difference, bilateral implants allow the listener to accurately determine the location of the sound source, improve the signal-to-noise ratio of speech sounds, enhance speech comprehension in noisy environments, and avoid the hearing deprivation effects of unilateral cochlear implants. Bilateral implants stimulate the development of the central nervous system more quickly than unilateral implants, establishing the advantages of binaural listening. Studies have also shown that early bilateral cochlear implantation has a better effect on the development of the auditory system and related systems. Early cochlear implantation refers to the early implantation of cochlear implants for deaf patients who are suitable for cochlear implants. From the earliest days when cochlear implants were used only for adults, to children over 6 years old, to children over 2 years old, to the generally accepted implantation for children over 1 year old, developed medical countries and regions such as Europe are now pushing the age of implantation one step further by introducing the concept of early implantation, i.e. 6-12 months of age. Studies have found that newborns begin to communicate with the outside world as soon as they are born, promoting the development of auditory-verbal functions through constant listening. The critical period for auditory and speech development is between birth and 3 years of age. During this period, the auditory cortex of the brain develops rapidly and auditory functions are gradually improved, allowing them to recognize different sounds and learn to speak by imitating the sounds they hear. If there is a lack of auditory stimulation at this time due to deafness, the development of the auditory cortex of the brain will be affected. Therefore, children with prelingual deafness should have cochlear implants as early as possible to receive adequate sound stimulation during the critical period of speech development and to achieve auditory and speech rehabilitation so that they can catch up with their hearing peers in all aspects of life and learning. A growing number of studies have shown that children with early implants achieve faster open speech perception, and that the advantages of early implantation become more evident the longer the implantation period. Of course, early implantation requires a higher level of skill related to pediatric surgery and must be performed with the help of a hospital and surgeon who has specialized experience in pediatric anesthesia and pediatric surgery. It is due to the improved clinical surgical techniques and the good results obtained with early implantation that the concept of early implantation is now becoming more and more accepted. In patients with postlingual deafness, the concept of early implantation means that the cochlear implant is performed as early as possible after the loss of hearing. If sound stimulation is lost for a long period of time, the auditory speech center will gradually degenerate, resulting in delayed speech comprehension and slurred speech. Early implantation of cochlear implants can maintain the function of the auditory center, which is conducive to auditory rehabilitation and speech understanding. 4. Cochlear implantation for the elderly With the increase of life expectancy in China, the elderly population is increasing and some cities have already entered the aging cities, the number of people with senile deafness is increasing and the number of years suffering from deafness is also increasing. Aging is a universal law of nature, and so far there is no exact and effective way to reverse this process. Age-related deafness is mainly due to the aging and degeneration of the auditory organs, commonly known as “aging”. Elderly people with hearing loss will minimize their communication with others due to speech impairment, and over time, they tend to become withdrawn, irritable, cognitive decline, and even develop dementia. Therefore, senile deafness not only directly leads to communication impairment, but also causes a variety of psychological problems, which seriously affects the physical and mental health of the elderly. For the treatment of senile deafness that affects the quality of life due to hearing impairment, most people with mild or moderate deafness can recover their hearing through hearing aids, but for some patients with severe and very severe senile deafness, if wearing hearing aids is not effective, cochlear implantation may become the only way to treat their senile deafness. improve their quality of life. The cochlear implant can be used to restore hearing and improve the quality of life of the elderly. There is no age limit for cochlear implantation, as long as the patient is in good health and can receive general anesthesia. The maximum age of cochlear implant patients at home and abroad is currently 89 years old. It is believed that as human life expectancy increases, the record for the maximum age of implant patients will continue to be broken. At present, more than 90% of cochlear implant patients in China are children, and less than 10% of elderly deaf patients have cochlear implants, while the proportion of elderly implants in foreign countries is more than 50%. The reasons for this are, firstly, that the attention to elderly deafness in China is relatively lagging behind, secondly, that there is insufficient awareness of the dangers of elderly deafness among all people, and thirdly, that the elderly themselves are relatively backward in terms of health awareness. It is believed that as people’s living standards improve, their health awareness increases, their pursuit of quality of life improves, the implantation technology continues to advance and the aid policy is improved, more and more elderly people will rebuild their hearing by means of cochlear implants. In the foreseeable future, cochlear implantation will become an important direction and means of treatment for elderly deaf patients.