From the technical point of view, cochlear implant (CI) surgery in adults is a well established procedure. Pre- and postoperative evaluation, surgical approach and rehabilitation programs are standardized, presenting CI as a low risk procedure with rare complications similar to those of middle ear surgery. Modern advanced CI devices offer technical reliability and multiple speech encoding strategies and recently, even small processors which are worn behind the ear. Further technical advances are continuously available, even for implanted patients. Upgrading is usually easy because the outer parts of the implant are exchangeable and software upgrades can be transmitted transcutaneously to the implant. Assuming that medical and rehabilitation requirements are available, there are only very few indications against CI in adults. Candidate patients should therefore be transferred to CI-centres where a decision can be taken depending on presurgical evaluation results.