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Yassin Abdelsamad, PhD

Published Feb 12, 2026

Early Activation in Cochlear Implantation

The early activation of cochlear implant audio processors is an option that growing numbers of hearing implant clinics now offer. This article summarizes recent publications on early activation in cochlear implantation and its reported impact on patient care, safety, impedance values, fitting parameters, audiological outcomes, complications, and more.

A young child sits beside an adult while a clinician adjusts and activates the child’s cochlear implant audio processor. The clinician works at a nearby desk with a laptop displaying audio settings, and colorful toys are placed on the table to engage the child. A large window behind them shows a green outdoor landscape.

For decades, cochlear implants have traditionally been activated three to six weeks after surgery to allow time for healing. However, with advances in surgical techniques and postoperative care, early activation has emerged as an option offered by some clinics.

With early activation, the audio processor is activated within the first 1-14 days following cochlear implantation.[1][4][5][9][11]

This article covers research findings on early activation and its association with:

1 Surgical Advancements
2 Safety & Complications
3 Impedance Values and Stabilization Times
4 ECAP Measurements & Fitting Parameters
5 Audiological Outcomes
6 Wearing Comfort & Device Usage
7 Patient & Clinician Feedback

Surgical Advancements Have Paved the Way for Early Activation

“Over 15 years ago, we adopted minimally invasive surgical techniques and introduced early activation for our cochlear implant patients. After thousands of successful cases, early activation has consistently proven to be a safe, reliable, and transformative approach. Without a doubt, it is one of the most rewarding decisions I have made in my career.”

Professor Abdulrahman Hagr, MBBS FRCS(c)

King Saud University, Riyadh, Saudi Arabia

Surgical techniques and considerations have significantly improved healing times and cosmetic outcomes, creating the opportunity for safe early activation. These advancements include:

Additionally, recent innovations have helped strengthen the safety and feasibility of early activation:

Individualized cochlear implant electrodes, tailored to each ear’s anatomy and hearing profile
Pre-operative otological planning to enable anatomy-based electrode selection
Robotic-tools for precision surgery that can help enhance consistency and reduce insertion trauma
Atraumatic insertion strategies to better preserve delicate cochlear structures and residual hearing
Enhanced protocols to support faster healing and improved cosmesis [1]

Together, these advancements form a framework that can help clinics make early activation safe for cochlear implant recipients while providing them access to sound sooner.

Research on Early Activation After Cochlear Implantation

In the last two years, the number of publications comparing early activation to classic activation has nearly doubled. These have covered a wide variety of topics ranging from safety, electrode impedances, ECAP values, audiological and speech outcomes, device wearing times, and feedback from implant recipients.

Safety

A systematic review including 19 studies and 857 patients who underwent early activation, mentioned that:

“Early activation is safe and feasible and does not impact the hearing and speech outcomes of the patients undergoing CI procedures.”

Alshalan et al., (2023)

Complications

According to the current literature, there are no major complications with early activation after cochlear implantation, and complication rates are comparable to those of classic activation.

However, some minor complications were reported with early activation, such as incision integrity issues.[16] coil or magnet retention problems,[10][16] mild pain,[1][6][6][10] skin infections,[1][5][6][16] and the need for magnet strength adjustments.[6][11][16]

Impedance Stabilization Patterns

One study found that impedance stabilization tends to occur weeks earlier than in classic activation,[17] while other studies reported that early and classic activation values were comparable.[3][10]

With regard to long-term impedance values, it has been found that they tend to be lower in the period up to two years post-implantation.[2]

ECAP Measurements and Fitting Parameters

Relatively few studies have reported on ECAP measures and fitting parameters.

One study found that ECAP thresholds with early activation are comparable to classic activation,[5] and results have varied with respect to maximum comfort levels, threshold levels, and dynamic ranges.[3][4][18]

Audiological and Speech Outcomes

Early activation has been shown not to compromise patient outcomes,[15] and hearing thresholds are generally found to be similar between patients with early and classic activation.[5][7] Studies examining speech performance have shown equivalent results in short, mid, and long-term evaluations.[5][7]

Magnet Strength Adjustments and Wearing Comfort

Most MED-EL patients can use standard magnet strength from early activation to follow-up.[7][12] However, temporary adjustments may be needed in the early period after activation,[6][7] and although they are rare, skin irritation problems can occur.[5]

Device Use and Daily Wearing Time

While initial audio processor use may be lower in the first few days with early activation after cochlear implantation,[7] wearing time was found to be comparable to classic activation from the period from one to three months.[7][19]

Feedback From Patients and Caregivers

A systematic review including 15 studies and 625 patients who underwent early activation showed that:

“Early cochlear implant activation is feasible and allows patients with no contraindications earlier access to auditory perception and rehabilitation and reduces anxiety linked to delay in activation.”

Parker et al., (2024)

Important Considerations for Early Activation

The magnet strength should be monitored regularly after early activation.

In the literature, it is recommended to postpone activation in patients with vestibular issues, wound infections or pain, serum collection, swelling, edema, or receiver-stimulator instability.[1][8][14][16]

Clinicians are encouraged to use their discretion to decide the most appropriate activation time for each patient.

Rethinking the Timeline to Hearing

“Early activation shortens the time between surgery and the first activation of the audio processor. It is safe and does not negatively affect wound healing or increase pain. Additionally, it enables cochlear implant recipients to initiate auditory rehabilitation sooner, which can result in more rapid improvements in speech perception and language development.”

Prof. Dr.-Ing. Uwe Baumann

Head of Section Audiological Acoustics / ENT Department, Goethe University Frankfurt

MED-EL has over a decade of experience working with clinics that offer early activation.

While it may not be appropriate for all recipients, early activation has already proven to be safe, effective, cost-efficient, and emotionally transformative for thousands of MED-EL cochlear implant recipients.

References

^[1]
Alahmadi, A., Abdelsamad, Y., Alothman, N. I., Alshalan, A., Almuhawas, F., AlAmari, N. A., Alyousef, M. Y., Alhabib, S. F., & Hagr, A. (2023). A Literature Review on Cochlear Implant Activation: From Weeks to Hours. Ear, Nose & Throat Journal, 1455613231188294. https://doi.org/10.1177/01455613231188294
^[2]
Alahmadi, A., Abdelsamad, Y., Yousef, M., Almuhawas, F., Hafez, A., Alzhrani, F., & Hagr, A. (2024). Cochlear Implantation: Long-Term Effect of Early Activation on Electrode Impedance. Journal of Clinical Medicine, 13(11), 3299. https://doi.org/10.3390/jcm13113299
^[3]
Alhabib, S. F., Abdelsamad, Y., Yousef, M., Alzhrani, F., & Hagr, A. (2021). Effect of early activation of cochlear implant on electrode impedance in pediatric population. International Journal of Pediatric Otorhinolaryngology, 140, 110543. https://doi.org/10.1016/j.ijporl.2020.110543
^[4]
Alsabellha, R. M., Hagr, A., Al-momani, M. O., & Garadat, S. N. (2014). Cochlear Implant Device Activation and Programming. Otology & Neurotology, 35(4), e130–e134. https://doi.org/10.1097/mao.0000000000000266
^[5]
Alshalan, A., Abdelsamad, Y., Yousef, M., Alahmadi, A., Almuhawas, F., & Hagr, A. (2023). Early activation after cochlear implantation: a systematic review. European Archives of Oto-Rhino-Laryngology, 280(8), 3489–3502. https://doi.org/10.1007/s00405-023-07965-3
^[6]
Batuk, M. O., Yarali, M., Cinar, B. C., Kocabay, A. P., Bajin, M. D., Sennaroglu, G., & Sennaroglu, L. (2020). Is Early Cochlear Implant Device Activation Safe for All on-the-Ear and off-the-Ear Sound Processors? Audiology and Neurotology, 24(6), 279–284. https://doi.org/10.1159/000503378
^[7]
Bruschke, S., Baumann, U., & Stöver, T. (2021). Long-Term Follow-Up of Early Cochlear Implant Device Activation. Audiology and Neurotology, 26(5), 327–337. https://doi.org/10.1159/000512760
^[8]
Bruschke, S., Zeh, R., Baumann, U., Helbig, S., & Stöver, T. (2024). Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment. HNO, 72(Suppl 2), 67–77. https://doi.org/10.1007/s00106-024-01441-y
^[9]
Chen, J. K.-C., Chuang, A. Y.-C., Sprinzl, G. M., Tung, T.-H., & Li, L. P.-H. (2013). Impedance and Electrically Evoked Compound Action Potential (ECAP) Drop within 24 Hours after Cochlear Implantation. PLoS ONE, 8(8), e71929. https://doi.org/10.1371/journal.pone.0071929
^[10]
Coelho, D. H., Shiao, A.-S., & Li, L. P.-H. (2023). Very early activation of cochlear implants: A review of the literature. Journal of the Chinese Medical Association, 86(1), 7–10. https://doi.org/10.1097/jcma.0000000000000816
^[11]
Günther, S., Baumann, U., & Stöver, T. (2018). Early Fitting in Cochlear Implantation. Otology & Neurotology, 39(4), e250–e256. https://doi.org/10.1097/mao.0000000000001745
^[12]
Hagr, A., Garadat, S. N., Al-Momani, M., Alsabellha, R. M., & Almuhawas, F. A. (2015). Feasibility of one-day activation in cochlear implant recipients. International Journal of Audiology, 54(5), 323–328. https://doi.org/10.3109/14992027.2014.996824
^[13]
Hajr, E. A., & Almuhawas, F. (2019). Financial Benefits of the Early Fitting of a Cochlear Implant Speech Processor: Assessment of the Direct Cost. Cureus, 11(9), e5684. https://doi.org/10.7759/cureus.5684
^[14]
Marsella, P., Scorpecci, A., Pacifico, C., Resca, A., Vallarino, M. V., Ingrosso, A., & Luchenti, S. (2014). Safety and Functional Results of Early Cochlear Implant Switch-On in Children. Otology & Neurotology, 35(2), 277–282. https://doi.org/10.1097/mao.0000000000000259
^[15]
Parker, R., Muzaffar, J., AuD, M. A., & Brassington, W. (2024). Early activation of cochlear implants: a systematic review and narrative synthesis. Cochlear Implants International, 25(1), 81–92. https://doi.org/10.1080/14670100.2023.2290777
^[16]
Selvaratnam, C., & Teagle, H. F. B. (2024). Next day cochlear implant switch-on: the New Zealand experience. Journal of the Royal Society of New Zealand, 55(3), 520–529. https://doi.org/10.1080/03036758.2024.2376057
^[17]
Abdelsamad, Y., Mertens, G., Sweedy, R., Lammers, M. J., Rompaey, V. V., Hagr, A., & Alzhrani, F. (2025). A Model for Evaluating Electrode Impedance Stabilization in Pediatric Cochlear Implant Recipients. The Laryngoscope. https://doi.org/10.1002/lary.70042
^[18]
Soncini, A., Franzini, S., Marco, F. D., Riccardi, P., Bacciu, A., Pasanisi, E., & Lella, F. D. (2024). Early fitting in cochlear implant surgery: preliminary results. European Archives of Oto-Rhino-Laryngology, 281(1), 61–66. https://doi.org/10.1007/s00405-023-08076-9
^[19]
Tawakkul, Q., Almuhawas, F., Alarifi, S., Fatani, N., & Hagr, A. (2025). Bilateral Simultaneous Cochlear Implants: How Early Activation Influences Wearing Hours. Journal of Clinical Medicine, 14(3), 961. https://doi.org/10.3390/jcm14030961

Yassin Abdelsamad, PhD

Yassin Abdelsamad is the Head of Research, Middle East for MED-EL. Having authored and co-authored many publications on hearing implant technology and clinical outcomes, he is a researcher in the hearing implant field, holding a MSc and a PhD in Biomedical Engineering. His work focuses on developing innovative solutions for auditory implants and on bridging the gaps between research and clinical practice.

Early Activation in Cochlear Implantation

Surgical Advancements Have Paved the Way for Early Activation