With advances in cochlear implant technology and surgical techniques, this life changing device has become available to patients from whom such intervention would previously have been considered contraindicated. This is particularly true for patients with ossified and congenitally malformed cochleae. However, with improved understanding and anatomy and operative technique, patients can and have benefited from implantation. This session, presented by world experts with decades of experience, will review the radiology, surgery, risks, complications, and post-operative programming issues that are essential to maximizing outcomes. By the end of this session, attendees will feel more comfortable providing cochlear implantation to this challenging but rewarding patient population.