By Brooke Barry, Nicole T. Jiam, M.D., and Archana Podury, M.D.
Cochlear implants (CIs) are one of the most successful neural prostheses in modern medicine. Since their invention, they have dramatically improved communication for those with severe to profound hearing loss.
Yet while CIs excel at restoring speech perception, they still fall short in reproducing the complex forms of sound that make up the auditory environment, such as music, which represents the pinnacle of hearing.
A new review study has suggestions for improving cochlear implant users’ experience of music. Credit: Alex Mussomeli
The hearing organ, the cochlea, is lined with small hair cells that are activated in response to specific pitches. These cells are organized tonotopically, with cells responsive to higher pitches located towards the base of the cochlea, and to lower pitches towards the apex. When stimulated, hair cells send electrical signals through the auditory nerve to the brain’s auditory cortex, allowing us to interpret sound.
When these hair cells are damaged, hearing becomes distorted or lost. CIs bypass these damaged cells by directly stimulating the auditory nerve via an electrode array inserted into the cochlea.
CI users generally do well with speech in quiet settings. However, perceiving complex sounds such as music remain major challenges. This is because current CI technology struggles to accurately reproduce finer sound details such as pitch and timbre. For many CI users, music sounds inexpressive or even unpleasant.
Music perception matters as it is an essential part of human life. Music supports emotional well-being, community, and has been shown to provide benefits for certain medical conditions that are affordable and accessible.
Furthermore, as music is one of the most complex forms of sound in our auditory environment, it is an ideal benchmark for evaluating CI performance. For CI users, the ability to appreciate music offers an important connection to broader social life and an avenue to improve overall health.
Our review study published in Brain Sciences in May 2025 proposes a shift in how we may evaluate and provide care to CI users: by adjusting our current speech-focused performance metrics to incorporate music perception, and by integrating personalized medicine into CI. This approach can be broken down into four key stages: hearing loss prevention, pre-implantation, surgery, and post-implantation care.
In prevention, personalized care includes technologies that allow patients to monitor and adjust noise levels as well as proactive hearing screenings in primary care settings.
Pre-implantation strategies include reducing stigma and improving education around hearing loss as well as using machine learning tools to more effectively identify CI candidates.
During surgery, approaches personalized to each patient’s anatomy, such as anatomy-based fitting of electrodes, can allow for more precise positioning, access to a broader frequency range, and reduced pitch mismatch.
After implantation, individualizing pitch maps using imaging, enhancing signal processing algorithms, and incorporating music-focused programs into CI rehabilitation can further improve sound quality and enjoyment.
CIs have come a long way, but restoring speech perception is just the first step. With a greater focus on individualized care and music-based outcomes, we can work toward a future where CI users experience sound in all its richness—not just through perceiving speech, but by truly listening to and connecting with the auditory world around them.
Study coauthor Brooke Barry (left, top) is the junior specialist in the Sound and Music Perception Lab at the University of California, San Francisco (UCSF), working under Nicole T. Jiam, M.D. Barry received a B.A. in music performance and a B.S. in physiological science from the University of California, Los Angeles.
Study coauthor Nicole T. Jiam, M.D. (left, center), is a neurotology and skull base surgeon at UCSF. A 2024–2025 Emerging Research Grants scientist, Jiam is the recipient of an Elizabeth M. Keithley, Ph.D. Early Stage Investigator Award, generously supported in part by Susan and Steve Kaufman.
Study coauthor Archana Podury, M.D. (left, bottom), is currently an otolaryngology–head and neck surgery resident at the University of California, San Diego. She received a B.A. in neurobiology & behavior from Cornell University, after which she received a M.D. from Harvard Medical School in the Harvard-MIT Health Sciences and Technology Program.
Jiam also co-presented on the topic of music and cochlear implants at the 2024 International Fall Cochlear Implant Meeting, as published in Otology & Neurotology Open in June 2025.
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Our review published in Brain Sciences in May 2025 proposes a shift in how we may evaluate and provide care to CI users: by adjusting our current speech-focused performance metrics to incorporate music perception, and by integrating personalized medicine into CI.