There are an almost infinite number of ways to evaluate performance with a cochlear implant (CI). This chapter provides an overview of recent developments for performance evaluation, using the current clinical evaluation as a baseline. Clinical evaluation includes identifying candidacy, postoperative monitoring schedules, device programming, and audiologic evaluations. Audiologic evaluation typically comprises the measurement of aided hearing thresholds and speech recognition. Emphasis is placed on tailoring the clinical evaluation for individual patient needs and special populations. However, clinical evaluations are quite limited in their ability to capture the listening difficulties patients experience in everyday life. It is important to assess outcomes, particularly speech perception, in realistic environments. These include modifications of the stimuli or listening experience to have greater ecological validity. Music and sound quality perception are also discussed. Realistic environments are not the real world and still present significant limitations for understanding performance for CI users. A recent line of work evaluates CI performance in the listener’s everyday life using tools such as ecological momentary assessment (EMA) and wearable technology, providing continuous, context-dependent insights. Finally, we explore broader outcomes beyond perception, including healthcare utilization, mental health, and social connectedness, with an emphasis on elderly and pediatric populations. Outcome assessment measures for CI users reflect a growing interest in increasing ecological validity and consideration of the broader patient experience. Future studies will aim to incorporate these new metrics into clinical practice to improve patient satisfaction and performance.