As cochlear implant technology advances and procedures become increasingly common, perioperative considerations warrant thorough discussion. This section addresses the preoperative assessment for cochlear implantation, including audiological and imaging evaluations. It also outlines the indications for implantation across diverse patient groups, such as young children, individuals with inner ear malformations, auditory neuropathy, cerebral white matter lesions, inflammatory middle ear conditions, and candidates for bilateral implantation. Finally, surgical issues are explored, including the selection of surgical side and approach, as well as the considerations of a clean surgery.