Cochlear Implantation After Temporal Bone Fracture: A Systematic Review of Preoperative Predictors and Timing

<b>Background/Objectives</b>: Cochlear implants (CIs) constitute a viable method for auditory rehabilitation in patients with profound sensorineural hearing loss after temporal bone fractures (TBFs). These patients comprise a challenging population due to the anatomical deformity and neural injury. <b>Methods</b>: By performing this systematic review, we attempted to evaluate the viability of CIs in the context of TBF. The literature search, across Pubmed/MEDLINE, Scopus and Google Scholar, was performed under the PRISMA guidelines. The selected time period was from December 1995 to September 2025. The final analysis included 11 manuscripts. The majority of the studies were retrospective case series with a moderate risk of bias. <b>Results</b>: The primary outcome was postoperative auditory function, evaluated with speech perception tasks and aided sound-field pure-tone audiometry. The secondary outcomes were the report of radiological and electrophysiologic prognosticators of implants' viability, timing of surgery, procedural feasibility and complications. Across the studies, CIs conferred meaningful auditory benefit when the cochlear nerve was intact. High-Resolution Computed Tomography (CT) was utilized for TBF classification and cochlear patency, whereas Magnetic Resonance Imaging (MRI) and a promontory test were crucial for the assessment of neural integrity. Prompt placement, optimally within 12 months after trauma, was related to improved outcomes by limiting cochlear fibrosis and ossification. Despite patients' impedance fluctuation, restricted speech perception in noise and frequent abnormal facial nerve excitation, the overall audiologic and speech discrimination results are comparable to non-trauma recipients. <b>Conclusions</b>: A CI appears to be the choice of treatment over auditory brainstem implants, as long as the cochlear nerve remains intact. Rapid implantation in well-selected patients coupled with ordinal mapping and follow-up can restore dysfunctional hearing and improve patients' quality of life.