Remote cochlear implant programming: a systematic review of clinical effectiveness and implementation outcomes

Remote cochlear implant (CI) programming is increasingly used to expand access to follow-up care. This systematic review evaluated the clinical effectiveness and implementation outcomes of synchronous, asynchronous and hybrid remote CI programming in adults and children. PubMed, Embase, Scopus, CINAHL and the Cochrane Library were searched from January 2010 to July 2025. Eligible studies were randomised or observational designs reporting clinical outcomes (speech perception, aided thresholds, impedances, threshold/comfort levels) and/or implementation outcomes (feasibility, satisfaction, technical performance). Two reviewers independently screened, extracted data and assessed risk of bias. Given heterogeneity in design and outcomes, a narrative synthesis was conducted. Eleven studies (n = 356 CI recipients) met inclusion criteria. Across comparator studies, remote programming produced no clinically meaningful differences relative to in-person programming for speech perception (7/7 studies) or aided thresholds (5/5), and programming parameters remained stable (5/5). Feasibility was high, with session-completion rates typically ≥ 85%. CI recipients and clinicians reported favourable satisfaction, citing reduced travel burden and increased flexibility. Key challenges included intermittent connectivity, need for additional preparation or troubleshooting, limited digital literacy among older adults, and caregiver dependency in paediatric sessions. Remote CI programming yields clinical outcomes comparable to in-person programming and is feasible and well accepted across delivery models. However, small sample sizes, limited paediatric evidence, inconsistent technical reporting and a lack of cost-effectiveness data limit confidence in large-scale adoption. Standardised technical endpoints and rigorous multicentre evaluations are required to support scalable and equitable implementation.