Impact of Preimplant Musicianship on Outcomes Following Cochlear Implantation: A Scoping Review

BACKGROUND: Enhanced auditory processing and cognitive flexibility associated with musical training have led to the proposition of preimplant musicianship, defined as musical training and/or experience before cochlear implantation (CI), as a potential modifier of outcomes following CI. While CI is a widely used intervention for severe-to-profound sensorineural hearing loss, substantial interindividual variability in CI outcomes persists. The relationship between preimplant musicianship and postimplant performance remains incompletely understood and has not been systematically synthesized. The main objective of this review was to assess the relationship between preimplant musicianship and postimplant outcomes in adult CI users. METHODS: A scoping review of adult CI literature published from 2000 to 2025 was conducted using PubMed, Embase, and Scopus. Studies were included if they assessed participants' level of preimplant musicianship and explicitly linked it to postimplant outcomes. After abstract and full-text screening, 47 studies met the inclusion criteria. Extracted data included study characteristics, measures of musicianship, outcome domains (music perception, enjoyment, and speech perception), and key findings. RESULTS: Preimplant musicianship was most often assessed via self-report (eg, years of lessons, ensemble experience), with substantial heterogeneity in methodology. While a minority of studies demonstrated modest associations between musicianship and music perception (eg, melody recognition, instrument detection), these effects were generally task-specific and small in magnitude. Preimplant musicianship did not consistently predict speech outcomes, subjective enjoyment, or quality of life postimplantation. In contrast, ongoing postimplant music engagement was more strongly associated with enjoyment and, to a lesser extent, perceptual outcomes. A "musicianship paradox" emerged in some studies, where individuals with extensive training reported greater dissatisfaction due to higher expectations. CONCLUSIONS: Across 47 studies, preimplant musicianship was not consistently associated with superior post-CI outcomes. While some evidence suggests modest benefits in specific perceptual domains, these findings were not broadly generalizable. Future research should prioritize prospective designs with standardized assessments of musicianship and examine how preimplant musicianship interacts with rehabilitation strategies and CI programming approaches.