Patient barriers to adult cochlear implantation: a systematic review of literature

Cochlear implantation among adults remains disproportionately low compared with paediatric populations. This systematic review identified and synthesised the patient-related barriers that limit access to and uptake of cochlear implantation in adults. A systematic search of English-language literature was performed from January 1st, 1990, to November 21st, 2025, using PubMed, MEDLINE, CINAHL, EMBASE and PsycINFO databases. Twenty-eight studies met the inclusion criteria, and findings were synthesised descriptively. This systematic review was registered with PROSPERO (Registration number: CRD42024540401). Ninety-five patient-related barriers were identified and grouped into four overarching themes: (1) uncertainties, fears, and beliefs, (2) knowledge and professional guidance, (3) system and organisational factors, and (4) psychosocial and practical support. Common barriers included fear of surgery and residual hearing loss, limited professional guidance, perceived financial burden, fragmented funding systems, and inadequate psychosocial support. Adult cochlear implantation is limited by multifactorial barriers spanning psychological, informational, systemic, and social domains. Addressing these challenges requires coordinated strategies, including improved CI-specific education for healthcare professionals, clearer communication of funding options, standardised adult hearing screening programs, and integration of telehealth to reduce logistical burdens. Targeted interventions addressing fear, misinformation, and psychosocial support are essential to improve timely access and uptake of cochlear implantation.