A new paradigm of hearing loss and preservation with cochlear implants: Learnings from fundamental studies and clinical research

•Major outcomes and learnings of the Cochlear-sponsored collaborative Residual Hearing Research Program are described.•Novel tools and systematic approach developed and applied to identify causative factors and investigate the underlying mechanisms of acoustic hearing loss following cochlear implant surgery and device use.•Findings support peri-operative interventions as the most opportune to manage intracochlear trauma, inflammation, and the FBR to improve the likelihood of preservation and maintenance of cochlear health. In 2010 Cochlear initiated a coordinated preclinical research program to identify the factors and underlying mechanisms of acoustic hearing loss following cochlear implantation and device use. At its inception the program was structured around several major hypotheses implicated in the loss of acoustic hearing. The understanding of causes evolved over the course of the program, leading to an increased appreciation of the role of the biological response in post-implant hearing loss. A systematic approach was developed which mapped the cochlear implant journey along a timeline that considers all events in an individual's hearing history. By evaluating the available data in this context, rather than by discrete hypothesis testing, causative and associated factors may be more readily detected. This approach presents opportunities for more effective research management and may aid in identifying new prospects for intervention. Many of the outcomes of the research program apply beyond preservation of acoustic hearing to factors important to overall cochlear health and considerations for future therapies.