There are currently several trials for cochlear implantation (CI) in single-sided deafness (SSD) being undertaken to answer some of the questions this paper from New York raises. Who is best suited to receive one? What are their outcomes and how best can this be tested? The group have implanted 12 adult patients and four paediatric patients and assessed many more in making their conclusions. It is important to note that there are not sufficiently sensitive tests to demonstrate the subjective benefits that patients receive from CI in SSD in terms of improvement of localisation and speech understanding in difficult listening situations (in real-life situations). The study did not find any differences in localisation pre and post implant. Certain conditions the group state are absolute indications for a CI in SSD: 1) late stage Ménières disease. 2) “At risk” only-hearing ear, e.g. with an acoustic neuroma, implant the non-tumour deaf ear as a back-up in case the better hearing ear is deafened from the tumour. This also allays patient fears of turning completely deaf. 3) Paediatric progressive hearing loss, e.g. enlarged vestibular aqueduct. This is to prevent the untoward sequelae of long duration of deafness and total auditory deprivation. Current studies will inform us of the effect length of deafness has on CI outcomes in SSD and if there is a cut-off point or age. Overall a thought-provoking paper highlighting the challenges clinicians and patients face when deciding on a CI for SSD.