There is currently no national (UK) consensus on imaging patients for cochlear implantation. This paper may change that. It has shown increased hearing and quality of life in paediatric cochlear implant (CI) users when the programming has been assisted by knowledge of where the CI electrodes lie. This is obtained with a low dose CT pre and post-implantation (including contrast) to tell exactly the distance of the electrodes to the cochlear modiolus. The simplified surgeon’s version is: the further away the electrode from the modiolus, the greater the current spread to the spiral ganglion cells. Such troublesome electrodes that cross over into a neighbouring electrode’s stimulation area are switched off. This is thought to improve the hearing overall. The authors tested 21 ears in 18 paediatric patients with hearing tests and quality of life questionnaires comparing the experimental image guided programming method to the normal programming method. Almost all tests showed improvement with the experimental image guided programming method, although not all were statistically significantly better. However, 18 out of 21 (86%) ears chose to keep the experimental programme rather than the normal programme after using both, which is telling.