OBJECTIVE: To study the benefits of hearing preservation surgery in cochlear implantation after 2 years. STUDY DESIGN: A retrospective cohort study. SETTING: Performed at a single academic institution between 2008 and 2010 PATIENTS: Thirteen patients (1 bilateral): 43% male and 57% female subjects. Mean age at surgery was 51 years (range, 32-72 yr). Average duration of deafness was 25 years (range, 5-62 yr). INTERVENTION: Hearing preservation cochlear implantation surgery performed with the Med-El FlexEAS electrode. MAIN OUTCOME MEASURES: Pure tone thresholds, speech perception in quiet and noise and quality of life (Abbreviated Profile of Hearing Aid Benefit [APHAB] and Glasgow Hearing Aid Benefit [GHABP Scales] up to and including 2 years after surgery. RESULTS: At the first postoperative audiogram, the hearing preservation rate was 100% (complete (42.9%), partial (50%), and minimal (7.1%)). After 24 months, the breakdown was complete (25%), partial (12.5%), minimal (37.5%) and complete loss (12.5%). There was a trend in improvement in all areas of APHAB) with significant improvements in the background noise and reverberation categories as well as the global scores. The GHABP scores showed high levels of use, benefit, and low levels of residual disease. CONCLUSION: Hearing preservation can be achieved in the short term but deteriorates with time over the medium term at a rate greater than that can be expected with the natural progression of the disease. Patients show benefits in speech outcomes and quality of life regardless of whether hearing preservation was achieved in the medium term. © 2013, Otology & Neurotology, Inc.