TICI: The Totally Implantable Cochlear Implant — What’s Available, Where, and When
Living with a cochlear implant10 min read· Reviewed
TICI, the totally implantable cochlear implant, has every part under the skin, including the part that picks up sound and a rechargeable battery. Nothing is worn on the ear, so no one can see it. It is often called the invisible cochlear implant, the name MED-EL uses in its launch films. Today one is on sale: MED-EL’s TICI UNICO, in Europe only. Cochlear Ltd and Envoy Medical are testing theirs in trials, and none is FDA-approved.
Envoy Medical said its US Acclaim trial has passed the six-month follow-up milestone and two of the four parts of its FDA application are submitted. Its CEO said an FDA decision is possible by the end of 2027 or in the first part of 2028, which is a company forecast.
The British Cochlear Implant Group issued public guidance: a totally implantable cochlear implant is not routinely available in the UK, including on the NHS, and anyone offered a conventional cochlear implant should not delay.
MED-EL launched TICI UNICO in Europe on September 29, 2026, calling it the first totally implantable cochlear implant on sale. It was granted a CE mark in July 2026 and is not FDA-approved.
Cochlear Ltd announced that both pivotal trials of its investigational totally implantable cochlear implant have finished recruiting: ELEVATE in the US (56 adults) and ENTERPRISE in Australia and France (36 adults).
A standard cochlear implant has two parts. The cochlear implant itself sits under the skin. A sound processor sits on the ear or the side of the head, picks up sound, and passes it through the skin. The processor is the part people see.
A totally implantable cochlear implant moves that outside job under the skin. Each company does it differently. MED-EL’s TICI UNICO puts a small microphone about 6 mm under the skin, above and behind the ear, with a rechargeable battery inside. Cochlear Ltd says its system, still in trials, uses two microphones under the skin to cut down body noise. Envoy Medical’s Acclaim has no microphone at all. A sensor rests on one of the small bones of the middle ear and picks up their movement. Its battery sits in the chest.
One thing that is not the same: fully implantable middle-ear hearing devices, such as Envoy Medical’s Esteem and the Carina. They work on the middle ear and are meant for moderate-to-severe hearing loss. They are not cochlear implants. News stories call both kinds “invisible hearing implants,” so they get mixed up.
Who makes one, and where each stands
Three companies have a totally implantable cochlear implant on sale or in trials. The table gives each one the same columns, with the date we checked and the source. Claims such as “first” or “matches” belong to the company that makes them, and a date that is a forecast is marked as one.
Advanced Bionics has no public program. Cochlear Ltd acquired Oticon Medical’s cochlear implant business in May 2024, and Oticon Medical never made any work of its own on a totally implantable cochlear implant public.
MED-EL’s TICI UNICO is the only TICI on sale. MED-EL launched it in Europe on September 29, 2026.
Every totally implantable cochlear implant, company by company
System
Company
How it picks up sound
Status
Where
What’s next, as the company states it
Checked
TICI UNICO
CompanyMED-EL (Austria)
How it picks up soundA microphone under the skin, above and behind the ear.
StatusOn sale in Europe since September 29, 2026, after a CE mark was granted in July 2026. Not FDA-approved. About 40 people had one by launch day (BCIG).
WhereEurope. MED-EL has not named the countries; HearingTracker reports France among them.
What’s next, as the company states itMED-EL says it is pursuing FDA approval. It has not given a timeline.
How it picks up soundMicrophones under the skin. Cochlear describes two of them, to cut down body noise.
StatusIn two pivotal trials, both fully recruited. Not approved anywhere.
WhereTrials only: 11 sites in the US (ELEVATE); Sydney, Melbourne, Lille and Grenoble (ENTERPRISE).
What’s next, as the company states itThe trial registry estimates main results in April 2027 (ENTERPRISE) and October 2027 (ELEVATE). Cochlear has not given a submission or launch date.
How it picks up soundNo microphone. A sensor on one of the small bones of the middle ear picks up their movement. The battery sits in the chest.
StatusIn a pivotal trial in the US, fully recruited. Investigational, not approved.
WhereTrial only: 7 sites in the US.
What’s next, as the company states itEnvoy Medical says an FDA decision is possible by the end of 2027 or in the first part of 2028. This is a company forecast.
The big change is that there is nothing to wear. That opens up the hours when an outside processor is usually off.
No one can see it. With all three systems, nothing sits on or behind the ear in everyday use.
Water. With nothing outside to get wet, you can hear in the shower. MED-EL lists swimming and snorkeling for TICI UNICO; it has not published a depth rating.
Sleep and all-day hearing. You can hear at night. In one Cochlear Ltd study, some people found it too sensitive for sleep and were given a quieter night setting.
Hearing while charging. MED-EL says you keep hearing while its charger sits over the cochlear implant.
What doesn’t change, or isn’t known yet
A totally implantable cochlear implant trades the outside processor for a battery and a microphone or sensor under the skin. That brings its own trade-offs, and some answers are not in yet.
Daily charging. TICI UNICO runs for up to 40 hours on a charge and usually needs about 1 to 1.5 hours of charging a day (BCIG). Envoy Medical says the Acclaim battery lasts multiple days between charges, a company claim for a system still in trials.
A new battery means surgery. TICI UNICO’s battery cannot be replaced on its own; replacing it takes another operation. MED-EL designed it to last at least 15 years at one charge a day. Envoy Medical says its chest battery can be replaced without removing the whole system.
No direct Bluetooth in fully implanted mode. TICI UNICO has a telecoil, and MED-EL suggests bone-conduction headphones or over-ear headphones placed over the microphone. Envoy Medical says Acclaim lets you wear earbuds.
Body sounds. A microphone under the skin can pick up chewing, footsteps and your own voice. How much that affects daily listening is still an open question (BCIG).
Upgrades. The sound processing sits inside, so it cannot be swapped for a newer model the way an outside processor can. TICI UNICO can also run with some of MED-EL’s outside processors, which MED-EL calls processor mode.
MRI. MED-EL says TICI UNICO can have MRI scans at 1.5 and 3.0 tesla without removing the magnet, under the conditions in its instructions, and the microphone shows on the image. Cochlear Ltd’s earlier research system could not have MRI scans. Envoy Medical has not published MRI conditions.
Price. No company has published one.
Surgery. The operation takes longer than a standard cochlear implant operation: MED-EL adds the microphone, and Envoy Medical adds a chest incision and work in the middle ear.
What the results show so far
MED-EL says TICI UNICO matches its cochlear implants that use an outside microphone. Two studies sit behind that claim. In the first, with 6 adults, speech scores in quiet and in noise were close to the same people’s scores with an outside processor. One person had signs of infection that cleared (Lefebvre et al., 2025). A larger 30-adult study was completed in September 2025. Its results went to a journal, HearingTracker reports, and are not out yet.
Cochlear Ltd’s earlier-generation study of 10 adults found lower word scores in fully implanted mode than with an outside processor, and two of the 10 systems failed and were replaced with conventional cochlear implants (Briggs et al., Ear and Hearing). Cochlear’s pivotal trials have not reported results.
Envoy Medical reports that word scores in its first 10 trial participants rose between surgery and 12 months, with no serious adverse events. These are company figures and not yet peer-reviewed.
Nobody has results over 10 to 20 years. The British Cochlear Implant Group lists battery and cochlear implant lifespan, how often more surgery will be needed, and whether any group does better than with a conventional cochlear implant as open questions.
Who it’s for
Every totally implantable cochlear implant so far is for adults with severe-to-profound hearing loss who already qualify for a cochlear implant. Envoy Medical’s Acclaim also needs a healthy middle ear. None is approved for children, and BCIG says families should not delay a conventional cochlear implant for a child.
It is not a replacement for hearing aids when hearing loss is milder. If your hearing aids still help, this is not the next step. The “invisible” you are looking for may be a hearing aid that sits deep in the ear canal, which is a different product for a different level of hearing.
A cochlear implant team decides who qualifies, using hearing tests. If you are unsure, ask your audiologist whether a cochlear implant evaluation makes sense for you.
Should I wait for one?
The neutral guidance points one way. The British Cochlear Implant Group says that if you have been offered a conventional cochlear implant, you should not delay, and that switching from a working cochlear implant is not normally recommended without a clear medical reason. The coordinating investigator of Cochlear Ltd’s US trial said people who could benefit from a cochlear implant today should not wait for these future systems.
Your own answer depends on your hearing and your history, so take the question to your cochlear implant team or audiologist. Our page on waiting for better cochlear implant technology covers the rest of that decision.
Whatever you choose, you can start practicing now
Hearing aids today, a cochlear implant, a totally implantable one later: each brings sound in. Understanding speech through it is the part people practice. MED-EL’s own steps after activation include follow-up with hearing professionals and listening exercises at home.
People reliably improve on the listening tasks they practice. How far that carries is still being studied. A few minutes a day is enough to start.
If you already have a cochlear implant, nothing here asks you to wait. Listening practice usually starts in the weeks after activation, and our activation timeline walks through them.
If you wear hearing aids, practice with the ones you have now. The free listening check shows where speech gets hard for you, in quiet and in noise.
Sources
Every fact on this page comes from these sources. The date at the top of the Latest box is the day we last re-checked them.
Is the invisible cochlear implant available in the US?
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No. No totally implantable cochlear implant is FDA-approved, so none is available in the United States outside trials. MED-EL says it is pursuing FDA approval for TICI UNICO but has given no timeline. Cochlear Ltd and Envoy Medical have finished recruiting their US pivotal trials, and Envoy Medical says an FDA decision on its Acclaim is possible by the end of 2027 or in the first part of 2028, which is a company forecast.
Is a TICI cochlear implant available in the UK, Canada or Australia?
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Not routinely. In the UK, MED-EL’s TICI UNICO has a CE mark but is not routinely available, including on the NHS, and the NHS funding bodies have not decided (British Cochlear Implant Group, October 3, 2026). We found no approval in Canada or Australia. In Australia, Cochlear Ltd’s ENTERPRISE trial runs in Sydney and Melbourne and has finished recruiting.
How much does a TICI cochlear implant cost?
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No price has been published. MED-EL has not announced one for TICI UNICO, and HearingTracker reports that reimbursement is still being pursued in many countries. A proposal for a German hospital procedure code says a totally implantable cochlear implant costs far more than a conventional one. In the US no system is approved, so insurance coverage does not apply yet.
How long does the battery last in a totally implantable cochlear implant?
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MED-EL’s TICI UNICO runs up to 40 hours on a charge and usually needs about 1 to 1.5 hours of charging a day, and you keep hearing while it charges. MED-EL designed the battery to last at least 15 years at one charge a day. It cannot be replaced on its own: a new battery means another operation. Envoy Medical says its Acclaim battery, which sits in the chest, lasts multiple days and can be replaced without removing the whole system.
Can you swim with a TICI cochlear implant?
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MED-EL lists swimming and snorkeling for TICI UNICO, and with nothing worn outside there is nothing to take off or keep dry. MED-EL has not published a depth rating, so ask your cochlear implant team before diving or other deep water.
Can I switch from my current cochlear implant to a totally implantable one?
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Switching would mean surgery to remove your current cochlear implant and place a new one. The British Cochlear Implant Group says switching from a working cochlear implant is not normally recommended without a clear medical reason. Newer outside processors remain the usual upgrade, and your cochlear implant team can tell you which ones fit yours.
Is a TICI cochlear implant for hearing aid users?
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Only for hearing aid users whose hearing loss is severe to profound and who qualify for a cochlear implant. It does not replace hearing aids for milder hearing loss. If your hearing aids still help, you can practice listening with them now, and an audiologist can tell you whether a cochlear implant evaluation makes sense.
Who makes totally implantable cochlear implants?
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Three companies make one. MED-EL’s TICI UNICO has been on sale in Europe since September 29, 2026. Cochlear Ltd’s system is in pivotal trials in the US, Australia and France. Envoy Medical’s Acclaim is in a pivotal trial in the US. Advanced Bionics has no public program.
Hearing devices change. Listening practice works with whichever one you have. The free listening check shows where speech gets hard for you, then short daily sessions practice exactly that.
