Cochlear Implants
Nexa was a finalist for the 2026 Prix Galien USA award for Best Medical Technology, and it made TIME's Best Inventions of 2026 list. Finalist is not winner. The 2026 winner in that category was Guardant Health's Shield. The honors give us a reason to explain what "smart implant" means and what it does not.
California Hearing Center does cochlear implant candidacy evaluations and post-activation mapping in San Mateo and San Carlos. An ENT surgeon performs the surgery. Everything about the device on this page is Cochlear's own description unless we say otherwise. See also our main page on cochlear implant evaluation and programming.
At a glance
- Cochlear says Nexa is its first smart implant system, with upgradeable firmware and onboard memory in the implant. Cochlear says its first firmware upgrade has already been delivered.
- The FDA decision on Nexa was July 3, 2025, as PMA supplement P970051/S225. It is approved and available in the U.S.
- Nexa was a Prix Galien USA 2026 finalist and is on TIME's 2026 Best Inventions list. It was not the Prix Galien winner.
- Two fully implantable implants are not available in the U.S.: Envoy Medical's Acclaim is investigational, and MED-EL's TICI is not approved here.
- A candidacy evaluation, not a news story, decides whether an implant is right for you.
What is the Nucleus Nexa system?
Nexa is Cochlear's newest implant platform. Cochlear describes it as its first smart cochlear implant system. The implanted part carries its own firmware and internal memory and manages its own power. In the past, an implant was fixed at the time of surgery for life, and a new sound-processing feature usually meant a new external processor at best. Cochlear says Nexa can receive firmware upgrades and that the first upgrade has already been delivered. Cochlear has not published the implant's memory capacity, so we do not give a number. The company's Nexa page lists the features that upgrade added.
What does an upgradeable implant mean for you?
In plain terms, new capability can arrive as software, without a second operation. That is a real change for people choosing an implant today. It does not promise any particular feature or result, and it does not change how well any implant works for you. The upgradeable parts live in the implant, so the feature belongs to Nexa implants. We do not tell anyone with an earlier Nucleus implant that it can be upgraded this way. If you have an earlier implant, ask your implant team what applies to your device, and see our page on the Integro processor for a different example of what a processor upgrade can and cannot do.
Who is Nexa for?
Cochlear's labeling covers a wide range of ages and hearing losses. It starts at 9 months of age, and it includes moderate-to-profound sensorineural loss, with single-sided deafness criteria set out in the instructions for use. We summarize it loosely here on purpose. Cochlear's labeling holds the full criteria, and your audiologist confirms candidacy at your evaluation. Insurance policies also set their own criteria. Our cochlear implant page explains the 60/60 referral guideline, one widely used referral signal.
Which sound processors work with Nexa?
Two external processors work with the Nexa implant. The Nucleus 8 Nexa sits behind the ear, and the Kanso 3 Nexa is worn off the ear. Cochlear claims up to about 17 hours of battery for the Nucleus 8 Nexa, depending on configuration. Cochlear describes Nexa as Auracast-ready, with caveats. A firmware update and adoption by other companies are both required, so Nexa does not yet do everything the word Auracast suggests. See whether your hearing technology supports Auracast.
Is Nexa the first and only smart implant?
Cochlear and TIME describe Nexa as the world's first smart cochlear implant system. That claim is contested. MED-EL's Canadian site now uses language about upgradeable firmware and built-in memory for its own implant. We do not decide who was first. We use Cochlear's words as Cochlear's and keep our comparison to what is available and approved.
What is available now, and what is still coming?
This is the table that most often saves patients from a wrong turn. A news story about a new implant does not mean you can get one. We date every status.
| System | U.S. status | Notes |
|---|---|---|
| Cochlear Nucleus Nexa | FDA-approved and available | PMA supplement P970051/S225, decision July 3, 2025. Upgradeable firmware, per Cochlear |
| Advanced Bionics Marvel CI platform | Approved and available | Naída CI Marvel and Sky CI Marvel processors with the Ultra 3D implant, approved 2020 to 2021. Not an upgradeable-firmware implant of the Nexa type |
| MED-EL current line | Approved and available | Includes the SONNET 3 processor and FLEX electrode arrays in several lengths |
| MED-EL TICI (UNICO), fully implantable | Not approved or available in the U.S. | CE-marked, with first commercial implants in Europe in October 2026 |
| Envoy Medical Acclaim, fully implantable | Investigational. Not approved or available in the U.S. | Module 1 of its PMA was submitted June 30, 2026 and module 2 on October 12, 2026. Envoy targets the final clinical module for the end of Q2 2027, per Envoy |
Did Nexa win a Prix Galien?
No. Nexa was a finalist for Best Medical Technology at the 2026 Prix Galien USA awards, held October 29, 2026, at the American Museum of Natural History. Guardant Health's Shield won that category. Cochlear won a Prix Galien in 2024 for a different product, the Osia system. TIME separately included Nexa in its 2026 Best Inventions list. Awards honor innovation. They do not measure how an implant will work for you.
What does a candidacy evaluation involve here?
We start with your hearing history and a full hearing test. We then check how you hear with hearing aids that have been verified, because a poorly fitted hearing aid can look like a hearing aid that has failed. We test speech understanding, talk through your goals and expectations, and explain what the process involves. If an implant is worth considering, an ENT surgeon performs the surgery. After activation, we do the mapping, which is the programming of the implant. You can read more, including the 60/60 referral guideline, on our cochlear implant page.
What to do next
Book a cochlear implant candidacy evaluation at our San Mateo office or our San Carlos office, or call 650-342-9449. To see how the future devices stand, read our report on TICI UNICO versus Envoy Acclaim and our page on the TICI UNICO. If hearing aids are no longer giving you clear words, read what changed in the 2026 guidelines for severe and profound hearing loss.
Last updated and sources
Last updated November 2, 2026. What changed: this is the first version. We will re-check every status line each quarter and update the table when the FDA, Cochlear, MED-EL, Advanced Bionics or Envoy Medical report a change. Sources: Cochlear: Nucleus Nexa System, Cochlear media release on the TIME Best Inventions honor, Medical Design and Outsourcing: most innovative medical devices, 2026 Prix Galien, FDA PMA supplement P970051/S225, and the Advanced Bionics, MED-EL and Envoy Medical product and investor pages.
Medical information notice
This page offers general information. It is not medical advice, and it does not diagnose or recommend treatment. Cochlear implant candidacy is decided at an evaluation, and outcomes vary. Sudden hearing loss, hearing loss in one ear, ear pain or dizziness need prompt medical care. Call 650-342-9449 to book at our San Mateo office, 88 N. San Mateo Drive, or our San Carlos office, 1008 Laurel Street.
Frequently asked questions
Questions patients ask us
Can a cochlear implant be upgraded without surgery?
Cochlear says the Nexa implant carries upgradeable firmware, so new capability can arrive by software update. Cochlear says the first upgrade has been delivered. This describes the Nexa implant, not earlier implants.
Is Cochlear Nucleus Nexa FDA-approved?
Yes. The FDA decided on PMA supplement P970051/S225 on July 3, 2025, and Nexa is available in the U.S.
Did Nexa win the Prix Galien?
No. Nexa was a finalist for the 2026 Prix Galien USA Best Medical Technology award. Guardant Health's Shield won it.
Is a fully implantable cochlear implant available yet?
Not in the U.S. Envoy Medical's Acclaim is investigational, and MED-EL's TICI is not approved here. See our report on both devices.
Can I get Nexa if I already have a Nucleus implant?
The upgradeable design is part of the Nexa implant. We do not promise that an earlier implant can be upgraded this way. Ask your implant team what applies to your device.
Does California Hearing Center do the surgery?
No. We do candidacy evaluations and post-activation mapping. An ENT surgeon performs the surgery.