Purpose <p>The present study aims to provide a comprehensive analysis of primary cochlear implant (CI) cases performed in a centre over ten years, as well as cases referred from other centres for the management of complications of cochlear implantation. The study also aims to compare outcomes of bilateral simultaneous and sequential cochlear implantation.</p> Methods <p>Cumulative surgical, anesthesia, and hospital stay for bilateral simultaneous and sequential CI were investigated, and complications of CI surgery were analyzed in patients who underwent CI surgery at our centre or were referred for complication management from other centres between January 2015 and April 2025.</p> Results <p>821 patients with 1502 ears (428 males (51.1%); 393 females (47.9%); age 1–74 years) who received CI in our centre were included. Among 821 patients, a total of 140 patients received unilateral CI, while 147 underwent bilateral sequential implantation, and 534 had bilateral simultaneous implantation. Simultaneous bilateral CI demonstrated a significant reduction in cumulative anesthesia time, surgical time, and hospitalization stay (<i>p</i> &lt; 0.001 for all) compared to sequential CI, with no significant difference in complication rates. Complications were observed in 10.7% of patients (<i>n</i> = 162), including 6% (<i>n</i> = 91) minor and 4.7% (<i>n</i> = 71) major complications. The ten-year overall revision surgery necessity of CI received patients was found to be 5.9% (<i>n</i> = 90).</p> Conclusion <p>In suitable patients, bilateral simultaneous CI is a more advantageous option than sequential bilateral CI, with reduced cumulative surgical and anesthesia time and hospital stays, without differences in complication rates.</p>