Purpose <p>Finite element (FE) modeling is a powerful computational tool used to simulate complex systems. In recent years, a considerable number of publications have reported the use of the FE method to study the cochlea and cochlear implants (CIs). However, large variability exists in the development of cochlear FE models.</p> Objective <p>To present a systematic review of FE macromechanical modeling of the cochlea, identifying the techniques used and associated limitations across existing studies.</p> Method <p>A literature search was conducted through PubMed, Scopus, and IEEE-Xplore databases of studies using FE modeling to study the cochlea and CIs. Studies published between January 1, 1985, and February 15, 2025, were assessed using the Covidence systematic review platform (<a href="http://www.covidence.org">www.covidence.org</a>).</p> Results <p>A total of 1209 publications were found through the initial database search. After screening and full-text review, 77 studies met the inclusion criteria. Two primary modeling strategies were identified: simplified uncoiled model or realistic coiled model, including either two chambers or three chambers by incorporating the scala media and Reissner’s membrane. Substantial variation was observed in material assumptions, particularly regarding basilar membrane stiffness. Validation was inconsistent; most studies compared model outputs with established experimental data such as Greenwood’s frequency–place function, while some used computational comparisons or limited clinical data.</p> Conclusion <p>FE cochlear models provide valuable insight into cochlear mechanics yet remain constrained by simplified geometries, non-standardized material parameters, and insufficient experimental validation. Future work should integrate imaging and functional data and establish standardized modeling, material properties, and validation frameworks to improve physiological and clinical relevance.</p>