Cochlear implantation in post-meningitic or labyrinthitic deafness presents significant challenges due to rapid and unpredictable cochlear ossification, as well as for what previously described in otosclerosis. Also in these patients, preoperative imaging and electrophysiological evaluation are essential for optimal surgical planning and realistic patient counseling. Early intervention is essential, as fibrosis and ossification may progress quickly and are often underestimated by CT alone. MRI is critical for assessing cochlear patency and surgical feasibility. When ossification is severe, subtotal petrosectomy and scala vestibuli insertion may be necessary.