{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:09:40Z","timestamp":1793912980655,"version":"4.8.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"Importance<\/jats:title>Cochlear implants enable improvements in speech perception, but music perception outcomes remain variable. Image-guided cochlear implant programming has emerged as a potential programming strategy for increasing the quality of spectral information delivered through the cochlear implant to improve outcomes.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To perform 2 experiments, the first of which modeled the variance in music perception scores as a function of electrode positioning factors, and the second of which evaluated image-guided cochlear implant programming as a strategy to improve music perception with a cochlear implant.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This single-center, prospective study recruited 50 adult patients with at least 6 months of cochlear implant listening experience and normal cochlear anatomy to participate in experiment 1 from 2013 to 2023. Data analysis was conducted from January to February 2024. Thirty-four of the 50 patients from experiment 1 also completed experiment 2.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Cochlear implant programming using a computed tomography\u2013guided electrode selection strategy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>University of Washington Clinical Assessment of Music score, including subtests of pitch discrimination thresholds, isochronous familiar melody recognition, and timbre recognition.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 50 participants, 20 (40%) were female, and the mean (SD) age was 57.7 (16.4) years. Experiment 1 suggested that better music perception abilities in the 50 participants were associated with patients who were younger and had a postlingual onset of deafness, as well as electrode arrays with a full scala tympani insertion, higher modiolar distance, and shallower insertion depth. Experiment 2 suggested improvements in melody recognition in the 34 participants using the image-guided cochlear implant programming strategy. Patients with apical electrodes that were deactivated were more likely to demonstrate an improvement in their pitch perception thresholds with the image-guided strategy, likely due to the low-frequency stimuli used in the University of Washington Clinical Assessment of Music.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study identified patient and device factors that were associated with music perception outcomes with a cochlear implant. 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