The cochlear implant surgery is currently an only option to treat the patients with bilateral severe or profound hearing loss. The cost of cochlear implant surgery in Thailand is around 1 million baht per case and it needs the experience surgeon to perform this operation. The success of the operation depends on many factors such as hearing level before surgery, the cause of hearing loss, duration of hearing loss, experience of using hearing aids, and readiness to rehabilitation. The Royal College of Otolaryngology – Head and Neck Surgery of Thailand had issued the guideline for cochlear implantation and suggested the need of cochlear implants registry to collect the operation results prospectively including hearing and speech levels, costs, and quality of life of the patients after surgery. This report collected the cochlear implantation data from 16 May 2016 to 29 June 2022. 1. The status of Cochlear Implants Registry in Thailand. The phase 1 to phase 3 of this study start from 16 May 2016 to 29 June 2022. There were 580 patients who underwent cochlear implant surgery. There were 289 males (52 percent), 268 females (48 percent), and 23 no gender data (4 percent). The mean age was 27. 43 ± 24. 65 years. Most patients were adults (50 percent). In children, the most common age group was 2-4 years old (15 percent). The most common cause of hearing loss was congenital (45.36 percent) and mostly idiopathic (38 percent). While the most common cause of acquire hearing loss is meningitis (18.56 percent). The mean hearing level before surgery was 95.53 dB (profound hearing loss). The mean CAP score before surgery was 0 (no awareness of environmental sound). 2. The results of cochlear implantation in Thailand After surgery, the mean hearing level at 500-4,000 Hz was significantly improved at first month post operation. The mean pure-tone hearing level was improved from profound to mild hearing loss at third month after surgery (p < 0.001). The speech hearing level was also improved from profound to mild hearing loss at third month after surgery (p < 0. 001). The speech discrimination score was improved to the level that can communicate that sixth month after surgery. The complication after surgery were found in 7.51 percent of patients. The most common events were facial palsy, vertigo, and extrusion of electrode. 3. Pre-authorization System The National Health Security Office of Thailand announced the cochlear implantation benefit for the newborn and young children since 1 January 2021 who had severe to profound hearing loss to improve the speech and language development of this group of patients. Pre-authorization (PA) for cochlear implantation surgery was developed by this project to ensure the benefit of patients including review pre-surgical condition to ensure the fitness to undergo cochlear implant surgery, review that the surgeon is adequately trained and review that the hospital has adequate staffs and instruments for surgery and rehabilitation after the surgery. The National Health Security Office of Thailand agreed to use this project’s preauthorization system as announcement NHSO 2.57/vor.2685 on 3 May 2021 before performing the cochlear implantation under the National Health Security Office of Thailand benefit.