OBJECTIVES: Cochlear implants (CI) are electronic devices introduced surgically into the inner ear. This is the only medical treatment for profound total deafness. CI is particularly useful in children because they can have an impact on the children education. The aim of this study is to assess the cost and the educational impact of CI in French implanted children over a four year period METHODS: 268 profoundly deaf children were recruited and implanted between September 2002 and December 2004 in 16 specialized French hospitals. The educational impact was assessed in children aged less than 2 years and aged over 2 years using the educational rate evolution and the type of integrated school 4 years after implantation. This prospective economic analysis adopted the health care payer’s perspective and took into account direct medical, direct non-medical and indirect costs RESULTS: Two hundred and three implanted children were included in the study and followed during four years. The rate of school children implanted later (i.e. after 2 years) goes from 71,4% to 95,3% four year after implantation and goes from 28,6% to 87,5% for children implanted earlier (i.e. before 2 years). If children are implanted earlier (i.e. < 2 years), they are more likely to integrate ordinary classroom four years after implantation (69.0%) than if children were implanted later (46,9%). The mean total costs over one year period were €34,703 (+/- 5,231). The preoperative, implantation and one year follow-up mean costs were €1,304 (+/- 1,014), €24,285 (+/- 1,150) and €9,115 (+/-4,694) respectively. Ambulatory care was the costs driver in preoperative and one year follow up costs (42,0% and 66,6% respectively), while in implantation costs the driver was implant cost (90,0%). The cost of the next three year follow-up is being processed CONCLUSIONS: CI is an expensive medical treatment but they have a positive impact on children education.