Aims: The primary objective of this systematic review is to examine the effect of cochlear implant (CI) insertion on the functional balance of adults with sensorineural hearing loss. Secondary outcomes were to assess how objective balance assessment correlates with patients’ symptoms of dizziness, and vestibular function tests. Methodology: A systematic literature search was carried out on 18th September 2025, in Medline All, Web of Science, CINAHL, and Embase data bases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion/exclusion criteria: •Inclusion: Prospective cohort studies, written in English, with adults (>18-years-old) with hearing loss managed by cochlear implantation (uni- and/or bilateral). Functional balance assessment carried out using objective clinical assessment tools for balance and/or gait pre- and post-CI insertion. •Exclusion: Reviews, meta-analyses, opinion articles and commentaries. Assessment of vestibular function or lab-based balance assessment only. Results: From a total of 607 records identified, 3 studies met the inclusion criteria. There was heterogeneity in methods of assessment and reporting of outcomes. Balance was assessed using functional gait assessment, timed up-and-go, and Rombergs on foam. Short-term follow-up showed decline in postural balance, correlating to increased risk of falls. Longer-term follow-up showed some improvement in dynamic balance, and possible reduction in falls risk, however these results were not statistically significant. There was no significant difference found between test results with CI on or off. Conclusion: There is limited evidence in the literature on the impact of cochlear implantation on functional balance, and how this correlates to vestibular function and patients’ subjective symptoms of dizziness. There may be short-term decline in balance following CI, leading to increased risk of falls, which may improve in the longer term.