AIMS In patients with residual low frequency hearing undergoing cochlear implantation (CI), preservation of that residual low-frequency hearing has been shown to offer significant benefits for speech perception and sound quality. Use of a shorter electrode yielding a shallow angular insertion depth (AID) may reduce the risk of trauma to more apical regions of the cochlea and thus improve the likelihood of hearing preservation (HP), but in cases where that residual hearing is lost a shallow insertion may be associated with a poorer overall outcome. This conundrum makes electrode selection challenging in cases of HP-CI. In this context imaging-based software that predicts AID can assist in selecting the most appropriate electrode. The aim of this study is to assess the relationship between AID, postoperative hearing outcomes and quality of life (QoL) outcomes in patients undergoing HP-CI. METHODOLOGY A retrospective analysis was conducted on 45 HP-CI recipients with at least 12 months of implant experience and follow-up. Predicted and actual AID were measured using pre- and post-operative imaging. Pure-tone audiogram (PTA) thresholds, speech perception in quiet and noise, and QoL were measured pre- and post-operatively and compared with AID. RESULTS Predicted AID correlated well with actual AID. Increased AID did not compromise HP. While deeper insertions were associated with trends towards improved postoperative speech perception in both quiet and noise, and improved QoL, these relationships did not reach statistical significance. CONCLUSION Imaging-based prediction of AID is accurate and can assist in personalised electrode selection. When soft surgical techniques are used, deeper insertions do not compromise HP and seem to offer functional advantages. These findings support the careful consideration of deeper insertion in HP-CI candidates.