This paper describes the development of adult cochlear implantation in Birmingham over its first six years, from 1990 to 1996. During this time 366 patients were referred to the implant programme, female referrals outnumbered males 1.2:1. Eight per cent of referrals were over the age of 70. The annual rate of referral suggests a fairly steady demand for the service. Approximately one third of patients referred each year were subsequently implanted. The centre is currently performing an average of 2 implants per month. The average time from referral to implant is approximately 19 months. The greatest number of referrals originated from health districts closest to the implant centre. An examination of patients implanted suggested an imbalance in the uptake of the service amongst the different socio-economic groups.