Severe hearing loss and deafness have posed significant clinical and social challenges, with management strategies evolving alongside advances in anatomy, technology, and surgical innovation. Early approaches focused on non-surgical amplification, including ear trumpets and later analogue hearing aids, which offered limited benefit for profound sensorineural loss. The twentieth century marked a turning point with improved understanding of cochlear physiology and the role of the auditory nerve, shifting management from sound amplification to neural stimulation. Pioneering experimental work in the 1950s and 1960s laid the foundation for cochlear implantation, despite significant initial scepticism within the medical community. The introduction of multichannel cochlear implants in the late twentieth century represented a major milestone, enabling more precise frequency encoding and dramatically improving speech perception outcomes. Subsequent refinements in surgical technique, electrode design, and signal processing have expanded indications to include children, individuals with residual hearing, and cases of single-sided deafness. More recently, emphasis has shifted toward hearing preservation, minimally traumatic insertion techniques, and hybrid electro-acoustic stimulation. Understanding the evolution of severe hearing loss management provides important context for current debates around outcomes and future directions, including gene therapy, regenerative medicine, and next-generation auditory prostheses.