ObjectiveTo review studies evaluating clinically implemented image-guided cochlear implant programing (IGCIP) and to determine its effect on cochlear implant (CI) performance.Data SourcesPubMed, EMBASE, and Google Scholar were searched for English language publications from inception to August 1, 2021.Study SelectionIncluded studies prospectively compared intraindividual CI performance between an image-guided experimental map and a patient's preferred traditional map. Non-English studies, cadaveric studies, and studies where imaging did not directly inform programming were excluded.Data ExtractionSeven studies were identified for review, and five reported comparable components of audiological testing and follow-up times appropriate for meta-analysis. Demographic, speech, spectral modulation, pitch accuracy, and quality-of-life survey data were collected. Aggregate data were used when individual data were unavailable.Data SynthesisAudiological test outcomes were evaluated as standardized mean change (95% confidence interval) using random-effects meta-analysis with raw score standardization. Improvements in speech and quality-of-life measures using the IGCIP map demonstrated nominal effect sizes: consonant–nucleus–consonant words, 0.15 (−0.12 to 0.42); AzBio quiet, 0.09 (−0.05 to 0.22); AzBio +10 dB signal-noise ratio, 0.14 (−0.01 to 0.30); Bamford–Kowel–Bench sentence in noise, −0.11 (−0.35 to 0.12); Abbreviated Profile of Hearing Aid Benefit, −0.14 (−0.28 to 0.00); and Speech Spatial and Qualities of Hearing Scale, 0.13 (−0.02 to 0.28). Nevertheless, 79% of patients allowed to keep their IGCIP map opted for continued use after the investigational period.ConclusionIGCIP has potential to precisely guide CI programming. Nominal effect sizes for objective outcome measures fail to reflect subjective benefits fully given discordance with the percentage of patients who prefer to maintain their IGCIP map.