Telecommunication is limited or even impossible for more than one-thirds of all cochlear implant (CI) users.We sought therefore to study the impact of voice quality on speech perception with voice over Internet protocol (VoIP) under real and adverse network conditions.Telephone speech perception was assessed in 19 CI users (15-69 years, average 42 years), using the German HSM (Hochmair-Schulz-Moser) sentence test comparing Skype and conventional telephone (public switched telephone networks, PSTN) transmission using a personal computer (PC) and a digital enhanced cordless telecommunications (DECT) telephone dual device. Five different Internet transmission quality modes and four accessories (PC speakers, headphones, 3.5 mm jack audio cable, and induction loop) were compared. As a secondary outcome, the subjective perceived voice quality was assessed using the mean opinion score (MOS).Speech telephone perception was significantly better (median 91.6%, P<.001) with Skype compared with PSTN (median 42.5%) under optimal conditions. Skype calls under adverse network conditions (data packet loss > 15%) were not superior to conventional telephony. In addition, there were no significant differences between the tested accessories (P>.05) using a PC. Coupling a Skype DECT phone device with an audio cable to the CI, however, resulted in higher speech perception (median 65%) and subjective MOS scores (3.2) than using PSTN (median 7.5%, P<.001).Skype calls significantly improve speech perception for CI users compared with conventional telephony under real network conditions. Listening accessories do not further improve listening experience. Current Skype DECT telephone devices do not fully offer technical advantages in voice quality.