Objective: The aim was to evaluate the development of music and lexical tone perception in Mandarin-speaking adult cochlear implant (CI) users over a period of 1 year. Study Design: Prospective patient series. Setting: Tertiary hospital and research institute. Patients: Twenty five adult CI users, with ages ranging from 19 to 75 years old, participated in a year-long follow-up evaluation. There were also 40 normal hearing adult subjects who participated as a control group to provide the normal value range. Interventions: Musical sounds in cochlear implants (Mu. S. I. C.) test battery was undertaken to evaluate music perception ability. Mandarin Tone Identification in Noise Test (M-TINT) was used to assess lexical tone recognition. The tests for CI users were completed at 1, 3, 6, and 12 months after the CI switch-on. Main Outcomes Measures: Quantitative and statistical analysis of their results from music and tone perception tests. Results: The performance of music perception and tone recognition both demonstrated an overall improvement in outcomes during the entire 1-year follow-up process. The increasing trends were obvious in the early period especially in the first 6 months after switch-on. There was a significant improvement in the melody discrimination (p<0.01), timbre identification (p <0.001), tone recognition in quiet (p<0.0001), and in noise (p<0.0001). Conclusions: Adult Mandarin-speaking CI users show an increasingly improved performance on music and tone perception during the 1-year follow-up. The improvement was the most prominent in the first 6 months of CI use. It is essential to strengthen the rehabilitation training within the first 6 months.