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Updated: Jun 11, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Factors Influencing Pediatric Cochlear Implant Use
Erika B Gagnon1, Erin M Thompson1, Lisa R Park1
1Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill.
Insights
Pediatric cochlear implant device use, measured by hearing hours percentage (HHP), is crucial for spoken language outcomes. Factors like intellectual development delay (IDD) or autism spectrum disorder (ASD) negatively impact HHP, while age positively influences it.
Area of Science:
- Pediatric audiology
- Speech-language pathology
- Biomedical engineering
Background:
- Cochlear implant device use, quantified by hearing hours percentage (HHP), significantly impacts pediatric spoken language development.
- Understanding factors influencing HHP is essential for optimizing auditory access and intervention strategies.
Purpose of the Study:
- To identify key variables that predict hearing hours percentage (HHP) in pediatric cochlear implant recipients.
- To inform clinical interventions aimed at reducing barriers and enhancing HHP.
Main Methods:
- A retrospective chart review of 958 pediatric subjects (2019-2023) using data logging.
- A mixed-effects model analyzed HHP influenced by listener type, insurance, age at surgery, presence of ASD/IDD, and year of data collection.
Main Results:
- Mean HHP was 64.2%, below the recommended 80% goal.
- Lower HHP was associated with intellectual development delay (IDD) or autism spectrum disorder (ASD), Medicaid insurance, and older age at surgery.
- HHP increased with age, and COVID-19 pandemic years showed reduced HHP across all listener types.
Conclusions:
- Pediatric cochlear implant users access sound less than half the time compared to typically hearing peers.
- Identified variables provide targets for cochlear implant teams to improve HHP in vulnerable populations.
- Further research is needed to develop effective interventions for increasing HHP.
Purpose:
Cochlear implant device use, quantified by hearing hours percentage (HHP), is a known variable that impacts pediatric spoken language outcomes. Isolating specific factors that impact HHP could help clinicians intervene to reduce the implications of barriers and amplify the positive facets. The aim of this study is to identify variables that predict HHP in children.
Method:
A retrospective chart review was completed using data collected from 2019 to 2023. Subjects were included if they were under the age of 18 years at the time of data collection and had data logging recorded in the clinical patient database. A mixed-effects model weighed the influence of year of the clinical visit (2019, 2020, 2021, 2022, and 2023), race/ethnicity (White, African American, Asian, Hispanic, Mixed Race, or Other), listener type (bilateral simultaneous, sequential, bimodal, unilateral hearing loss, or unilateral listener; one cochlear implant and a contralateral deaf ear), insurance type (private, Medicaid, or military, or none), age at surgery, presence of autism spectrum disorder (ASD) or an intellectual development delay (IDD), and age at test on HHP.
Results:
There were a total of 5,106 data points from 958 subjects. The mean HHP of the cohort was 64.2% (SD = 26.94%). Lower HHP was associated with the presence of IDD or ASD, use of Medicaid, and older age at surgery. HHP increased with age. Subjects of color did not have a significantly different HHP than those who were White. There was an interaction between year of data collection and listener type. Each listener type's HHP was impacted differently by the year of data collection; however, years of the COVID-19 pandemic yielded lower HHP for all listener types.
Conclusions:
The group mean of 64.9% is lower than the recommended 80% HHP goal, indicating that pediatric cochlear implant recipients have slightly more than half the access to sound as their age-matched typically hearing peers. Several variables that impact HHP were identified in this study. Cochlear implant teams can utilize these data to support vulnerable patients to increase HHP. Additional investigation is needed to determine what interventions most effectively improve HHP.
