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Updated: Aug 5, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Multifactorial determinants of auditory outcomes in pediatric cochlear implantation: A long-term longitudinal study
Joan Lorente-Piera1, Raquel Manrique-Huarte1, Lucia Carbonell Coll2
1Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain.
Insights
Early cochlear implantation (CI) significantly improves speech recognition in children. Earlier CI, especially before 12 months, leads to better long-term outcomes and reduced variability in hearing development.
Area of Science:
- Audiology
- Pediatric Otolaryngology
- Speech-Language Pathology
Background:
- Early cochlear implantation (CI) is crucial for auditory development in children with severe-to-profound sensorineural hearing loss.
- Long-term outcomes of pediatric CI are variable and not fully understood.
- This study investigates the long-term impact of implantation timing and other factors in a large pediatric cohort.
Purpose of the Study:
- To evaluate the long-term impact of age at cochlear implantation on speech recognition outcomes.
- To identify other variables that may modify long-term results in pediatric CI recipients.
- To understand the multifactorial influences on auditory development post-CI.
Main Methods:
- Retrospective longitudinal cohort study of 494 children (588 ears) aged ≤10 years at implantation.
- Longitudinal assessment of speech recognition scores (SRS) up to 10 years post-implantation.
- Stratification by age at implantation: <12 months, 1-2, 3-5, 6-8, and 9-10 years.
Main Results:
- Earlier implantation (<12 months) was significantly associated with superior long-term SRS (p<0.001).
- Perimodiolar electrodes and prior hearing aid use were independent predictors of better outcomes.
- Age at implantation and electrode type were the strongest independent predictors of 10-year SRS.
Conclusions:
- Age at implantation is the primary determinant of long-term speech recognition in pediatric CI users.
- Earlier CI enhances average performance and decreases outcome variability.
- Electrode design and prior auditory stimulation are important modulators of auditory development.
Introduction:
Early cochlear implantation (CI) is considered a key determinant of auditory development in children with severe-to-profound sensorineural hearing loss. However, long-term outcomes remain highly variable and still incompletely understood. This study aimed to evaluate the long-term impact of age at implantation and other modifying variables in a large pediatric CI cohort.
Methods:
A retrospective longitudinal cohort study was conducted including 588 implanted ears from 494 children aged ≤10 years. Speech recognition scores (SRS) at 65 dB SPL were assessed longitudinally up to 10 years after implantation. Patients were stratified according to age at implantation (<12 months, 1-2 years, 3-5 years, 6-8 years, and 9-10 years).
Results:
Earlier implantation was associated with significantly superior SRS at all follow-up intervals (p < 0.001). Children implanted before 12 months achieved the highest outcomes, with 100% reaching SRS >75% at 10 years, whereas those implanted at 9-10 years showed substantially lower performance. Prior hearing aid use was associated with better long-term outcomes, becoming significant from 6 years onward (p = 0.010). Perimodiolar electrodes demonstrated superior early performance and remained an independent predictor of higher 10-year SRS (p = 0.005). In multivariable analysis, only age at implantation (p = 0.004) and electrode array type (p = 0.005) remained independently associated with long-term results.
Conclusions:
Age at implantation is the strongest determinant of long-term speech recognition outcomes in pediatric CI recipients. Earlier implantation not only improves average performance but also reduces outcome variability. Electrode design and prior auditory stimulation further modulate outcomes, supporting a multifactorial model of auditory development.
