Speech Perception Development From Childhood to Adulthood Following Pediatric Cochlear Implantation: A 30-year Longitudinal Study.

OBJECTIVE

Speech perception development in pediatric cochlear implant users varies widely, and its progression into late childhood and early adulthood remains unclear. This study examines long-term developmental trajectories and influencing factors using a longitudinal clinical dataset.

STUDY

DESIGN

Speech perception data collected across 22 clinical tests conducted in English and in quiet were retrospectively analyzed with a hierarchical scoring system to understand development of 294 pediatric cochlear implant users between 1992 and 2024 at Boys Town National Research Hospital. Medical records provided data on age at cochlear implant activation, year of first cochlear implant implantation, device configuration, daily device use, hearing loss etiology, revision history, primary language use, insurance type, race, and comorbidities. These variables were incorporated into statistical models to predict longitudinal speech perception outcomes.

RESULTS

Pediatric cochlear implant users generally show steady improvement in speech perception with chronological age. Faster early development of speech perception was associated with implantation before 18 months of age, bilateral cochlear implant use, longer daily device use, spoken English as a primary language, having private insurance, and better vestibular function. Alternatively, auditory neuropathy, syndromic hearing loss, hearing loss due to prenatal infections and low socioeconomic status were associated with poorer speech perception.

CONCLUSIONS

Auditory neuropathy or syndromic hearing loss and low socioeconomic status are key factors associated with slower speech perception development. Improving access to cochlear implant specialists and encouraging consistent device use-especially for later implantees-may enhance outcomes. Additional support for families and educators is recommended to promote increased device use.