Language outcomes following pediatric cochlear implantation: Associations with clinical, socioeconomic, and rehabilitation factors

Objective: Language outcomes after pediatric cochlear implantation vary widely and are not fully explained by established clinical factors such as age at implantation and neurodevelopmental comorbidities. This study examined the associations between selected clinical, socioeconomic, and appointment-related factors and receptive and expressive language outcomes following cochlear implantation. Methods: We conducted a retrospective cohort study of children with congenital bilateral severe-to-profound sensorineural hearing loss who underwent cochlear implantation, received post implantation Auditory Verbal Therapy and completed post-implant language assessments using the Preschool Language Scale, Fifth Edition. Receptive and expressive language age-equivalent scores were analyzed over two years after activation (n = 36). A subset of children with at least two post-implant language assessments available (n = 17) was included in secondary analyses estimating language development rates. Associations between language outcomes and first-year post-activation appointment measures, clinical factors, and socioeconomic variables were evaluated using nonparametric tests and linear regression. Results: Post-activation appointment count emerged as the factor most consistently associated with language outcomes. Higher appointment attendance was associated with higher receptive and expressive language scores beginning approximately one year after activation and persisting through later hearing-age intervals. Neurodevelopmental diagnosis was associated with lower receptive and expressive language scores at hearing age 4. In longitudinal analyses, appointment volume remained significantly associated with expressive language development rate after adjustment for available covariates. Receptive language outcomes demonstrated greater variability across hearing ages, and no variables were significantly associated with receptive language development rate. Conclusions: Higher appointment attendance was consistently associated with more favorable language outcomes following pediatric cochlear implantation. Whether this association reflects increased rehabilitation exposure, broader family and social factors, or a combination of these influences remains uncertain.