Social development in Chinese hearing-impaired children with binaural-bimodal fitting (BIM) versus unilateral cochlear implant: A comparative study

Binaural-bimodal fitting (BIM) has emerged as the predominant intervention for mitigating auditory deprivation in bilateral hearing-impaired children in China. However, it remains unclear whether BIM, compared with unilateral cochlear implantation (UCI), can fully narrow the developmental gap between children with hearing impairment and their normal-hearing (NH) peers. This secondary analysis of cross-sectional data collected from children in grades 3–5 in Xi'an, China, aimed to compare the social development of Chinese children with bilateral hearing impairment who received BIM, those who received UCI, and their NH peers. Participants included 24 BIM users, 35 UCI users, and 209 NH children. Propensity score matching was used to control for covariates, and group comparisons were conducted using the Hodges-Lehmann aligned-rank test. Analyses revealed that compared with UCI users, BIM users demonstrated significantly stronger parent-child closeness, teacher-student closeness, and teacher-student dependence, as well as lower teacher-student conflict and lower peer-related loneliness. Compared with NH children, BIM users exhibited significantly higher teacher-student closeness, with no significant differences in other social development outcomes. The findings suggest that children with hearing impairment who used BIM had better relationships with adults and peers than those who used UCI, and showed a level of social development comparable to that of their NH peers. These results support the potential value of BIM in the rehabilitation of Chinese children with bilateral hearing impairment.