Spoken Language Outcomes After Early Cochlear Implantation in a Diverse, Multi-Institutional Cohort of Congenitally Deaf Children

OBJECTIVE: To evaluate spoken language outcomes in a diverse, multi-institutional cohort of children with severe-to-profound hearing loss who have undergone cochlear implantation (CI). STUDY DESIGN: Retrospective cohort. SETTING: Multi-institutional study at 9 cochlear implant centers and schools with data from 2017 to 2025. PATIENTS: Children with bilateral congenital severe-to-profound SNHL who underwent CI before 24 months of age. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: Standardized, age-normed language assessments [Preschool Language Scales (PLS) and Receptive-Expressive Emergent Language (REEL)]. Sociodemographic status was assessed using the Social Vulnerability Index (SVI), a validated, national geocoded measure based on residential home address. RESULTS: One hundred forty patients identified at 9 separate institutions were included. The mean SVI was 0.493 (SD=0.274; range: 0.011 to 0.973). The majority of patients (57.9%, 81 patients) were implanted before 12 months (early CI), while 42.1% (59 patients) were implanted from 12 to 24 months (late CI). At age 3, the mean total language score for the early CI group was higher than that of the late CI group (94.0 vs. 73.4, P<0.001). In a sub-analysis of the early CI cohort, total language was higher in babies implanted before 9 months compared with those implanted before 12 months (100.2 vs. 88.5, P<0.001). SVI was not associated with age at implantation (P=0.10). On multivariable regression, SVI and age at CI were associated with total language scores. CONCLUSIONS: Earlier cochlear implantation, particularly before 9 months of age, is associated with significantly improved spoken language outcomes in a diverse cohort of infants with congenital bilateral severe-to-profound hearing loss.