Clinical and behavioral delineation of cochlear implant non-users: a 20-year retrospective descriptive analysis

Although cochlear implants (CIs) effectively restore hearing, device abandonment (‘non-use’) remains a critical challenge limiting long-term auditory rehabilitation. This study aimed to evaluate the prevalence, clinical and radiological characteristics, and patient-reported reasons for CI non-use, comparing pre-lingually and post-lingually deafened individuals to inform long-term retention strategies. We retrospectively reviewed 545 CI recipients implanted between 2002 and 2023 (excluding 24 patients lost to follow-up or with incomplete data). Clinical features, temporal bone CT, internal auditory canal MRI, and speech-language therapy records of 36 non-users were analyzed. Overall non-use rate was 6.6% (36/545), comprising 8.7% (25/287) in pre-lingual and 4.3% (11/258) in post-lingual recipients. Inner ear anomalies were identified in 11 pre-lingual non-users, including two with isolated cochlear nerve deficiency. Primary non-use reasons were sound maladaptation (48.0% pre-lingual vs. 36.4% post-lingual) and lack of subjective listening effect (48.0% vs. 18.2%). Post-lingual non-users presented distinct adult-specific psychosocial barriers (27.3%), including depression and cognitive decline. CI non-use is driven by distinct physiological, psychological, and socioeconomic factors depending on deafness onset. Delineating these onset-specific profiles provides essential guidance for tailored preoperative counseling and age-appropriate post-implantation monitoring to minimize long-term device abandonment.