Longitudinal Cochlear Implant Use in Pediatric Patients with Unilateral hearing loss

Introduction: Reports of cochlear implant (CI) use vary in pediatric CI recipients with unilateral hearing loss (UHL). While some studies have shown consistent use, others have suggested decreased use over time. This study aims to characterize the longitudinal pattern of CI use in children with UHL.

Methods: Retrospective cohort study of pediatric CI recipients with UHL at 2 academic tertiary care centers from 2018 to 2024. Datalogging results were obtained through Cochlear Corporation software for each recipient. Average hours of use per day at 3, 6, 12, 18 and 24 months were captured, and were interpolated when necessary. Patients were dichotomized for analysis to moderate use (more than 4 hours of use) or regular use (more than 6 hours of use).

Results: 49 patients with datalogging information at 3 months were identified. Of those, 44 had data at 6 months, 37 at 12 months, 28 at 18 months, and 24 at 24 months. Of the 25 patients without data at 24 months, 15 were not yet at 2 years post-activation. Of the remaining 10 patients, 4 had regular use recorded at their last entry, 1 had moderate use, and only 5 had less than 4 hours, suggesting that lack of follow up did not equate to poor device use.

At 3 months, 40/49 (82%) of patients had at least moderate CI use while 38/49 (78%) had regular use. Of those with moderate use at 3 months, moderate use was sustained in 35/37 (95%), 32/33 (97%), 25/26 (96%) and 19/23 (83%) at 6, 12, 18 and 24 months, respectively. Similarly, sustained regular use in those with regular use at 3 months was 30/35 (86%), 21/29 (72%), 19/25 (76%) and 11/20 (55%) over the same time intervals. The 5 patients with less than 4 hours of use at 3 months never achieved greater use. Among sustained CI users, there was minimal median change in hours of use over time. There was no association between age or duration of deafness, and CI use.

Conclusions: Most patients with moderate to regular CI use at 3 months sustained similar device use over time, independent of age at implantation or duration of deafness. The 3 months’ time interval after activation may be a critical adaptation period, as non-use at this time interval portended non-use at subsequent time intervals.