Some Challenging Questions About Outcomes in Children With Cochlear Implants.

Purpose: Cochlear implants (CIs) have improved the quality of life for many children with severe-to-profound sensorineural hearing loss. Despite the reported CI benefits of improved speech recognition, speech intelligibility, and spoken language processing, large individual differences in speech and language outcomes are still consistently reported in the literature. The enormous variability in CI outcomes has made it challenging to predict which children may be at high risk for limited benefits and how potential risk factors can be improved with interventions. In this article, we consider four challenging, unresolved issues that exist in the field of pediatric cochlear implantation (age at implantation, comorbid diagnoses, preimplant functioning in infants, and communication modality) to illustrate the value of adopting a broader integrated multidisciplinary approach to explaining variability and individual differences in outcomes. Conclusions: Four challenging and unresolved issues concerning our ability to predict individual differences before implantation were discussed. In order to address some of the current barriers to progress in dealing with these unresolved issues, a biopsychosocial system model is proposed as a possible unifying approach to conceptualizing these issues. Additionally, several new research directions to better understand and explain variability in pediatric CI outcomes are suggested.