Patterns of Cochlear Implant Use and Speech Exposure in Children With Single-Sided Deafness Compared to Bimodal Devices in the Post-Pandemic Period.

objectivesThis study evaluated whether Coronavirus disease 2019 (COVID-19)-related decreases in device use and speech exposure in children with unilateral cochlear implants (CIs) persisted post-pandemic. It was hypothesized that CI use is lower in children with single-sided deafness (SSD) than in children using bimodal devices and that speech exposure has recovered to pre-pandemic levels.

designDatalogs (n = 608) from children with unilateral CIs (n = 111) and good hearing in their non-implanted ear (unaided pure tone average <60 dB) were analyzed across the pre-pandemic, peri-pandemic (during the pandemic), and post-pandemic periods. Participants were separated into children with single-sided deafness using a CI (SSD-CI group, n = 70), and children using a CI and contralateral hearing aid (bimodal devices group, n = 41). They were further divided by age at the start of the pandemic (preschool-aged and school-aged). Datalogs were collected from October 1, 2013 to April 1, 2024, and included daily CI use, speech duration, and speech-in-noise sounds captured by the CI.

resultsCI use was lower in the SSD-CI group (mean ± SD = 5.78 ± 3.06 hours/day) than in the bimodal devices group (7.24 ± 3.75 hours/day, p = 0.013). In addition, of 17 children lost to follow-up, 14 were in the SSD-CI group. Preschool-aged children showed a steeper increase in CI use over time from CI activation in the bimodal devices group (slope ± SE = 0.96 ± 0.14 hours/day per year) than the SSD-CI group (0.15 ± 0.19 hours/day per year, p < 0.001). CI use declined more rapidly over time in school-aged children in the SSD-CI group (-0.63 ± 0.09 hours/day per year) compared to the bimodal devices group (-0.07 ± 0.09 hours/day per year, p < 0.001). Speech exposure was similar in the SSD-CI (3.13 ± 1.83 hours/day) and bimodal devices (3.82 ± 2.11 hours/day) groups ( p = 0.08). In preschool-aged children, speech exposure increased from the pre-pandemic (3.11 ± 1.44 hours/day) to the peri-pandemic (3.51 ± 2.21 hours/day, p = 0.011) and post-pandemic period (4.53 ± 1.84 hours/day, p < 0.001) in line with increased daily CI use. In school-aged children, speech exposure decreased from the pre-pandemic (3.38 ± 1.76 hours/day) to the peri-pandemic period (2.94 ± 2.16 hours/day, p = 0.002), remaining low post-pandemic (2.91 ± 2.45 hours/day, p = 0.69). The proportion of speech exposure measured by the CI decreased from the pre-pandemic period (52.5% ± 12.2%, p = 0.99) to the peri-pandemic period (44.7% ± 16.1%, p = 0.008) and returned to pre-pandemic levels post-pandemic (51.9% ± 17.3%, p = 0.55).

conclusionsDaily CI use varies widely in children with good residual hearing in their non-implanted ear and is at greater risk for decline over time in the SSD-CI group compared to the bimodal device users. Reduced CI use in school-aged children with SSD leads to decreased hours of speech exposure through the CI. The percentage of speech exposure logged by the CI confirms that speech access declined during the pandemic but reveals an encouraging return to pre-pandemic levels after restrictions were lifted.