Communication Preferences of School-Age Children with Cochlear Implants in Multilingual Educational Settings: Implications for Inclusive Education and Public Health

<b>Background:</b> School-age children with cochlear implants (CIs) navigate academic and social settings by adopting varied communication strategies. Understanding these preferences and their determinants is essential for inclusive education and equitable public health. Evidence from multilingual contexts remains limited. <b>Objective:</b> The aim of this study was to investigate the communication preferences among school-age children with CI and the influence of social adaptability, home language, and CI duration. <b>Methods:</b> A cross-sectional study was conducted with 32 CI user school-age children (mean age = 13.4 years) at Sharjah City for Humanitarian Services. A structured questionnaire assessed communication mode, adaptability, comfort, and effectiveness. Quantitative associations were tested with Chi-square or Fisher's exact tests; Pearson's correlation examined links with CI duration. Qualitative responses were thematically analysed. <b>Results:</b> Most school-age children with CI preferred bimodal communication (spoken and sign). The primary spoken language used in the household was associated with communication preferences across settings (<i>p</i> ≤ 0.031). Gender differences appeared in family communication (<i>p</i> = 0.036). Longer CI duration correlated with greater spoken-language comfort (r = 0.32; <i>p</i> = 0.038). Self-reported adaptability was high but not significantly associated with preferences. <b>Conclusions:</b> School-age children with CI in multilingual environments predominantly adopt bimodal communication, shaped by sociocultural and linguistic contexts. Recognising bimodal use as normative supports bilingual education, family-centred care and public health strategies promoting equity and participation.