Baseline Function Predicts Gains in Both Speech Recognition and Quality of Life After Cochlear Implantation

OBJECTIVE: To characterize patterns of improvement in speech recognition and quality of life (QOL) after cochlear implantation and examine how baseline performance, device use, and candidacy status ("borderline," qualifying in noise only vs. "traditional," qualifying in quiet) predict postoperative gains in both domains. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: One hundred one adult unilateral CI recipients implanted between 2019 and 2023 with complete preoperative and postoperative (6 or 12 mo) speech recognition and QOL data. INTERVENTIONS: Unilateral cochlear implantation. MAIN OUTCOME MEASURES: AzBio sentence recognition in quiet (AzBioQ) and Cochlear Implant Quality of Life (CIQOL) Global scores. Clinically meaningful improvement was defined using validated thresholds for each measure. RESULTS: Of 101 patients, 97 demonstrated clinically meaningful improvement in at least one domain: 44 improved in both speech recognition and QOL (dual improvers), 43 in speech recognition only, 10 in QOL-only, and 4 showed no significant improvements. Patients with lower baseline scores in a given domain demonstrated greater gains in that domain. Greater daily device use ("datalogging") was associated with larger speech-recognition gains (r=0.34, P<0.01) but not QOL improvements (r=0.12, P=0.24). Borderline candidates (n=24) achieved QOL gains comparable to traditional candidates (n=77) despite smaller speech-recognition improvements. CONCLUSIONS: The vast majority of CI recipients demonstrate meaningful improvements in speech recognition, QOL, or both domains. Baseline performance predicts domain-specific gains, and borderline candidates achieve meaningful QOL benefits despite smaller speech-recognition gains. These findings provide further support for incorporating patient-reported outcome measures into candidacy evaluations and postoperative assessments.