Emotional Prosody Evaluation in Adults with Cochlear Implants

Objectives: This cross-sectional study evaluates emotional prosody recognition in adults with unilateral cochlear implants (UCI, n = 22), bilateral cochlear implants (BCI, n = 15), and typical hearing, defined as normal hearing sensitivity confirmed by standard audiometric assessment (TH, n = 21), using the Montreal Affective Voices (MAV). Secondary aims assess demographic and clinical factors influencing performance. Materials and Methods: Participants underwent audiological testing (PTA5, speech-in-noise at SNR +5 dB), cognitive screening (MoCA), visual emotion recognition, and MAV assessment for emotion identification (happiness, sadness, fear, anger, surprise, pleasure, pain, disgust, neutral), and subjective valence ratings. Mean age ± SD was 56.2 ± 8.1 years in UCI participants, 46.1 ± 19.7 years in BCI participants, and 35.5 ± 11.5 years in TH participants. Group comparisons were performed using non-parametric tests (Kruskal–Wallis, Mann–Whitney U), and multivariable linear regression models adjusted for study group, age, and education, with corresponding visual emotion-recognition scores and speech-in-noise performance at +5 dB SNR evaluated as additional covariates. Results: Both CI groups showed profound deficits in auditory emotion recognition (unadjusted total scores: UCI 30.4 ± 10.6, BCI 30.1 ± 8.7 vs. TH 61.9 ± 7.4; p < 0.001). After FDR correction, significant overall group effects were observed for eight of the nine emotion-specific outcomes; Sadness did not remain significant after correction. No Bonferroni-adjusted UCI-versus-BCI comparison was significant. Older age and lower education level were associated with poorer performance for selected outcomes. Visual emotion-recognition scores were positively associated with auditory performance for Anger and Neutral. Global cognition and disability (WHODAS 2.0) were comparable across groups. Conclusions: Cochlear implant users showed substantially poorer recognition of emotional prosody than typical-hearing participants, with no consistent statistically significant difference between unilateral and bilateral users. Technological improvements and targeted rehabilitation may help to enhance socioemotional communication in CI users.