Copyright © 2019 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. Original Study Comprehensive Analysis of Factors Leading to Poor Performance in Prelingual Cochlear Implant Recipients à Smriti Panda, à Kapil Sikka, yVishwajeet Singh, à Shivani Agarwal, à Rakesh Kumar, à Alok Thakar, and à Suresh C. Sharma à Department of Otorhinolaryngology and Head and Neck Surgery; and yDepartment of Biostatistics, All India Institute of Medical Sciences, New Delhi, India Objective: To comprehensively analyze the prognostic fac- tors responsible for affecting outcomes following cochlear implantation in prelinguals. Study Design: Retrospective cohort study from June 2004 to November 2015. Setting: Tertiary care center. Patients: Patients who had undergone cochlear implantation during June 2004 to November 2015 for prelingual sensori- neural hearing loss with a minimum follow-up of 2 years. Intervention: Patients were evaluated for the presence of 20 risk factors possibly influencing postimplantation outcomes using a questionnaire. Main Outcome Measures: Assessment for speech and auditory function was done at the last follow-up with speech intelligibility ratings (SIR) and categories of auditory perfor- mance (CAP) scores, respectively. Results: One hundred fifty-one patients were included in this study. On univariate analysis for CAP, age at implantation, noncompliance to pre and postimplantation auditory and speech habilitation, poor parental motivation, socioeconomic status and literacy were found to be associated with lower scores ( p < 0.05). Whereas, for SIR, additionally, attention deficit hyperactivity disorder and inner ear malformation were statistically significant negative predictors on univariate analysis. Finally, factors responsible for low CAP scores on multivariate analysis were poor parental literacy, poor socioeconomic status, irregular pre/postimplantation rehabili- tation, and attention deficit hyperactivity disorder. While for SIR, additionally age at implantation was also a significant negative predictor. Increasing IQ and duration of implant use were associated with higher CAP (univariate) and SIR scores (univariate and multivariate) ( p < 0.05). Conclusion: We were able to demonstrate negative impact of higher age at implantation, minimal cognitive disorder, adverse parental/socioeconomic profile, and poor compliance to pre/postimplantation auditory verbal habilitation on audi- tory and speech outcomes. Key Words: Cochlear implant—Non-user—Outcome—Prognostic factor. Otol Neurotol 40:754–760, 2019. India shares a large part of the global burden of severe to profound hearing loss (1). WHO estimated incidence of hearing loss to be 1 to 6 per thousand newborns screened (2). Cochlear implantation is the standard of care for patients who do not benefit from standard amplification techniques. Despite having strict guide- lines in terms of candidacy, postoperative gains in terms of auditory perception, meaningful speech acquisition, and subsequent integration into mainstream education and vocation are highly variable. Given the heteroge- neous nature of possible etiologies contributing to the development of hearing loss along with impact of paren- tal social and educational profile on audio verbal training, prognostication becomes a complex yet indispensable entity before implantation. There is a plethora of knowledge in terms of assess- ment of individual prognostic variables affecting post- cochlear implantation auditory and speech outcomes (3 – 11). There are also a few studies where the authors have enquired into a comprehensive analysis of various factors responsible for language outcomes (12–18). These stud- ies are more informative as they enlighten the reader about the complex interplay of various factors influenc- ing auditory and speech outcomes postimplantation. Except study by Kraaijenga et al. (17), most studies had limited follow-up periods (24–36 mo). Black et al. (13) have extensively studied familial influences along with other well-established factors predicting out- come (age at implantation, inner ear anomalies, associ- ated disabilities, GJB2 mutation). The same author has also developed a prognostic model based on the findings of this study which was implemented on 25 patients showing fair concordance with postimplantation perfor- mance (12). Address correspondence and reprint requests to Kapil Sikka, M.S., Associate Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Teaching Block, 4th Floor, All India Institute of Medical Sciences, Ansari Nagar, East, New Delhi 110029, India; E-mail: Kapil_sikka@yahoo.com The authors disclose no conflicts of interest. DOI: 10.1097/MAO.0000000000002237 ß 2019, Otology & Neurotology, Inc.