Cochlear implantation before age one or after: cognitive flexibility, planning, and problem-solving in pediatric recipients

AbstractPurpose This study investigated the association between age at cochlear implantation and executive function outcomes,including cognitive flexibility (CF) and planning and problem-solving (PPS), in school-age children with cochlear implants(CIs). Demographic, cognitive, and audiological factors associated with these outcomes were also examined.Methods Sixty-one children with CIs aged 8–10 years were divided into Infancy CI (implanted within the first year of life;n = 30) and Toddlerhood CI groups (implanted between 13 and 24 months; n = 31). CF was assessed using the Modified CardSorting Test and PPS using the Tower of London Test. Group comparisons, correlations, and hierarchical regression analyseswere performed.Results The Infancy CI group showed significantly better CF and PPS performance than the Toddlerhood CI group (p < 0.01).CF was associated with maternal education, nonverbal intelligence, receptive vocabulary, and CI thresholds, whereas PPSwas associated with receptive vocabulary and CI hearing thresholds. Regression analyses revealed different predictor pat-terns. Age at implantation predicted CF initially but was no longer significant after controlling for receptive vocabulary, CIthresholds, nonverbal intelligence, and maternal education; receptive vocabulary was the only independent predictor of CF.In contrast, age at implantation and CI thresholds independently predicted PPS (p < 0.05).Conclusion Earlier cochlear implantation is associated with better executive function outcomes, although different domainsappear to be influenced by distinct factors. CF may be more closely related to language development, whereas PPS may bemore strongly associated with implantation timing and auditory access.