Highlight
- Longer unaided deafness duration (≥20 years) slows early post-implant speech perception gains but does not reduce 12-month outcomes.
- Patients without measurable pre-operative hearing thresholds exhibit higher rates of device non-use and poor open-set speech perception.
- Meaningful speech outcomes are achievable despite prolonged deafness, supporting cochlear implantation candidacy even after extended auditory deprivation.
- Pre-operative hearing assessment can guide counseling and set realistic expectations for cochlear implant recipients.
