Psychosocial Development in 5-Year-Old Children With Hearing Loss Using Hearing Aids or Cochlear Implants.

The outcomes came from parent reports, so teacher ratings or child self-report may have identified different problems. There was substantial missing data, especially for language and non-verbal cognitive testing, and the missingness was not always random, so imputed regression estimates may be biased. The study was not randomised, and children with cochlear implants and hearing aids differed in severity and family background, so differences cannot be attributed to the device alone. The cochlear implant group was smaller than the hearing aid group, and this reduced power for that group. The analyses describe children at 5 years, so they do not show how social skills, emotional problems, or behavior change as school demands increase. A large amount of psychosocial variance remained unexplained, especially for children with cochlear implants, so other family, school, and child factors likely matter.

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Do not conclude that cochlear implants improve psychosocial outcomes compared with hearing aids. This was an observational cohort study, not a randomised trial, and the groups differed in hearing loss severity, additional disabilities, communication mode, and family factors. The contribution of the device alone cannot be separated from those factors.