Developmental Contextual Factors Contributing to Speech Perception and Hearing Outcomes Following Paediatric Bilateral Cochlear Implantation: A Scoping Review

Bilateral cochlear implantation is the typical intervention for children with severe-to-profound sensorineural hearing loss intended to support development of skills across language, cognitive, social, behavioural and academic domains. However, speech-perception outcomes post-implantation remain variable. This scoping review explores which contextual factors relate to speech perception and hearing outcomes following paediatric bilateral cochlear implantation based on themes aligned with Bronfenbrenner’s ecological systems theory: 1) individual; 2) microsystem; 3) exosystem; 4) macrosystem; and 5) chronosystem. Twenty-three research articles met the criteria for inclusion, and the contextual factors identified ranged from the proximal context, such as individual cognitive and social development, cochlear implant usage and the home environment, to the distal context, such as socio-economic health determinants. Contextual factors were explored with a narrative synthesis approach, with methodological limitations discussed. Study quality was assessed using Quality Assessment with Diverse Studies (QuADS) criteria. Our results indicate that research on outcomes related to bilateral cochlear implantation should actively integrate and examine contextual factors in prospective, longitudinal designs. This approach will facilitate the development of interventions to target specific levels of the bioecological system, thereby improving outcomes for the paediatric bilateral cochlear implant recipient.