Effects of Marital Status on Cochlear Implant Outcomes

Objective: To examine the association between marital status and post-CI speech recognition and hearing-related QoL in adult CI users, and to explore how this relationship interacts with key sociodemographic factors, including sex, employment, and residential location, and device usage (datalogging). Methods: Retrospective cohort analysis of prospectively collected data (2018–2024) from 604 postlingually deafened adults undergoing unilateral cochlear implantation. Outcomes were speech recognition (AzBio, CNC) and hearing-related QoL (CIQOL), collected at 6 or 12 months post-CI. Results: Unmarried users had significantly poorer speech recognition outcomes (CNC [95% CI −15.2 to −5.5], AzBio quiet (AzBioQ) [95% CI −15.2 to −2.8]) compared to married users when controlling for key clinical covariates. No significant differences were observed in CIQOL scores. There were positive nonsignificant interactions between marital status and sex (β, 9.33, [95% CI −3.44 to 22.12]), employment status (β, 8.52, [95% CI −6.47–23.51]), and residential location (β, 12.96, [95% CI −0.54–26.46]) on AzBioQ. The benefits of marriage were stronger among women, full-time employed individuals, and rural residents than among men, those not in full-time employment, and urban residents. Marital status also significantly interacted with device usage (β, 1.70, [95% CI 0.11–3.28]). The relationship between device usage and AzBioQ was stronger in married individuals, suggesting a greater protective effect of marriage in individuals with higher device usage. Conclusion: Marital status predicts CI speech recognition outcomes through both its main effect and its interaction with three additional sociodemographic factors and device usage. Recognizing this significant impact can help guide clinical counseling and inform the importance of social relationships. Level of Evidence: 3.