{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:50:54Z","timestamp":1785808254538,"version":"3.56.0"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009157","name":"National Institute on Disability, Independent Living, and Rehabilitation Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009157","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000862","name":"Doris Duke Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002046","name":"Hearing Health Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002046","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000193","name":"National Endowment for the Arts","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000193","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008069","name":"University of California, San Francisco","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n To characterize the temporal dynamics of post\u2010activation improvement, identify cochlear implant (CI) performance phenotypes, and establish an early prognostic benchmark following CI activation in adults.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Retrospective longitudinal cohort at a tertiary academic medical center. Adult CI recipients (\n N<\/jats:italic>\n \u2009=\u2009530 patient\u2010ears) were analyzed across a within\u2010subjects improvement cohort (\n n<\/jats:italic>\n \u2009=\u2009125, complete consonant\u2010nucleus\u2010consonant [CNC] data at 1, 3, 6, and 12\u2009months) and a prognostic validation cohort (\n n<\/jats:italic>\n \u2009=\u2009205, paired 1\u2010 and 12\u2010month CNC). Outcomes included CNC word recognition, improvement rates, device datalogging, and 1\u2010month prognostic validity.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n CNC improvement was front\u2010loaded. Early\u2010period (1\u2009\u2192\u20093\u2009month) rates of 4.44\u2009\u00b1\u20096.95 points\/month were approximately 35\u2010fold faster than late\u2010period (6\u2009\u2192\u200912\u2009month) rates of 0.13\u2009\u00b1\u20091.84 points\/month (Friedman \u03c7\n 2<\/jats:sup>\n \u2009=\u200926.97,\n p<\/jats:italic>\n \u2009<\u20090.001).\n k<\/jats:italic>\n \u2010means clustering identified three performance phenotypes distinguishable at 1\u2009month (\n p<\/jats:italic>\n \u2009<\u20090.001). Preoperative CNC did not differ across clusters (\n p<\/jats:italic>\n \u2009=\u20090.25). Device usage was a stable patient\u2010level trait. It differed between clusters (\n p<\/jats:italic>\n \u2009<\u20090.001) but did not predict CNC improvement (\n \u03c1<\/jats:italic>\n \u2009=\u20090.02,\n p<\/jats:italic>\n \u2009=\u20090.82). However, sustained or increasing engagement through 6\u2009months was associated with higher 12\u2010month CNC than declining engagement (\n p<\/jats:italic>\n \u2009=\u20090.004). The 1\u2010month CNC score strongly predicted 12\u2010month outcomes (\n \u03c1<\/jats:italic>\n \u2009=\u20090.68,\n p<\/jats:italic>\n \u2009<\u20090.001;\n R<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.45), a 15\u2010fold gain over preoperative CNC. A 1\u2010month CNC\u2009\u2265\u200944% predicted functional success (12\u2010month CNC\u2009\u2265\u200950%) with AUC 0.82 (95% CI: 0.76\u20130.88; sensitivity: 0.66, specificity: 0.89).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Adult CI recipients undergo accelerated auditory adaptation concentrated in the first 3\u2009months post\u2010activation, with performance trajectories largely established by 1\u2009month. A 1\u2010month CNC threshold of \u2265\u200944% represents a clinically actionable prognostic checkpoint, and sustained device engagement through 6\u2009months is associated with optimal long\u2010term outcomes.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n 3.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lary.70779","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:32:57Z","timestamp":1785807177000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Performance Phenotypes and Early Prognostic Benchmarking After Adult Cochlear Implantation"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5253-6392","authenticated-orcid":false,"given":"Stephanie","family":"Younan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Chang\u2010Chien","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2821-3502","authenticated-orcid":false,"given":"Lourdes","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4249-1197","authenticated-orcid":false,"given":"Pearl","family":"Doan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Ushijima","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Im","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliot D.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen C.","family":"Barrett","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"},{"name":"Institute for Health and Aging University of California\u2014San Francisco School of Nursing, University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9838-5065","authenticated-orcid":false,"given":"Nicole T.","family":"Jiam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1904407"},{"issue":"10","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1001\/jamaoto.2020.0998","article-title":"Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements","volume":"146","author":"Buchman C. 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