To examine auditory environments and challenges faced by pediatric cochlear implant (CI) users in Saudi Arabia by comparing auditory settings and device usage between preschoolers and school-age children. A retrospective analysis was conducted on prelingually deafened children under 18 years of age using SONNET2/RONDO3 MED-EL CI. Children were categorized based on Saudi Arabia's primary school enrollment age. Datalogging metrics from 2020-2022 on device usage and auditory scene exposure were analyzed using R Software, with descriptive statistics and regression models exploring relationships between demographic factors and data logging metrics. A total of 178 ears met inclusion criteria, with a median age of 5.8 years and a median implantation age of 2.0 years. Median daily CI use was 10.1 hours, with preschoolers using their devices for 7.9 hours and school-age children for 11.6 hours. Predominant auditory exposure was to "speech-in-noise" (49%) and "noise" (37%). Significant correlations were found between age, implantation age, and various datalogging metrics. Pediatric CI users in Saudi Arabia showed increased daily CI use with age, primarily in noisy environments, highlighting the need for acoustically optimized settings to support speech perception. Chronological age was a key determinant of CI usage and auditory exposure, emphasizing its role in tailoring interventions to improve outcomes for children with CI.

Background/Objectives: Cochlear implantation (CI) is a transformative intervention for individuals with sensorineural hearing loss, providing auditory and speech perception improvements. Traditional CI activation occurs 4–6 weeks post-surgery; however, recent advancements allow for early activation within 1–2 days. The integration of data logging in modern CI systems offers objective insights into processor usage and auditory exposure, which are crucial for optimizing rehabilitation outcomes. Methods: A retrospective study was conducted on 63 patients with bilateral simultaneous CIs using MED-EL SONNET2/RONDO3 devices. Patients were classified into early activation (n = 30, activation within 1–2 days) and classical activation groups (n = 33, activation after day 2). Data logging metrics, patient demographics, and implant details were analyzed using the Wilcoxon rank-sum test and Poisson regression. Results: Daily processor usage did not significantly differ between groups (9.5 ± 3.0 h/day for classical vs. 9.4 ± 3.7 h/day for early activation, p = 0.927). Subgroup analysis showed a significant 18% increase in processor usage with each additional year of patient age (IRR = 1.18, p < 0.001) and a 15% decrease in usage with each year delay in implantation age (IRR = 0.85, p < 0.001) among early activation users. Switch-on frequencies were comparable between groups, with no significant differences observed (p = 1.0). Conclusions: Early activation is feasible and associated with consistent CI usage, providing potential benefits in auditory rehabilitation. Future research should explore its impact on long-term speech and language outcomes to inform evidence-based practices.