Abstract
Background/Objectives: Cochlear implantation (CI) significantly enhances speech perception and quality of life in patients with severe-to-profound sensorineural hearing loss, yet outcomes vary substantially. Accurate preoperative prediction of CI outcomes remains challenging. This study aimed to develop and validate a machine learning model predicting postoperative speech recognition using a large, single-center dataset. Additionally, we compared model performance with expert clinical predictions to evaluate potential clinical utility. Methods: We retrospectively analyzed data from 2571 adult patients with postlingual hearing loss who received their cochlear implant between 2000 and 2022 at Hannover Medical School, Germany. A decision tree regression model was trained to predict monosyllabic (MS) word recognition score one to two years post-implantation using preoperative clinical variables (age, duration of deafness, preoperative MS score, pure tone average, onset type, and contralateral implantation status). Model evaluation was performed using a random data split (10%), a chronological future cohort (patients implanted after 2020), and a subset where experienced audiologists predicted outcomes for comparison. Results: The model achieved a mean absolute error (MAE) of 17.3% on the random test set and 17.8% on the chronological test set, demonstrating robust predictive performance over time. Compared to expert audiologist predictions, the model showed similar accuracy (MAE: 19.1% for the model vs. 18.9% for experts), suggesting comparable effectiveness. Conclusions: Our machine learning model reliably predicts postoperative speech outcomes and matches expert clinical predictions, highlighting its potential for supporting clinical decision-making. Future research should include external validation and prospective trials to further confirm clinical applicability.