A prospective study evaluated the spoken language development of children with severe-to-profound sensorineural hearing loss (SNHL) following cochlear implantation (CI). The study included 188 children who underwent CI before age 5 and 97 hearing children matched by age. Over a 3-year period, children with CI showed greater growth in spoken language performance than predicted by their pre-implantation scores. Children implanted at younger ages and with shorter histories of hearing loss demonstrated faster language acquisition. Multivariable analyses showed that greater residual hearing before CI, higher parent-child interaction ratings, and higher socioeconomic status (SES) were associated with better language growth. However, language age gaps between children with CI and hearing children persisted, highlighting the importance of early implantation. The study found that earlier implantation was linked to better spoken language outcomes, with children implanted before 18 months showing trajectories closer to those of hearing children. Despite improvements, language development was not fully restored to age-appropriate levels within 3 years. The study also found that family income, parent-child interaction, and environmental factors significantly influenced language outcomes. While CI improved spoken language skills, the benefits were not uniform across all children, and factors such as prolonged use of hearing aids before CI were associated with reduced language learning. The study underscores the importance of early CI in children with SNHL and the need for objective tools to monitor the effectiveness of amplification in supporting language development. The findings suggest that early implantation and residual hearing prior to CI are critical factors in spoken language acquisition. The study also highlights the role of environmental and socioeconomic factors in language development. Overall, the study provides evidence that CI is associated with better spoken language learning than predicted by pre-implantation scores, but language age gaps persist, emphasizing the importance of early intervention.A prospective study evaluated the spoken language development of children with severe-to-profound sensorineural hearing loss (SNHL) following cochlear implantation (CI). The study included 188 children who underwent CI before age 5 and 97 hearing children matched by age. Over a 3-year period, children with CI showed greater growth in spoken language performance than predicted by their pre-implantation scores. Children implanted at younger ages and with shorter histories of hearing loss demonstrated faster language acquisition. Multivariable analyses showed that greater residual hearing before CI, higher parent-child interaction ratings, and higher socioeconomic status (SES) were associated with better language growth. However, language age gaps between children with CI and hearing children persisted, highlighting the importance of early implantation. The study found that earlier implantation was linked to better spoken language outcomes, with children implanted before 18 months showing trajectories closer to those of hearing children. Despite improvements, language development was not fully restored to age-appropriate levels within 3 years. The study also found that family income, parent-child interaction, and environmental factors significantly influenced language outcomes. While CI improved spoken language skills, the benefits were not uniform across all children, and factors such as prolonged use of hearing aids before CI were associated with reduced language learning. The study underscores the importance of early CI in children with SNHL and the need for objective tools to monitor the effectiveness of amplification in supporting language development. The findings suggest that early implantation and residual hearing prior to CI are critical factors in spoken language acquisition. The study also highlights the role of environmental and socioeconomic factors in language development. Overall, the study provides evidence that CI is associated with better spoken language learning than predicted by pre-implantation scores, but language age gaps persist, emphasizing the importance of early intervention.