Development and evaluation of a virtual reality game targeting Central auditory processing skills in children using cochlear implants: a randomized controlled trial

To develop a virtual reality (VR)-based restaurant simulation game targeting central auditory processing skills for children aged 10–18 with bilateral cochlear implants (CIs) and to evaluate its usability and effectiveness on speech understanding in noise. This randomized controlled study had two phases. In Phase 1, a six-level VR restaurant game was developed and usability tested. This stage involved children with normal hearing and CIs, parents, a game developer, audiologists. The usability was examined using expert opinions, observation, game evaluation forms, the System Usability Scale, interviews, group score comparisons. In Phase 2, the game’s effectiveness was tested in 24 children with bilateral CIs randomly assigned to intervention (n = 12) and control (n = 12) groups. The intervention group continued traditional rehabilitation and additionally received VR-based training for four weeks. The control group continued traditional rehabilitation only for four weeks. All participants were administered the Turkish Hearing in Noise Test (HINT) pre- and post-intervention as the primary outcome measure of speech understanding in noise, results analysed via repeated-measures ANOVA. The game was usable and engaging. Normally hearing children scored higher than children with CIs on prototype levels (ppp This study demonstrated the usability of Cooklear, the first Turkish VR-based aural rehabilitation game for paediatric bilateral CI users, showing short-term improvements in speech understanding in noise. Further studies should examine broader auditory processing skills. ClinicalTrials.gov, NCT06788184. Integrating Virtual Reality (VR)-based auditory training with traditional auditory rehabilitation resulted in significant improvements in speech perception in noise in children with bilateral cochlear implants.The VR-assisted intervention provided an engaging and realistic listening environment that improved auditory attention, discrimination, and memory skills, supporting better generalisation of listening skills to everyday environments.The high usability and positive feedback from children, parents, and professionals highlight the potential of VR apps as motivating, child-friendly, and applicable tools that can complement traditional auditory rehabilitation programs. Integrating Virtual Reality (VR)-based auditory training with traditional auditory rehabilitation resulted in significant improvements in speech perception in noise in children with bilateral cochlear implants. The VR-assisted intervention provided an engaging and realistic listening environment that improved auditory attention, discrimination, and memory skills, supporting better generalisation of listening skills to everyday environments. The high usability and positive feedback from children, parents, and professionals highlight the potential of VR apps as motivating, child-friendly, and applicable tools that can complement traditional auditory rehabilitation programs. This study introduces Cooklear, the first Turkish-language VR–based auditory rehabilitation game designed specifically for children using bilateral cochlear implants.The randomized controlled results demonstrate that VR-supported training significantly improves speech perception in noise compared to traditional rehabilitation alone.The findings emphasise the feasibility and clinical value of incorporating VR technology into pediatric auditory rehabilitation programs. This study introduces Cooklear, the first Turkish-language VR–based auditory rehabilitation game designed specifically for children using bilateral cochlear implants. The randomized controlled results demonstrate that VR-supported training significantly improves speech perception in noise compared to traditional rehabilitation alone. The findings emphasise the feasibility and clinical value of incorporating VR technology into pediatric auditory rehabilitation programs.