Purpose <p>The study aims to compare the prevalence of TORCH (Toxoplasma, Rubella, Cytomegalovirus and Herpes virus) IgG and IgM titres in hearing-impaired children with normal-hearing children within the 1 to 5 year age group. It also seeks to examine long-term outcomes, in terms of speech using modified CAP (Categories of Auditory Performances) scores and SIR (Speech Intelligibility Rating) scores, for TORCH-positive versus TORCH-negative cochlear implant candidates in an age-specific manner.</p> Materials and methods <p>The study was conducted between April 2022 and September 2023 in the outpatient department of a tertiary care teaching hospital, with children aged between 1 and 5 years. 550 hearing-impaired children were screened for TORCH IgG and IgM titres over 1.5 years. 385 TORCH-positive children (children who had detectable IgG or IgM antibodies to any of the TORCH pathogens) and 165 TORCH-negative children were enrolled in the study following the inclusion criteria. In our study, we defined TORCH-positive children as those who had detectable IgG or IgM antibodies to any of the TORCH pathogens. This is purely a serological conclusion, and most children were clinically asymptomatic. From these 385 TORCH-positive children, 50 were selected through random sampling after exclusion. From the 165 TORCH-negative children, another 50 children were selected following random sampling after exclusion. The 100 hearing-impaired children underwent cochlear implant and followed up for 1 year with auditory verbal therapy, and assessment of speech outcome was done using the modified CAP score and SIR score. One hundred normal-hearing children from OPD were tested for the prevalence of TORCH IgG and IgM titers according to convenient sampling, aged between 1 and 5 years.</p> Results <p>For TORCH-positive, hearing-impaired children, the highest prevalence was observed for Rubella IgG (<i>n</i> = 44, 88%) and Rubella IgM (<i>n</i> = 5, 10%), followed by CMV IgG (<i>n</i> = 41, 82%) and CMV IgM (<i>n</i> = 12, 24%). The TORCH IgG and IgM titres were significantly higher in hearing-impaired children than in children with normal hearing. Among TORCH-negative children, mean CAP scores were 2, 4, 7 and 8 at the end of the 3rd ,6th ,9th and 12th month respectively. Among TORCH-positive children, mean CAP scores were 3, 5, 7 and 9 at the end of 3rd, 6th ,9th and 12th months, respectively. SIR scores were 4 and 5 at the end of the 6th and 12th months for TORCH-negative children, and 2 and 3 for TORCH-positive children. Speech outcomes, using modified CAP scores and SIR scores, were compared in an age-specific manner between TORCH-positive and TORCH-negative cochlear implant candidates. No significant difference was found between the two groups.</p> Conclusion <p>TORCH infection prevalence was higher in hearing-impaired children as compared to normal-hearing children. However, among cognitively normal cochlear implant recipients, no significant difference in modified CAP scores &amp; SIR scores were observed between TORCH- positive and TORCH-negative groups.</p>