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Objective: To determine the odds of different factors for developing poor speech intelligibility in pre-lingually deaf children who have undergone cochlear implantation. Study Design: Case-control study. Place and Duration of Study: Department of ENT, Combined Military Hospital, Rawalpindi Pakistan, Jan 2020 to Aug 2022. Methodology: This study was based on a sample of 60 patients: 30 cases with cochlear implants placed before two years of age, with a total time of using a cochlear implant of ≥1 year, and 30 controls. Both groups consisted of both genders aged between 3 and 12 years. All patients underwent assessment using the Speech Intelligibility Rating system and were documented for various factors influencing speech development. Results: The mean age of the sample at the time of the study was 6.37±3.17 years. A total of 34(56.7%) participants were male. Factors associated with poorer speech outcomes were male gender (OR0.44[CI 95% 0.15-1.30]), no peers in the household (OR 0.53 [CI 95% 0.15-1.84]), higher maternal literacy (OR 0.42[CI 95% 0.13-1.30]). Factors associated with improved speech development included primarily oral form of communication (OR 2.14[CI 95%0.41-11.17]), less than one-year age at implantation (OR 1.29 [CI 95% 0.24-6.96]), a total duration of speech therapy less than two years (OR 1.70[CI 95% 0.32-8.74]) and the presence of unilateral implants, (OR 6.33[CI 95% 1.00-40.07]). Conclusion: Earlier cochlear implantation with frequent verbal skill exercise appears essential to developing good speech intelligibility in pre-lingually deaf children. [ABSTRACT FROM AUTHOR]