The <i>objective</i> of the study was to measure the effectiveness of the aided auditory threshold and speech-language performance of children with cochlear implant use longer than 4 years in North-East region of rural India. <i>Study design</i>- A longitudinal study of ninety-three children with mean age of 3.8 years with standard deviation (SD) of 0.9 years (61 males and 32 females) with unilateral cochlear implant below poverty line in rural India and with 2 years intervention of post implant auditory verbal therapy were included in the study. This study was based on the assessment of outcomes of unilateral Cochlear Implantation while reviewing various measuring scoring systems like Categories of Auditory perception (CAP), Milestones for early communication development, Receptive Expressive Emergent Language Skill (REELS), Auditory Skills Checklist (ASC); for articulation assessment- available articulation test in local language and spontaneous speech sample and Aided audiogram thresholds. The <i>results</i> on the average of the post operative auditory global threshold (T0) just after cochlear implantation was 33.53±8.91dBSPL and after continuously using 4 years cochlear implant for auditory global threshold was 32.56±6.43dBSPL. The ASC revealed 46% were able to comprehend, CAP findings shows there is a significant difference (p=0.039, at p<0.05 level) in the auditory skills based on duration of hearing aid use before implantation. The difference between hearing aid user and non-hearing aid user was significant (p=0.034, p<0.05). The differences in the performance of children with Digisonic SP implantees group and Nucleus freedom implantees group in terms of aided auditory threshold and speech-language performance were not significant. Cochlear implant with auditory verbal therapy under ADIP scheme is evidence based treatment for children with profound hearing loss for speech and language acquisition and best hearing performance. This increased access to mainstream education, greater opportunities for employment, societal and economic benefits. In conclusion cochlear implant was beneficial to children with profound hearing loss, contributing to hearing performance and speech-language acquisition. However, there were indications of challenges with certain aspects of language, specifically receptive vocabulary and expressive grammar, suggested requirement of longer period intervention of post implant auditory verbal therapy. The results obtained seem to remain stable over the years.