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in Communication Disorders
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Permanent Childhood Hearing Loss
Cochlear Implants Treatment

Placement (e.g., unilateral, bilateral, sequential) 


 

External Scientific Evidence

Evidence-Based Practice Guidelines
Cincinnati Children's Hospital Medical Center

Best Evidence Statement (BESt). Quality of Life in Children with Sequential Bilateral Cochlear Implants
Cincinnati Children's Hospital Medical Center. (2011).
Cincinnati (OH): Cincinnati Children's Hospital Medical Center, 6 pages.
Added: July 2012

Description
This guideline provides recommendations for the use of sequential bilateral cochlear implants in children with hearing loss.

Recommendations
“There is insufficient evidence and a lack of consensus to make a recommendation on the use of sequential bilateral cochlear implants rather than a unilateral cochlear implant to improve the quality of life in children with hearing loss” (p. 1).

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Evidence-Based Systematic Reviews
What Is the Effect of Time between Sequential Cochlear Implantations on Hearing in Adults and Children? A Systematic Review of the Literature
Smulders, Y. E., Rinia, A. B., et al. (2011).
Laryngoscope, 121(9), 1942-1949.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of cohort studies investigating the effects of time between sequential cochlear implantations on hearing outcomes in adults and children with hearing loss.

Conclusions
The overall quality of the evidence was considered poor with a significant risk of bias. The authors concluded that in prelingually deafened children, “Current clinical evidence regarding the effect of time delay between sequential cochlear implantations, however, suggests that a second implant can be beneficial even after a substantial delay” (p. 1948).

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Effectiveness of Multi-Channel Unilateral Cochlear Implants for Profoundly Deaf Children: A Systematic Review
Bond, M., Elston, J., et al. (2009).
Clinical Otolaryngology, 34(3), 199-211.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of studies investigating the effectiveness of multi-channel unilateral cochlear implants in profoundly deaf children.

Conclusions
“The review of economic evaluations found unilateral implantation of children to be cost effective in those profoundly deaf children selected by implant centers” (p. 210). “As with clinical effectiveness, the particular characteristics of children for whom unilateral cochlear implants would be the most cost-effective are uncertain” (p. 207).

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The Effectiveness and Cost-Effectiveness of Cochlear Implants for Severe to Profound Deafness in Children and Adults: A Systematic Review and Economic Model
Bond, M., Mealing, S., et al. (2009).
Health Technol Assess, 13(44), 1-330.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of systematic reviews, meta-analyses, randomized controlled trials, and ongoing research investigating the effectiveness of cochlear implantation for children and adults with hearing loss.

Conclusions
  • “The evidence from these studies, albeit with important limitations, suggests that there may be an advantage of bilateral implantation over unilateral implantation in children” (p. 36). However, additional, higher-quality studies are needed.

  • “From the limited number of studies it seems that there may be an additional benefit for children from having two cochlear implants compared with one plus an acoustic hearing aid, although the methodological quality of these studies was limited” (p. 38). “Unilateral cochlear implants improve the hearing, speech perception and speech production of severely to profoundly and profoundly sensorineurally deaf children, and additional benefit may be gained by early implantation” (p. 30).

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The Effectiveness of Bilateral Cochlear Implants for Severe-to-Profound Deafness in Children: A Systematic Review
Sparreboom, M., van Schoonhoven, J., et al. (2010).
Otology & Neurotology, 31(7), 1062-71.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is of a systematic review of controlled studies investigating the effectiveness bilateral cochlear implantation (BiCI) compared to unilateral implantation (UCI) alone or with a contralateral hearing aid in children with severe-to-profound hearing loss. This is a partial update of another review (Bond, Mealing, Anderson, et al., 2009).

Conclusions
“No robust conclusions could be drawn about the clinical effectiveness of BiCIs from the present body of evidence. However, within the LoE [levels of evidence], it seemed that BiCIs were better than UCI in certain listening situations, such as the perception of speech in quiet and when the speech and noise were spatially separated” (p. 1069).

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Bilateral Paediatric Cochlear Implants: A Critical Review
Johnston, J. C., Durieux-Smith, A., et al. (2009).
International Journal of Audiology, 48(9), 601-17.
Added: July 2012

Description
This is a systematic review of the peer-reviewed literature investigating the effects of bilateral cochlear implants (BICIs) in children with hearing loss.

Conclusions
  • "The available articles on bilateral implantation in children provide evidence that there are benefits to children who receive a second CI [cochlear implant]. The benefits include improved performance on speech recognition in noise and sound localization tasks and in auditory brainstem and cortical evoked potential responses" (p. 616).

  • "Children with BICIs that are activated at earlier ages and with shorter gaps between surgeries appear to receive greater benefit than those implanted later and with longer gaps between surgeries” (p. 616).

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Bilateral Cochlear Implantation: An Evidence-Based Medicine Evaluation
Murphy, J., & O'Donoghue, G. (2007).
Laryngoscope, 117(8), 1412-8.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of the literature investigating the outcomes associated with bilateral cochlear implantation in children and adults with hearing loss.

Conclusions
  • “Comparisons within the pediatric group are difficult because of the small number and varieties of studies…The limited available data suggest that not only is bilateral implantation more effective than unilateral or bimodal stimulation, but improved auditory abilities are seen if the implantations are performed simultaneously. However, bimodal stimulation should not be dismissed because this can provide significant benefits from the additional pitch and timing information of the acoustical input in those patients with residual hearing in the contralateral ear” (p. 1418).

  • "The available evidence supports the current trend toward bilateral cochlear implantation. None of the studies found a disadvantage in using a second implant, and all of the studies demonstrated, to varying degrees, that the auditory ability investigated was materially improved by binaural hearing” (p. 1418).

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Clinical Expertise/Expert Opinion

Consensus Guidelines
Cochlear AG Europe

European Bilateral Pediatric Cochlear Implant Forum Consensus Statement
Ramsden, J. D., Gordon, K., et al. (2012).
Otology & Neurotology, 33(4), 561-565.
Added: May 2013

Description
This guideline provides recommendations for the use of cochlear implants in young children.

Recommendations
"...the infant or child with unambiguous cochlear implant candidacy should receive bilateral cochlear implants simultaneously as soon as possible after definitive diagnosis of deafness to permit optimal auditory development; an atraumatic surgical technique designed to preserve cochlear function, minimize cochlear damage, and allow easy, possibly repeated re-implantation is recommended" (p. 561).

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National Institute for Health and Clinical Excellence

Cochlear Implants for Severe to Profound Deafness in Children and Adults
National Institute for Health and Clinical Excellence. (2009).
London (UK): National Institute for Health and Clinical Excellence, No. TA166.
Added: July 2012

Description
This evidence-based and consensus-based guideline provides recommendations for the cochlear implantation of children and adults with severe to profound deafness. The primary audience of this guideline is healthcare professionals.

Recommendations

  • Children with severe to profound deafness who do not receive adequate benefit from hearing aids should have the option to undergo unilateral or simultaneous bilateral cochlear implantation.

  • For children with severe to profound hearing loss, sequential bilateral cochlear implantation is not recommended.

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Client/Patient/Caregiver Perspectives

Parental Perspectives on Decision-Making and Outcomes in Pediatric Bilateral Cochlear Implantation
Fitzpatrick, E. M., Jacques, J., et al. (2011).
International Journal of Audiology, 50(10), 679-687.
Added: July 2012

Description:
This is a qualitative study exploring parental perspectives on bilateral cochlear implantation by way of individual semi-structured interviews. Fourteen parents of children who had received a second cochlear implant during a three-year period agreed to participate.

Conclusions
The following findings were reported:

  • Three primary reasons for parents seeking bilateral implants for their children emerged: 1) maximizing the child’s potential, 2) capitalizing on neuroplasticity, and 3) ensuring that the child had a back-up device

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Functional Outcome of Sequential Bilateral Cochlear Implantation in Young Children: 36 Months Postoperative Results
Scherf, F. W., van Deun, L., et al. (2009).
International Journal of Pediatric Otorhinolaryngology, 73(5), 723-730.
Added: July 2012

Description:
This study examines the effects of bilateral cochlear implantation on young children. Outcomes included auditory performance, speech intelligibility, communication mode, classroom placement, and parent reports.

Conclusions
Almost all parents and children were satisfied with the second cochlear implant, however some advantages (from parents of children older than 6 years) including, long adjustment period, dominance of the first cochlear implant for speech understanding. Also parents of both younger (less than 6 years) and older children (6 years or older) reported no changes in behavior or localization after 3 years of use. No parents regretted the decision to pursue bilateral implantation, though many acknowledged that their child still experienced some difficulties.

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