Unilateral cochlear implantation in children with a potentially useable contralateral ear

Benefits and risks related to cochlear implantation for children with residual hearing: a systematic review

OBJECTIVE

This study aimed to synthesise information concerning the potential benefits and risks related to cochlear implants (CIs) versus hearing aids (HAs) in children with residual hearing.

DESIGN

A systematic review of articles published from January 2003 to January 2019 was conducted.

STUDY SAMPLE

Our review included studies that compared the benefits and risks of CIs versus HAs in children (≤18 years old) with residual hearing. A total of 3265 citations were identified; 8 studies met inclusion criteria.

RESULTS

Children with CIs showed significantly better speech perception scores post-CI than pre-CI. There was limited evidence related to improvement in everyday auditory performance, and the results showed non-significant improvement in speech intelligibility. One study on social-emotional functioning suggested benefits from CIs. In four studies, 37.2% (16/43) of children showed loss of residual hearing and 14.0% (8/57) had discontinued or limited use of their device.

CONCLUSIONS

Children with CIs showed improvement in speech perception outcomes compared to those with HAs. However, due to the limited number of studies and information to guide decision-making related to other areas of development, it will be important to conduct further research of both benefits and risks of CIs in this specific population to facilitate decision-making.

Children using a unilateral cochlear implant and contralateral hearing aid: bimodal hearing outcomes when one ear is outside the UK (NICE 2009) audiological criteria for cochlear implantation - a single site case-control study

INTRODUCTION

In the new revised National Institute for Health & Care Excellence (NICE, TA566, 2019) guidelines for cochlear implantation (CI) have clearly stipulated that the hearing loss must be bilateral. Prior to this revision, children and young people (CYP) with asymmetrical thresholds have been considered for unilateral CI when one ear was in audiological criteria. Children with asymmetrical hearing loss represent an important cohort of potential CI candidates, who will continue to be prevented from benefiting from CI unless evidence is produced to support implantation and maximise subsequent benefit.The aim of this study is to evaluate the 'real-life' hearing performance in a group of children who have received a unilateral CI and who have hearing thresholds in the contralateral ear that are outside the current UK NICE 2019 audiological criteria for CI. The contralateral ear will be aided using a conventional hearing aid (HA). The outcomes from this 'bimodal' group will be compared with a group of children who have received bilateral CI, and a group of children using bilateral HA, to extend the current knowledge about the different performance levels between bilateral CI, bilateral HA and bimodal hearing in CYP.

METHODS AND ANALYSIS

Thirty CYP aged 6-17 years old, 10 bimodal users, 10 bilateral HA users and 10 bilateral cochlear implant users will be subjected to a test battery consisting of: (1) spatial release from masking, (2) complex pitch direction discrimination, (3) melodic identification, (4) perception of prosodic features in speech and (5) TEN test. Subjects will be tested in their optimal device modality. Standard demographic and hearing health information will be collected. In the absence of comparable published data to power the study, sample size was determined on pragmatic grounds. Tests are exploratory and for hypothesis generating purposes. Therefore, the standard criterion of p<0.05 will be used.

ETHICS AND DISSEMINATION

This has been approved by the Health Research Authority and NHS REC within the UK (22/EM/0104). Industry funding was secured via a competitive researcher-led grant application process. Trial results will be subject to publication according to the definition of the outcome presented in this protocol.

In an era of bilateral funding and changing criteria, when is unilateral cochlear implantation a better option?

BACKGROUND

Funding for paediatric bilateral cochlear implantation became available in Ireland in 2014. Prior to this, children eligible for cochlear implantation received a unilateral implant.

OBJECTIVE

To examine the cohort of children who received a unilateral cochlear implant in the 4 year period following bilateral cochlear implantation funding becoming available.

METHODS

A clinical audit of all children implanted for the first time between July 2014 and July 2018. The unilaterally implanted children (n = 105) were divided into 3 groups according to whether they met the audiometric thresholds for implantation in neither ear (Group 1), one ear (Group 2) or both ears (Group 3). One year post operative functional outcomes were examined for all 3 groups.

RESULTS

All 3 groups showed significant improvements in functional outcomes at 1 year post op. To date, 20% of the unilaterally implanted children have proceeded to get a sequential CI, often where there was no change in audiological status.

CONCLUSIONS

The number of children in Groups 1 and 2 highlighted how our decision making around cochlear implantation has changed in recent years. Unilateral cochlear implantation in certain circumstances is good practice, independent of the audiological profile when an experienced multi-disciplinary team (MDT) is involved in the decision making process. Decision making using a holistic model approach is key, including involving the parent/carer and, where appropriate, the child/teenager themselves. A staged bilateral cochlear implant is also a good option, where careful monitoring and support for the first implant has resulted in positive outcomes.