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Updated: Sep 4, 2025
Robotic Cochlear Implantation for Direct Cochlear Access
Published on: June 16, 2022
In an era of bilateral funding and changing criteria, when is unilateral cochlear implantation a better option?
Olivia Ferguson1, Cristina Simões-Franklin2,3, Peter Walshe2,4
1National Hearing Implant and Research Centre (NHIRC), Beaumont Hospital, Dublin 9, Ireland. oliviaferguson@beaumont.ie.
Insights
Paediatric cochlear implant (CI) outcomes improved after bilateral CI funding. Unilateral CI remains beneficial in select cases, emphasizing a holistic approach and experienced multidisciplinary teams for optimal decision-making.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neurosurgery
Background:
- Paediatric bilateral cochlear implantation funding became available in Ireland in 2014.
- Previously, eligible children received unilateral cochlear implants.
- This study examines children receiving unilateral implants post-2014.
Purpose of the Study:
- To evaluate the outcomes of children who received a unilateral cochlear implant (CI) after bilateral CI funding was introduced.
- To analyze functional outcomes one year post-implantation.
Main Methods:
- Clinical audit of first-time implanted children (July 2014-July 2018).
- Categorized 105 unilaterally implanted children into three groups based on audiological thresholds.
- Assessed one-year postoperative functional outcomes for all groups.
Main Results:
- All three groups demonstrated significant functional improvements one year post-surgery.
- 20% of unilaterally implanted children later received a sequential contralateral CI.
- Sequential implantation occurred even without audiological status changes.
Conclusions:
- The shift towards unilateral implantation in specific cases reflects evolving decision-making processes.
- Unilateral CI can be effective, irrespective of audiological profile, with an experienced multidisciplinary team (MDT).
- A holistic decision-making model, including parental/patient involvement and staged bilateral implantation, is recommended.
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.
