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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Benefits of bilateral cochlear implantation in children: a systematic review and meta-analysis
Anastasia Zhuchkova1, Joan Remacha2, Marta Sandoval2
1Dept. of Surgical Specialties, University of Barcelona Medical School, Casanova 143, Barcelona, 08036, Spain.
Insights
Bilateral cochlear implantation (BiCI) offers significant advantages in speech perception, sound localization, and language development for children compared to unilateral cochlear implantation (UniCI). These benefits are most pronounced with early implantation, and BiCI is a safe and effective intervention.
Area of Science:
- Audiology and Speech-Language Pathology
- Pediatric Otolaryngology
- Medical Technology Assessment
Background:
- Unilateral cochlear implantation (UniCI) is a standard treatment for unilateral hearing loss.
- Bilateral cochlear implantation (BiCI) aims to improve auditory and communication outcomes in children with bilateral deafness.
- Comparative effectiveness data for BiCI versus UniCI in pediatric populations require systematic evaluation.
Purpose of the Study:
- To systematically evaluate the benefits and risks of bilateral cochlear implantation (BiCI) versus unilateral cochlear implantation (UniCI) in children.
- To compare auditory outcomes, language development, and potential complications between BiCI and UniCI.
- To synthesize current evidence on the efficacy of BiCI in pediatric populations.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searches of major databases (PubMed, Scopus, etc.) for pediatric studies comparing BiCI and UniCI.
- Inclusion of studies focusing on speech perception, sound localization, language development, quality of life, and adverse events.
Main Results:
- BiCI demonstrated significantly superior outcomes in speech perception in noise (SMD = +0.70) and sound localization (SMD = +0.74).
- Language development, including receptive vocabulary (SMD = +0.65), also favored BiCI.
- Complications were infrequent and comparable to UniCI, with higher quality-of-life ratings for BiCI users.
Conclusions:
- Bilateral cochlear implantation provides a significant advantage over unilateral implantation for children, especially in challenging listening environments.
- Early and simultaneous implantation maximizes the benefits of BiCI for auditory and language development.
- While BiCI is safe and effective, heterogeneity in outcomes necessitates standardized longitudinal assessments.
Objective:
To systematically evaluate the benefits and risks of bilateral cochlear implantation (BiCI) in children compared with unilateral cochlear implantation (UniCI), with a focus on auditory outcomes, language development, and potential complications.
Methods:
A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO (1128982). Searches were performed in PubMed, ScienceDirect, Scopus, and the Cochrane Library for studies published between 2015 and June 2025, with selective inclusion of earlier high-quality pediatric studies. Eligible studies included children with congenital or early-onset bilateral deafness who received BiCI or UniCI. Primary outcomes were speech perception (especially in noise), sound localisation, and spoken language development. Secondary outcomes included quality of life and adverse effects. Random-effects meta-analyses were performed using standardised mean differences (SMD).
Results:
Fifty studies were included in the qualitative synthesis and 20 in the meta-analyses. BiCI provided significantly better outcomes in speech perception in noise (SMD = + 0.70, p < 0.001) and sound localisation (SMD = + 0.74, p < 0.001), with consistent benefits across study designs and populations. Language development also favoured BiCI (SMD = + 0.65 for receptive vocabulary). Earlier implantation and shorter inter-implant intervals were associated with larger benefits. Surgical and vestibular complications were infrequent and did not exceed those reported for UniCI. Quality-of-life ratings were consistently higher in BiCI users.
Conclusion:
Bilateral cochlear implantation offers a significant but variable advantage over unilateral implantation in children, particularly in noisy environments, spatial hearing, and language acquisition. While language outcomes generally favour BiCI, results show greater heterogeneity compared to auditory measures. Benefits are most robust with early and simultaneous implantation. Although BiCI is a safe and effective intervention, the observed methodological and clinical heterogeneity underscores the need for standardized longitudinal assessments.