Family expectations regarding cochlear implant use in children and adolescents: a systematic review and meta-analysis

To answer the following question: what are the expectations of families of children and adolescents regarding the benefits of cochlear implant (CI) use?

This systematic review included studies assessing family expectations regarding the benefits of CI use in children and adolescents. Searches were performed across Embase, LILACS, PubMed, Scopus, Web of Science, Google Scholar, and ProQuest, without language or year restrictions. A meta-analysis of proportions with a random-effects model (DerSimonian-Laird) was performed, considering only 'strongly agree' responses as high expectations. An odds ratio meta-analysis was also conducted to compare expectations before and after CI activation.

Thirty-four studies were included, most presenting a high risk of bias. Approximately 55% of family members reported high expectations for exclusive oral communication, and 39% believed their child would understand speech without lip reading. Around 38% expected enrollment in mainstream schools, although only 14% strongly agreed that their child would keep up with hearing peers. Between 48% and 54% expressed high expectations regarding socialization in different contexts, and about 45% expected satisfactory CI functioning. The meta-analysis suggested a significant increase in expectations after CI activation, particularly for auditory and spoken language development.

Family expectations regarding the benefits of CI are generally high but vary across domains. Although the meta-analysis suggested an increase in expectations after device activation, the overall certainty of the evidence was low to very low, warranting cautious interpretation.