Cochlear Implants Versus Hearing Aids in Children With Auditory Neuropathy Spectrum Disorder: A Systematic Review

Auditory neuropathy spectrum disorder (ANSD) is a heterogeneous hearing disorder characterized by impaired auditory neural synchrony and variable auditory and communication outcomes. Hearing aids (HAs) are commonly used as initial treatment, whereas cochlear implantation (CI) may be considered for children who show inadequate progress with amplification. This systematic review compared auditory and communication outcomes of CI and HAs in children with ANSD. PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched through 6 August 2026 for comparative studies reporting quantitative auditory or communication outcomes for both CI and HA groups. Because outcomes were reported using heterogeneous measures and formats, findings were synthesized narratively, with one dichotomous outcome analyzed quantitatively. Open-set speech perception outcomes showed substantial overlap between children using CI and HAs, and no study demonstrated a statistically significant difference between devices. In one study, at least 60% open-set speech perception was achieved by 6/16 (37.5%) children with CI and 4/8 (50.0%) children with HAs, with no statistically significant difference. Closed-set speech perception was achieved by 14/16 (87.5%) children with CI and 6/8 (75.0%) children with HAs. Language outcomes were also broadly similar between treatment groups. Some children who showed inadequate progress with HAs subsequently achieved useful open-set speech perception after CI. Current evidence does not establish a clear difference in auditory or communication outcomes between CI and HAs in children with ANSD. Treatment decisions should be individualized according to auditory development, response to amplification, speech perception, language development, and other relevant clinical factors. Further prospective comparative studies using standardized outcome measures are needed.