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The Effectiveness of Bilateral Cochlear Implants for Severe-to-Profound Deafness in Children: A Systematic Review

Sparreboom, Marloes*; van Schoonhoven, Jelmer; van Zanten, Bert G. A.; Scholten, Rob J. P. M.§; Mylanus, Emmanuel A. M.*; Grolman, Wilko; Maat, Bert

doi: 10.1097/MAO.0b013e3181e3d62c
Cochlear Implants

Objective: To assess the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation alone or with a contralateral hearing aid (bimodal stimulation), in children with severe-to-profound hearing loss. Recently, the National Institute for Health and Clinical Excellence (NICE) in the U.K. has conducted a systematic review on cochlear implantation. We decided to update the pediatric part of the NICE review.

Data Sources: The electronic databases MEDLINE and Embase were searched for European, North American, and Australasian studies published between October 2006 and June 2009. Reference lists of the included articles were also searched for relevant articles.

Study Selection: Studies were included if they comprised data on comparisons between bilateral cochlear implantation and unilateral cochlear implantation and/or bilateral cochlear implantation and bimodal stimulation, in children with severe-to-profound sensorineural hearing loss. The following outcome measures were analyzed: audiological, speech perception, speech production, functional capacities, health-related quality of life, and/or educational outcomes.

Data Extraction: Characteristics of the participants, interventions, outcomes, and methodological comments were entered into data extraction forms and the level of evidence was assessed.

Data Synthesis: Results were standardized for each outcome measure by calculating a standardized mean difference (effect size).

Conclusion: Effect sizes could not be pooled because of the heterogeneity of the studies. Therefore, we presented the results qualitatively. Although the level of evidence was low, the advantages of bilateral cochlear implants corresponded with the primary benefits of bilateral hearing, that is, improved speech perception in quiet and noise. Localization results were less consistent. No data on audiologic, speech production, or educational outcomes were available.

*Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; †Department of Clinical and Experimental Audiology, Academic Medical Center, Amsterdam; ‡Department of Otorhinolaryngology and Head and Neck Surgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht; §Dutch Cochrane Centre and Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam; and ∥Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, The Netherlands

Address correspondence and reprint requests to Marloes Sparreboom, M.A., Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; E-mail:

This study was financed by the Dutch Health Care Insurance Board (CVZ, project OP08/642/020).

Supplemental digital content is available in the text.

© 2010 Otology & Neurotology, Inc.