Prognostic indicators in paediatric cochlear implant surgery: a systematic literature review

Abstract

Background: Paediatric cochlear implantation (PCI) requires complex case evaluation and counselling, surgical intervention, and habilitation. Outcomes vary and many cases have sub-optimal outcomes as a result of a broad spectrum of adverse influences.

Objective: To systematically review the literature to identify research papers that indicate a demonstrated outcome or prognostic factor in paediatric CI, the overall aim being to develop a prognostic index for clinical use.

Methods: Six main literature domains were assessed: medical/surgical; audiology; psychology; speech/language; education; and family. Search strategies were applied to appropriate databases and journals. A strict inclusion criterion was utilized. A critical appraisal tool was administered to evaluate the final eligible citations.

Results: The review identified 92 citations, of which 38 were eligible. Heterogeneity in study design prevented a quantitative meta-analysis of the data. Discussion While there are a large range of factors that impact PCI outcomes, well-constructed case control studies are limited in number and scope and relatively few demonstrated significant prognostic factors. Only four factors were identified as consistently influencing PCI outcomes: age at implantation, Connexin 26, inner ear malformations, and meningitis.

Conclusion: Evaluation of relevant adverse prognostic factors in paediatric CI remains a largely unreported field. Better identification of these factors is required for improving vital pre-operative counselling and resultant surgical expectations and outcomes.