Benefit of sequential bilateral cochlear implantation in children between 5 to 18 years old: A prospective cohort study

Abstract

Objective: To determine the benefit of sequential cochlear implantation after a long inter-implantation interval in children with bilateral deafness receiving their second implant between 5 and 18 years of age.

Study design: Prospective cohort-study.

Setting: Tertiary multicenter.

Patients: 85 children with bilateral deafness and unilateral implantation receiving a contralateral cochlear implant at the age of 5 to 18 years.

Method: The primary outcomes were speech recognition in quiet and noise (CVC) scores. The secondary outcomes were language outcomes and subjective hearing abilities, all measured before and 12 months after sequential bilateral cochlear implantation. Medians of the paired data were compared using the Wilcoxon signed-rank test. Univariable linear regression analyses was used to analyze associations between variables and performance outcomes.

Results: A significant benefit was found for speech recognition in quiet (96% [89-98] vs 91% [85-96]; p < 0.01) and noise (65% [57-75] vs 54% [47-71]; p = 0.01) in the bilateral CI condition compared to unilateral (n = 75, excluded 10 non-users). No benefit was seen for language outcomes. The subjective sound quality score was statistically significant higher in bilateral compared to the unilateral CI condition. Pre-operative residual hearing level in the ear of the second implant, the inter-implant interval and age at time of second implantation was not significantly associated with performance scores.

Conclusion: After 12 months of use, sequential bilateral cochlear implantation showed improved speech perception in quiet and noise and improved subjective sound quality outcomes in children despite a great inter-implantation interval (median of 8 years [range 1-16 years]).

Fig 1. Flow chart of available test scores.

Flow chart of study population and numbers of participants in analysis per outcome measure (in brackets missings per outcome). Note: CVC = consonant-vowel-consonant; SSQ = Speech, Spatial and Qualities of Hearing Scale; PPVT = Peabody Picture Vocabulary Test; CELF = Clinical Evaluation of Language Fundamentals. *For the non-users no postoperative performance outcomes were measured by the non-use of CI2 in daily life.