Quality of life in children with unilateral hearing loss undergoing cochlear implantation: A systematic review and meta-analysis

Abstract

Objectives: Children with Single-Sided Deafness (SSD) may experience a range of developmental challenges. While cochlear implantation has demonstrated significant improvements in hearing, its impact on Quality of Life (QoL) remains underreported. This review evaluates how cochlear implantation for SSD influences the quality of life in children.

Methods: A systematic review was conducted following the PRISMA guidelines across nine different databases, without language restrictions, including articles indexed up to December 15, 2023. Eligible studies included patients up to 18-years-old; severe to profound unilateral hearing loss, and normal contralateral hearing; cochlear implantation with more than 3 months of follow-up; QoL assessed by structured questionnaires. Meta-analysis compared QoL scores obtained between pre- and post-operative periods for time of onset or hearing loss (congenital vs. post-lingual), evaluated by parents and children, and the effective cochlear implant usage time.

Results: A total of 296 articles were identified, with 6 eligible for qualitative analysis and 3 for meta-analysis, involving 187 patients. The mean age at implantation was 5.8 years, with an average auditory deprivation time of 3.8 years. Both the congenital and post-lingual groups demonstrated improvement in QoL, with a mean increase of 1.51 points in children's evaluations (p-value < 0.001) and 2.70 points in parental perspectives (p-value < 0.001), assessed on a 10-point scale. The estimated effective device use time was 8.8 h per day, with 8.55 h per day for the congenital group and 10.37 h per day for the post-lingual group. There was no statistically significant difference in usage time between the two groups (p-value = 0.140).

Conclusion: The results indicated a significant improvement in QoL, as reported by both parents and through self-assessment. The treatment also demonstrated high levels of adherence. Both congenital and post-lingual groups yielded similar outcomes in terms of QoL and device usage time.

Keywords: Child; Cochlear implant; Quality of life; Unilateral hearing loss.

Fig. 1

PRISMA flowchart.

Fig. 2

Forest plot illustrating changes in quality of life, as measured by the increase in the mean scores obtained from the SSQ questionnaire after Cochlear Implantation (CI), in relation to the time of onset of hearing loss, as reported by parents. Note that the diamonds intersect the line of similarity, confirming no significant difference between the groups (p = 0.21).

Fig. 3

Forest plot illustrating changes in quality of life, as measured by the SSQ questionnaire, after Cochlear implantation (CI) in congenital hearing loss group, as reported by children.

Fig. 4

Forest plot illustrating the mean responses obtained from the SSQ questionnaire before Cochlear Implantation (CI) in congenital and post-lingual groups, as reported by parents. Note that the diamonds intersect the line of similarity, confirming no significant difference between the groups (p = 0.55).

Fig. 5

Forest plot illustrating Cochlear Implantation (CI) usage time, in hours per day, not separated by group.

Fig. 6

Forest plot comparing the time of use of children in the congenital/perilingual and post-lingual groups. In the Arndt et al. and Hicks et al. studies, the first occurrence corresponds to individuals with congenital hearing loss and the second to perilinguals.