Cochlear Implantation in Adults A Systematic Review and Meta-analysis

Importance: Sensorineural hearing loss is the third leading cause of years lived with disability worldwide. Cochlear implants may provide a viable alternative to hearing aids for this type of hearing loss. The Coverage and Analysis Group at the Centers for Medicare & Medicaid Services was interested in an evaluation of recently published literature on this topic. In addition, this meta-analysis is to our knowledge the first to evaluate quality-of-life (QOL) outcomes in adults with cochlear implants. Objective: To evaluate the communication-related outcomes and health-related QOL outcomes after unilateral or bilateral cochlear implantation in adults with sensorineural hearing loss. Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and previous reports from January 1, 2004, through May 31, 2012. Study Selection: Published studies of adult patients undergoing unilateral or bilateral procedures with multi-channel cochlear implants and assessments using open-set sentence tests, multisyllable word tests, or QOL measures. Data Extraction: Five researchers extracted information on population characteristics, outcomes of inter-est, and study design and assessed the studies for risk of bias. Discrepancies were resolved by consensus. Results: A total of 42 studies met the inclusion criteria. Most unilateral implant studies showed a statistically significant improvement in mean speech scores as measured by open-set sentence or multisyllable word tests; meta-analysis revealed a significant improvement in QOL after unilateral implantation. Results from studies assessing bilateral implantation showed improvement in communication-related outcomes compared with unilateral implantation and additional improvements in sound localization compared with unilateral device use or implantation only. Based on a few studies, the QOL outcomes varied across tests after bilateral implantation. Conclusions and Relevance: Unilateral cochlear implants provide improved hearing and significantly improve QOL, and improvements in sound localization are noted for bilateral implantation. Future studies of longer duration, higher-quality reporting, and large databases or registries of patients with long-term follow-up data are needed to yield stronger evidence. JAMA Otolaryngol Head Neck Surg. 2013; 139(3): 265-272. Published online February 21, 2013. doi: 10.1001/jamaoto.2013.1744