Bilateral or unilateral cochlear implantation for deaf children: an observational study

• Published in: Archives of disease in childhood Vol. 95; no. 2; pp. 107 - 112
• Main Authors: Lovett, R E S, Kitterick, P T, Hewitt, C E, Summerfield, A Q
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-02-2010; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adolescent; Assistive Technology; Auditory Perception; Biological and medical sciences; Care and treatment; Child; Child, Preschool; Childhood hearing disorders; Cochlear Implantation - methods; Cochlear Implantation - rehabilitation; Cochlear Implants; Cost analysis; Cross-Sectional Studies; Deafness; Deafness - psychology; Deafness - rehabilitation; Deafness - surgery; Design; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Ears & hearing; Families & family life; Family Income; Female; General aspects; Health aspects; Hearing disorders in children; Hearing Tests - methods; Humans; Infant; Listening comprehension; Listening Skills; Localization; Male; Medical sciences; Miscellaneous; Non tumoral diseases; Observational studies; Oral Language; Otorhinolaryngology. Stomatology; Patient outcomes; Performance Tests; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Schools; Socioeconomic Factors; Sound; Speech; Speech Perception; Surgery; Transplants & implants; Treatment Outcome; United States; United Kingdom > UK; Human; Pediatrics; Observational study; Auditory disorder; Unilateral; Cochlear implant; ENT disease; Bilateral; Child; Public health; Hearing loss
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2009.160325

Objective Cochlear implantation in one ear (unilateral implantation) has been the standard treatment for severe-profound childhood deafness. We assessed whether cochlear implantation in both ears (bilateral implantation) is associated with better listening skills, higher health-related quality of life (health utility) and higher general quality of life (QOL) than unilateral implantation. Design Cross-sectional observational study. Setting University of York. Participants Fifty severely-profoundly deaf and 56 normally-hearing children recruited via a charity, the UK National Health Service and schools. Interventions Thirty of the deaf children had received bilateral cochlear implants; 20 had unilateral cochlear implants. Main outcome measures Performance measures of children’s listening skills; parental-proxy valuations of the deaf children’s health utility obtained with the Health Utilities Index Mark 3 and of their QOL obtained with a visual analogue scale. Results On average, bilaterally-implanted children performed significantly better than unilaterally implanted children on tests of sound localisation and speech perception in noise. After conservative imputation of missing data and while controlling for confounds, bilateral implantation was associated with increases of 18.5% in accuracy of sound localisation (95% CI 5.9 to 31.1) and of 3.7 dB in speech perception in noise (95% CI 0.9 to 6.5). Bilaterally-implanted children did not perform as well as normally-hearing children, on average. Bilaterally- and unilaterally-implanted children did not differ significantly in parental ratings of health utility (difference in medians 0.05, p>0.05) or QOL (difference in medians 0.01, p>0.05). Conclusions Compared with unilateral cochlear implantation, bilateral implantation is associated with better listening skills in severely-profoundly deaf children.