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Original Investigation
May 14, 2020

Association of Patient-Related Factors With Adult Cochlear Implant Speech Recognition Outcomes: A Meta-analysis

Author Affiliations
  • 1Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. Published online May 14, 2020. doi:10.1001/jamaoto.2020.0662
Key Points

Question  What are the associations between patient-related factors and cochlear implant (CI) speech recognition outcomes?

Findings  In this meta-analysis of 13 studies comprising 1095 patients, CI speech recognition outcomes were found to be negligibly associated with age at implantation, duration of hearing loss, preimplant pure-tone average, and preimplant word recognition.

Meaning  Patient-related factors often thought to influence CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation, which presents an opportunity for additional research to identify patient-related and other factors that predict CI outcomes.

Abstract

Importance  Multiple studies have evaluated associations between post–cochlear implant (CI) speech recognition outcomes and patient-related factors. Current literature often appears equivocal or contradictory, so little is known about the factors that contribute to successful speech recognition outcomes with CIs.

Objective  To use a meta-analysis to pool data from the extant literature and provide an objective summary of existing evidence on associations of patient-related factors and CI speech recognition outcomes.

Data Sources  A literature search was performed using PubMed, Scopus, and CINAHL databases in January 2019 using the following search terms: cochlear implant or cochlear implants or cochlear implantation and speech recognition or word recognition or sentence recognition. Studies of postlingually deafened adult CI recipients that reported word or sentence recognition scores were included.

Study Selection  Inclusion criteria were postlingual adult CI recipients 18 years or older with word or sentence recognition scores at minimum 6-month postimplantation. Studies that included patients undergoing revision or reimplantation surgery were excluded.

Data Extraction and Synthesis  Following the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines, 1809 unique articles underwent review by abstract, and 121 articles underwent full-text review, resulting in 13 articles of 1095 patients for a meta-analysis of correlations. Random-effects model was used when the heterogeneity test yielded a low P value (P < .05).

Main Outcomes and Measures  The planned primary outcome was the pooled correlation values between postimplant speech recognition scores and patient-related factors.

Results  Of the 1095 patients included from the 13 studies, the mean age at implantation ranged from 51.2 to 63.7 years and the mean duration of hearing loss ranged from 9.5 to 31.8 years; for the 825 patients for whom sex was reported, 421 (51.0%) were women. A weak negative correlation was observed between age at implantation and postimplant sentence recognition in quiet (r = −0.31 [95% CI, −0.41 to −0.20]). Other correlations between patient-related factors and postimplant word or sentence recognition were statistically significant, but all correlations were absent to negligible (r = 0.02-0.27).

Conclusions and Relevance  Given that most associations were weak, negligible, or absent, patient-related factors often thought to affect CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation. Additional research is needed to identify patient-related and other factors that predict CI outcomes, including speech recognition and other important variables related to success with CIs.

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