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Review
August 27, 2020

Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
  • 3Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
  • 4Department of Otology and Neurotology, University of Nottingham, Nottingham, United Kingdom
  • 5Nottingham Biomedical Research Center, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, United Kingdom
  • 6Ohio State University Wexner Medical Center, The Ohio State University, Columbus
  • 7Rocky Mountain Ear Center, Englewood, Colorado
  • 8Department of Otolaryngology, The University of Melbourne, Melbourne, Victoria, Australia
  • 9Otology and Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  • 10Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  • 11Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota
  • 12Department of Otolaryngology, General Hospital of People’s Liberation Army, Beijing, China
  • 13Division of Head and Neck Surgery and Communication Sciences, Duke Surgery, Duke University School of Medicine, Durham, North Carolina
  • 14Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
  • 15Division of Otolaryngology–Head & Neck Surgery, School of Medicine, University of Utah Hospital, Salt Lake City
  • 16Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
  • 17now with Department of Otolaryngology, University of Miami, Miami, Florida
  • 18Cochlear Implant Department, Karolinska University Hospital, Stockholm, Sweden
  • 19Department of ENT and Head Neck Surgery, Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, India
  • 20Cochlear Implant Center, Stanford University School of Medicine, Stanford, California
  • 21Department of Ear Nose Throat, Radboud University Medical Centre, Nijmegen, the Netherlands
  • 22NYU Langone Health, New York University School of Medicine, New York
  • 23Royal National Throat, Nose and Ear Hospital and University College London Ear Institute, London, United Kingdom
  • 24Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Nadarzyn, Poland
  • 25Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
  • 26Institute of Sensory Organs, Kajetany, Nadarzyn, Poland
  • 27Arizona Hearing Center, Phoenix
  • 28School of Population Health–Audiology, The University of Auckland, Auckland, New Zealand
  • 29Department NKO & Head-Neck Surgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
  • 30Service d’Otologie et Oto-Neurologie, Centre Hospitalier Universitaire de Lille, Lille, France
  • 31Department of Otolaryngology–Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 32Department of Otorhinolaryngology and Auditory and Voice Surgery, University of Tokyo Hospital, Tokyo, Japan
  • 33Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.0998
Key Points

Question  How can we improve awareness about the potential advantages of cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss?

Findings  A Delphi consensus panel of 30 international specialists voted on statements about cochlear implant use, informed by a systematic review of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience.

Meaning  The consensus statements provide recommendations on the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss; they could inform the development of clinical practice guidelines, which could increase access to cochlear implantation worldwide and improve hearing and quality of life in eligible adults.

Abstract

Importance  Cochlear implants are a treatment option for individuals with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss (SNHL) who receive little or no benefit from hearing aids; however, cochlear implantation in adults is still not routine.

Objective  To develop consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral SNHL.

Design, Setting, and Participants  This study was a modified Delphi consensus process that was informed by a systematic review of the literature and clinical expertise. Searches were conducted in the following databases: (1) MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE, (2) Embase, and (3) the Cochrane Library. Consensus statements on cochlear implantation were developed using the evidence identified. This consensus process was relevant for the use of unilateral cochlear implantation in adults with severe, profound, or moderate sloping to profound bilateral SNHL. The literature searches were conducted on July 18, 2018, and the 3-step Delphi consensus method took place over the subsequent 9-month period up to March 30, 2019.

Main Outcomes and Measures  A Delphi consensus panel of 30 international specialists voted on consensus statements about cochlear implantation, informed by an SR of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience. A modified 3-step Delphi consensus method was used to vote on and refine the consensus statements. This method consisted of 2 rounds of email questionnaires and a face-to-face meeting of panel members at the final round. All consensus statements were reviewed, discussed, and finalized at the face-to-face meeting.

Results  In total, 6492 articles were identified in the searches of the electronic databases. After removal of duplicate articles, 74 articles fulfilled all of the inclusion criteria and were used to create the 20 evidence-based consensus statements. These 20 consensus statements on the use of unilateral cochlear implantation in adults with SNHL were relevant to the following 7 key areas of interest: level of awareness of cochlear implantation (1 consensus statement); best practice clinical pathway from diagnosis to surgery (3 consensus statements); best practice guidelines for surgery (2 consensus statements); clinical effectiveness of cochlear implantation (4 consensus statements); factors associated with postimplantation outcomes (4 consensus statements); association between hearing loss and depression, cognition, and dementia (5 consensus statements); and cost implications of cochlear implantation (1 consensus statement).

Conclusions and Relevance  These consensus statements represent the first step toward the development of international guidelines on best practices for cochlear implantation in adults with SNHL. Further research to develop consensus statements for unilateral cochlear implantation in children, bilateral cochlear implantation, combined electric-acoustic stimulation, unilateral cochlear implantation for single-sided deafness, and asymmetrical hearing loss in children and adults may be beneficial for optimizing hearing and quality of life for these patients.

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