Auditory Outcomes Following Cochlear Implantation in Children with Unilateral Hearing Loss.

OBJECTIVE: Unilateral hearing loss (UHL) in children is associated with speech and language delays. Cochlear implantation (CI) is currently the only rehabilitative option that restores binaural hearing. This study aims to describe auditory outcomes in children who underwent CI for UHL and to determine the association between duration of hearing loss and auditory outcomes. STUDY DESIGN: Retrospective case series. SETTING: Three tertiary-level, academic institutions. PATIENTS: Children <18 years with UHL who underwent CI between 2018 and 2021. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Speech perception and Speech, Spatial and Qualities of Hearing Scale (SSQ) were assessed postimplantation. Scores >50% on speech perception and SSQ scores >8 points were considered satisfactory. Associations between duration of UHL and implantation age and outcomes were assessed using Spearman's rank correlation. RESULTS: Of the 38 children included, mean age at CI was 7.9 ± 3.2 years and mean UHL duration was 5.0 ± 2.8 years. Mean datalogging was 8.1 ± 3.1 hours/day. Mean auditory testing scores were SSQ, 7.9 ± 1.2; BABY BIO, 68.1 ± 30.2%; CNC, 38.4 ± 28.4%; WIPI, 52.5 ± 23.1%. Scores >50% on CNC testing were achieved by 40% of patients. SSQ scores >8 points were reported by 78% (7/9) of patients. There were no significant correlations between UHL duration and auditory outcomes. CONCLUSION: Overall, children with UHL who undergo CI can achieve satisfactory speech perception scores and SSQ scores. There were no associations between duration of hearing loss and age at implantation with auditory outcomes. Multiple variables may impact auditory outcomes, including motivation, family support, access to technology, and consistent isolated auditory training postactivation and should be taken into consideration in addition to age at implantation and duration of UHL in determination of CI candidacy.

Health-Related Quality of Life in Children With Unilateral Sensorineural Hearing Loss Following Cochlear Implantation.

OBJECTIVE: Evaluate health-related quality of life (HR-QOL) benefits with cochlear implantation (CI) in children with unilateral sensorineural hearing loss (USNHL) versus bilateral sensorineural hearing loss (BSNHL). STUDY DESIGN: A cross-sectional survey of parents of children who underwent CI for USNHL and BSNHL. SETTING: Tertiary care academic centers. METHODS: The "Children with cochlear implants: parental perspectives" survey was administered. Parents rated responses on a 5-point Likert scale. Scores greater than 3.0 were considered favorable. Responses were recorded within 8 domains and groups were compared with respect to domain scores. Analysis of covariance models was used to compare groups while adjusting for age at implantation and duration of implant use. RESULTS: There were 31 patients with USNHL and 27 patients with BSNHL. The average age of implantation in BSNHL patients was 1.9 and 6.7 years for USNHL. Parents of all children answered favorably in all domains. When adjusted for age at implantation and duration of implant use, parents of BSNHL children responded significantly more favorably only in 2 domains. When comparing patients with older age or prolonged duration of hearing loss in the USNHL cohort, there were favorable responses in all domains with no significant differences between groups. CONCLUSION: There are HR-QOL benefits of CI in USNHL children; less pronounced favorable results were noted only in 2 domains when compared to BSNHL children. Benefits were noted with CI in USNHL children at an older age at implantation or prolonged duration of hearing loss. Therefore, these factors should not be absolute contraindications for CI in USNHL.

(Even Off-Label) Cochlear Implantation in Single-Sided Deafness and Asymmetric Hearing Loss Results in Measurable Objective and Subjective Benefit.

OBJECTIVE: To quantify objective and subjective outcomes in cochlear implant (CI) recipients with asymmetric hearing loss, including single-sided deafness (SSD) whose candidacy was determined on an ear-specific basis when word recognition was 50% or less. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. BACKGROUND: The effectiveness of CI in cases of SSD and asymmetric hearing loss (AHL) has been described in terms of tinnitus suppression, improved speech recognition in quiet and noise, enhanced localization ability, and improved quality of life. However, CI is not yet routinely offered as a top option or standard of care for these individuals. Recent Food and Drug Administration (FDA) labeling limits aided word recognition in the ear to be implanted to only 5% in cases of AHL/SSD, which is significantly poorer than 40 to 50%, which is often referenced in cases of bilateral hearing loss. Anecdotal experience suggests that patients with much better preoperative word recognition than 5% can benefit from CI. METHODS: We conducted a retrospective chart review of all adult CI candidates, with one ear exhibiting consonant-nucleus-consonant (CNC) word recognition scores at least 50% and one ear not meeting CI candidacy (i.e., CNC word recognition >50%). Outcome variables of interest included word and sentence recognition and subjective handicap questionnaires (hearing, tinnitus, dizziness) and the Speech Spatial Qualities questionnaire. RESULTS: Statistically and clinically significant improvement in speech understanding (word, sentence, sentence in noise) was noted for both the SSD and AHL groups in the implanted ear. There were statistically and clinically significant subjective improvements noted for both groups on the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Speech Spatial Qualities questionnaire by 1 month after activation. There were no significant differences between the AHL and SSD groups on either objective or subjective measures of the implanted ear. Individual word understanding improved for the majority of recipients across both groups and is not dependent on meeting the FDA criteria of less than 5%. CONCLUSIONS: Cochlear implantation is a viable option with measurable objective and perceived benefits for recipients with preoperative aided CNC word scores exceeding current FDA labeling. There is no significant difference between the AHL and SSD groups, suggesting that candidacy and outcome expectations should be set based on the ear to be implanted alone, without regard for the ability of the better hearing ear.