Background: Annually an estimated 223 children in the UK are born with or acquire permanent profound bilateral deafness (PBHL >or= 95 dB). These children may gain little or no benefit from acoustic hearing aids. However, cochlear implants might enable them to hear.
Objectives of the review: To bring together the diverse research in this area under the rigor of a systematic review to discover the strength of evidence when comparing the effectiveness of unilateral cochlear implants with non-technological support or acoustic hearing aids in children with PBHL.
Type of review: Systematic review.
Search strategy: This examined 16 electronic data bases, plus bibliographies and references for published and unpublished studies.
Evaluation method: Abstracts were independently assessed against inclusion criteria by two researchers, results were compared and disagreements resolved. Included papers were then retrieved and further independently assessed in a similar way. Remaining studies had their data independently extracted by one of five reviewers and checked by another reviewer.
Results: From 1,580 abstracts and titles 15 studies were included. These were of moderate to poor quality. The large amount of heterogeneity in design and outcomes precluded meta-analysis. However, all studies reported that unilateral cochlear implants improved scores on all outcome measures. Additionally five economic evaluations found unilateral cochlear implants to be cost-effective for profoundly deaf children at UK implant centres.
Conclusions: The robustness of systematic review methods gives weight to the positive findings of 15 papers reporting on this subject that they individually lack; while an RCT to show this would be unethical.