Cochlear implantation impact on health service utilisation and social outcomes: a systematic review

Tolesa Bekele Okuba; Reidar P Lystad; Isabelle Boisvert; Anne McMaugh; Robyn Cantle Moore; Ramya Walsan; Rebecca J Mitchell

doi:10.1186/s12913-023-09900-y

Cochlear implantation impact on health service utilisation and social outcomes: a systematic review

BMC Health Serv Res. 2023 Aug 30;23(1):929. doi: 10.1186/s12913-023-09900-y.

Authors

Tolesa Bekele Okuba¹, Reidar P Lystad², Isabelle Boisvert³, Anne McMaugh⁴, Robyn Cantle Moore⁵, Ramya Walsan², Rebecca J Mitchell²

Affiliations

¹ Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia. tolesa.okuba@mq.edu.au.
² Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
³ Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁴ Macquarie School of Education, Faculty of Arts, Macquarie University, Sydney, Australia.
⁵ NextSense Institute, Sydney, Australia.

Abstract

Background: Hearing loss can have a negative impact on individuals' health and engagement with social activities. Integrated approaches that tackle barriers and social outcomes could mitigate some of these effects for cochlear implants (CI) users. This review aims to synthesise the evidence of the impact of a CI on adults' health service utilisation and social outcomes.

Methods: Five databases (MEDLINE, Scopus, ERIC, CINAHL and PsychINFO) were searched from 1st January 2000 to 16 January 2023 and May 2023. Articles that reported on health service utilisation or social outcomes post-CI in adults aged ≥ 18 years were included. Health service utilisation includes hospital admissions, emergency department (ED) presentations, general practitioner (GP) visits, CI revision surgery and pharmaceutical use. Social outcomes include education, autonomy, social participation, training, disability, social housing, social welfare benefits, occupation, employment, income level, anxiety, depression, quality of life (QoL), communication and cognition. Searched articles were screened in two stages ̶̶̶ by going through the title and abstract then full text. Information extracted from the included studies was narratively synthesised.

Results: There were 44 studies included in this review, with 20 (45.5%) cohort studies, 18 (40.9%) cross-sectional and six (13.6%) qualitative studies. Nine studies (20.5%) reported on health service utilisation and 35 (79.5%) on social outcomes. Five out of nine studies showed benefits of CI in improving adults' health service utilisation including reduced use of prescription medication, reduced number of surgical and audiological visits. Most of the studies 27 (77.1%) revealed improvements for at least one social outcome, such as work or employment 18 (85.7%), social participation 14 (93.3%), autonomy 8 (88.9%), education (all nine studies), perceived hearing disability (five out of six studies) and income (all three studies) post-CI. None of the included studies had a low risk of bias.

Conclusions: This review identified beneficial impacts of CI in improving adults' health service utilisation and social outcomes. Improvement in hearing enhanced social interactions and working lives. There is a need for large scale, well-designed epidemiological studies examining health and social outcomes post-CI.

Keywords: Adults; Cochlear implants; Health service utilisation; Social outcomes.

Publication types

Systematic Review

MeSH terms

Adult
Cochlear Implantation*
Cochlear Implants*
Cross-Sectional Studies
Health Services
Humans
Quality of Life