Cochlear Implantation and Perioperative Management in Autoimmune Inner Ear Disease: A Systematic Review and Meta-Analysis

Nikita Deshpande; Nathan Aminpour; Hui Cheng; J Dixon Johns; Michael Hoa

doi:10.1097/ONO.0000000000000006

Cochlear Implantation and Perioperative Management in Autoimmune Inner Ear Disease: A Systematic Review and Meta-Analysis

Otol Neurotol Open. 2021 Dec 9;1(2):e006. doi: 10.1097/ONO.0000000000000006. eCollection 2021 Dec.

Authors

Nikita Deshpande¹, Nathan Aminpour¹, Hui Cheng², J Dixon Johns³, Michael Hoa^{3

4}

Affiliations

¹ Georgetown University School of Medicine, Washington, DC.
² Bioinformatics and Biostatistics Collaboration Core, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD.
³ Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC.
⁴ Auditory Development and Restoration Program, Otolaryngology Surgeon-Scientist Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD.

Abstract

Objective: To assess outcomes in autoimmune inner ear disease (AIED) after cochlear implantation (CI) through systematic review and meta-analysis.

Databases reviewed: PubMed, MedLine, Embase, and CINAHL.

Methods: Databases were queried for inclusion of AIED patients who underwent CI with outcomes recorded ≥3 months postoperatively. We examined demographics, pure-tone average (PTA), speech perception, preoperative imaging, intraoperative management, and postoperative complications.

Results: Twenty-six articles encompassing 124 patients met inclusion criteria. Mean implantation age was 26.2 years (range 4-65 years) with average length of follow-up at 28.2 months (range 3-120 months). Meta-analysis demonstrated significant improvement in speech perception following CI. There was a statistically significant improvement in speech recognition score (SRS) (standard mean difference [SMD] = 6.5, 95% confidence interval [CI], 4.8-8.0, P < 0.0001) as well as word recognition score (WRS) (SMD = 5.5, 95% CI, 4.2-6.8, P < 0.0001) after CI. Anomalous preoperative radiologic manifestations were reported by 57.7% (15/26) studies. Disease activity-related intraoperative adjustment was noted in 57.7% (15/26) studies; common consequences were cochlear drill-out (53.3%), difficult round window insertion (26.7%), and scala vestibuli insertion (26.7%). Frequent postoperative complications noted in 26.9% (7/26) studies included systemic AIED flares (71.4%) and wound healing delay (42.9%).

Conclusion: Findings of this systematic review of AIED cochlear implant literature demonstrate a lack of consistent reporting standards for PTA and speech perception as well as a lack of long-term follow-up. Despite these findings, meta-analysis suggests that CI is a viable treatment for improving speech perception in AIED patients.

Keywords: Autoimmune inner ear disease; Cochlear implant; Pure-tone average; Speech perception; intraoperative management.