Identification of Pure-Tone Audiologic Thresholds for Pediatric Cochlear Implant Candidacy

Abstract

IMPORTANCEAlthough current guidelines recommend cochlear implantation only for children with profound hearing impairment (HI) (>90 decibel [dB] hearing level [HL]), studies show that children with severe hearing impairment (>70-90 dB HL) could also benefit from cochlear implantation. OBJECTIVE To perform a systematic review to identify audiologic thresholds (in dB HL) that could serve as an audiologic candidacy criterion for pediatric cochlear implantation using 4 domains of speech and language development as independent outcome measures (speech production, speech perception, receptive language, and auditory performance).EVIDENCE REVIEW PubMed and Embase databases were searched up to June 28, 2017, to identify studies comparing speech and language development between children who were profoundly deaf using cochlear implants and children with severe hearing loss using hearing aids, because no studies are available directly comparing children with severe HI in both groups. If cochlear implant users with profound HI score better on speech and language tests than those with severe HI who use hearing aids, this outcome could support adjusting cochlear implantation candidacy criteria to lower audiologic thresholds. Literature search, screening, and article selection were performed using a predefined strategy. Article screening was executed independently by 4 authors in 2 pairs; consensus on article inclusion was reached by discussion between these 4 authors. This study is reported according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement.FINDINGS Title and abstract screening of 2822 articles resulted in selection of 130 articles for full-text review. Twenty-one studies were selected for critical appraisal, resulting in selection of 10 articles for data extraction. Two studies formulated audiologic thresholds (in dB HLs) at which children could qualify for cochlear implantation: (1) at 4-frequency pure-tone average (PTA) thresholds of 80 dB HL or greater based on speech perception and auditory performance subtests and (2) at PTA thresholds of 88 and 96 dB HL based on a speech perception subtest. In 8 of the 18 outcome measures, children with profound HI using cochlear implants performed similarly to children with severe HI using hearing aids. Better performance of cochlear implant users was shown with a picture-naming test and a speech perception in noise test. Owing to large heterogeneity in study population and selected tests, it was not possible to conduct a meta-analysis. CONCLUSIONS AND RELEVANCEStudies indicate that lower audiologic thresholds (Ն80 dB HL) than are advised in current national and manufacturer guidelines would be appropriate as audiologic candidacy criteria for pediatric cochlear implantation.

A Scoping Review of Studies Comparing Outcomes for Children With Severe Hearing Loss Using Hearing Aids to Children With Cochlear Implants

“…We suggest that more consistent approaches to data collection, for example, by developing core outcome sets or establishing other forms of international consensus on choice of outcomes, would aid future evidence syntheses in addition to greater consistency in how study populations are defined by inclusion and exclusion criteria. Scoping reviews such as this are complimentary to systematic reviews such as that of de Kleijn et al (2018) in part because they can catalogue a wider range of outcomes, and study designs, and in doing so identify gaps for further research to address, and opportunities for formal meta-analyses to be conducted where there is evidence of comparable outcome data.…”

“…We aimed to ensure that our review complemented rather than duplicated (Bond et al 2009a). We therefore searched for studies published from July 2007 to the present, immediately following the search by Bond et al (2009a), but overlapping the period considered by de Kleijn et al (2018) due to the more restricted range of outcomes they considered. Only peer-reviewed records were included.…”

Evolving Criteria for Adult and Pediatric Cochlear Implantation

“…While the expansion of the indication to recognize the benefits of adequate binaural hearing, the literature suggests that children with greater degrees of word understanding in the poorer hearing ear may similarly benefit from implantation. 52,[55][56][57] Further, children under the age of 5 have also been successfully implanted. Cushing et al suggest that every effort must be made to limit the period of auditory deprivation in CI candidate ear, encouraging CI as early as possible before the age of 4 years in the case of congenital deafness.…”

Pediatric Bilateral Sensorineural Hearing Loss: Minimum Test Battery and Referral Criteria for Cochlear Implant Candidacy Evaluation

“…The review identified PTA >80 dB HL as a criterion for cochlear implantation. 9 These guidelines may still be overly restrictive. Carlson et al reported that 51 pediatric implant recipients with greater residual hearing than specified by current indications demonstrated a mean postimplant open-set speech recognition score of 85% in the cochlear implantation–only condition, which represented a 63–percentage point improvement over the preoperative aided score.…”