Cochlear Implantation in Children with Autism Spectrum Disorder: A Systematic Review and Pooled Analysis

Abstract

Objective: To determine outcomes following cochlear implantation (CI) in children with autism spectrum disorder (ASD). Databases Reviewed: MEDLINE, Embase, Web of science, Cochrane Library, and Clinicaltrial.gov. Methods: The review was performed according to the PRISMA statement. Primary outcomes measures were changes in speech perception and speech production scores. Secondary outcome measures included communication mode, device use, parental recommendation of implant, postoperative hyperacusis, and quality of life measures. Pooled analysis of outcomes was performed if possible. Results: Twenty-four studies reported on 159 children with ASD. There were improvements in speech perception in 78% of cases and in speech expression in 63% of cases, though the extent of this improvement was variable. Seventy-four percent of children with ASD and CI are nonoral communicators. Intermittent/nonuse rate was 31%. Hearing outcomes are worse compared to children with other disabilities. The vast majority of parents would recommend CI based on their experiences. Conclusion: Outcome in children with ASD and CI are highly variable and significantly poorer compared to non-ASD children. Despite this, most parents report positive experiences and the evidence supports the use of CI in children with ASD.

The interface of paediatric ENT and autism spectrum disorder: a complex conundrum for otolaryngologists

“…The link between hearing loss and ASD, however, has sparse evidence to support it. Some studies estimate the hearing loss in ASD to be ten times higher than in the neurotypical population, others documenting similar rates 3 . Some of the stereotypical signs of autism, for example, toe walking, hand flapping or 'sustained odd play' can result in an earlier diagnosis, but it has been shown that if a child has a hearing impairment, this can delay the diagnosis of autism 38 .…”

“…A review article 3 , showed that out of the 9 studies analysed, 8 demonstrated that autistic children had an overall improvement in their speech expression following cochlear implantation, although the extent of this was highly variable. It was also concluded that, in general, non-compliance was usually related to the severity of ASD 3 .…”

“…ASD diagnoses are usually made after age three, and hearing problems in ASD are prevalent. It is therefore essential for the otolaryngologists and audiologists to whom children present with a profound hearing loss, to be aware of the potential for a concurrent ASD diagnosis 3 .…”

“…Although autistic children require more from healthcare systems, particularly in the otorhinolaryngology field, than their non-autistic counterparts, paradoxically they are less likely to have their needs met 12 . It has also been recognised that if an autistic child has hearing problems, this can delay the diagnosis of both conditions 3 . Autistic children frequently present to ENT departments with non-auditory symptoms, including otitis media and allergic rhinitis 2 .…”

“…There are numerous theories behind the physiological cause of ASD, with multiple papers contradicting each other. Mathew et al discuss the 'early closure of neuroplasticity' in autistic children, proposing that therefore early intervention with hearing loss can be vital to improving the outcome 3 .…”