Aural (Re)habilitation Outcomes among Children with Unilateral Cochlear Implants in India: A Systematic Review

Abstract

Introduction: Cochlear implantation has now existed as an intervention for prelingual childhood hearing loss in our country for over two and a half decades. There is a significant need to understand the outcomes achieved in our context to promote the optimization of cochlear implant (CI) as a strategy for early intervention among children with prelingual hearing impairment. The aim of this study was to report auditory, speech-language, and educational outcomes among children with unilateral CIs in India based on the age of implantation and duration of implant use. Methods: Three primary databases (PubMed [including MEDLINE], SCOPUS, and Google Scholar) were searched using predetermined search strategies. This review included studies that described outcomes of children who underwent unilateral cochlear implantation under the age of 12 years. Studies with a minimum sample size of 10, published between 2000 and 2022 in English language, and reporting data from India were included. Cross-sectional, cohort, case–control, and randomized control study designs reporting quantitative data were considered. Results: A total of 32 studies qualified for the systematic review. The majority of studies reported that the age of cochlear implantation among their participants was between 3 and 6 years (72%). There were limited data on the postimplant timelines when sentence-level auditory comprehension and spontaneous connected speech were achieved. There was no data from any study on the integration of children with CI into mainstream schools. Factors such as prior hearing aid use, age of implantation, or duration of implantation were not taken into consideration as confounders. Conclusion: This systematic review suggests that aural re/habilitation outcomes in relation to CI are primarily limited to 1-year post-CI follow-ups. The success rate of open-set sentence/word auditory comprehension, verbal language outcomes with regard to connected speech as well as integration to mainstream education is unknown. Since the number of studies was so less, studies with high bias were not excluded based on quality evaluation. However, it is advised for readers to exercise caution when interpreting the data from these studies. In order to fully understand the value of cochlear implantation as an early intervention strategy in our country, future studies on outcomes should address these methodological flaws and restrictions, improve reporting (publications) of outcomes, conduct long-term follow-up studies, multi-center studies, and use appropriate research designs.