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Tang D, Tran Y, Lo C, Lee JN, Turner J, McAlpine D, McMahon C, Gopinath B. The Benefits of Cochlear Implantation for Adults: A Systematic Umbrella Review. Ear Hear 2024; 45:801-807. [PMID: 38233980 DOI: 10.1097/aud.0000000000001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES The uptake of cochlear implants among adults who could benefit (based on pure-tone audiometry) in developed countries is estimated to be less than 10%. Concerns about potential surgical complications, fear of losing residual hearing, and limited awareness about the benefits of this intervention contribute to the low adoption rate. To enhance quality of life and improve the uptake of cochlear implants, it is essential to have a clear understanding of their benefits. DESIGN This umbrella review aims to summarize the major benefits of cochlear implant usage in adults, by synthesizing findings from published review articles. A comprehensive search of databases including MEDLINE, EMBASE, PsycINFO, and Google Scholar, was conducted. The search was limited to English-language review articles published between 1990 and 2022, focusing on cochlear implant outcomes in at least 5 adults (aged ≥18 years). Two independent reviewers screened titles, abstracts, and full-text articles, and conducted a quality assessment using the Joanna Briggs Checklist for Systematic Reviews and Research Syntheses. RESULTS Forty-two articles were included in this review. There were 15 systematic reviews with meta-analysis, 25 systematic reviews without meta-analysis, and 2 systematic scoping reviews. All 42 articles underwent quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses, of which 40% (n = 17) satisfied 9 out of 11 quality criteria. This umbrella review shows that cochlear implants are associated with improvements in speech perception and recognition as well as improved quality of life and cognition. These benefits are observed in a significant proportion of adults undergoing the procedure, highlighting its effectiveness as a viable intervention for individuals with severe to profound hearing loss. CONCLUSIONS The potential benefits of cochlear implantation appear to outweigh the risks and complications associated with the procedure. It is recommended that adults with severe to profound hearing loss in particular, engage in informed discussions with healthcare professionals to consider cochlear implantation as a viable treatment option.
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Affiliation(s)
- Diana Tang
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Yvonne Tran
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Charles Lo
- Department of Management, Australian College of Applied Professions, Sydney, New South Wales, Australia
| | - Jien Nien Lee
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Jessica Turner
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - David McAlpine
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Catherine McMahon
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Bamini Gopinath
- Macquarie University Hearing Research Centre, Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
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Grenier B, Mosnier I, Ferrary E, Nguyen Y, Sterkers O, Kalamarides M, Lahlou G, Daoudi H. Cochlear Implantation in Neurofibromatosis Type 2-Related Schwannomatosis: Long-Term Hearing Outcomes. Otolaryngol Head Neck Surg 2024; 171:218-230. [PMID: 38482961 DOI: 10.1002/ohn.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To evaluate long-term hearing outcomes following cochlear implantation in patients with neurofibromatosis type 2 and ipsilateral vestibular schwannoma. STUDY DESIGN Retrospective study. SETTING Tertiary general hospital. METHODS Twenty-two patients undergoing cochlear implantation between 2004 and 2018 with at least 1 year of follow-up were included. Patients were categorized as "users" or "nonusers" of their cochlear implant (CI). For users, speech perception (disyllabic words) without lip-reading was assessed in quiet conditions 1-year postimplantation, and annually thereafter. CI users were classified into 2 groups on the basis of speech intelligibility (≥40% or <40%). Demographic data, treatment options, and tumor size were also recorded. RESULTS One year after implantation, 16 (73%) patients used their CI daily. Twelve of these patients had a speech intelligibility ≥40% (mean: 74 ± 21.9%). Three had a Koos stage IV tumor. At the last visit (mean duration of follow-up: 6 ± 5 years), 12 of these 16 patients were still using their implant daily, and 6 had a speech intelligibility ≥40%. No predictive factors for good performance at 1 year or performance stability were identified. CONCLUSION Neurofibromatosis type 2 is a complex disease profoundly affecting patient quality of life, and cochlear implantation should always be considered on a case-by-case basis. In some individuals, cochlear implantation can provide good speech intelligibility for extended periods, even posttreatment or in cases of large tumors.
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Affiliation(s)
- Baptiste Grenier
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - Isabelle Mosnier
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
- Technologies and Gene Therapy for Deafness, Hearing Institute, Pasteur Institute/Inserm /Université Paris Cité, Paris, France
| | - Evelyne Ferrary
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
- Technologies and Gene Therapy for Deafness, Hearing Institute, Pasteur Institute/Inserm /Université Paris Cité, Paris, France
| | - Yann Nguyen
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
- Technologies and Gene Therapy for Deafness, Hearing Institute, Pasteur Institute/Inserm /Université Paris Cité, Paris, France
| | - Olivier Sterkers
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - Michel Kalamarides
- Neurosurgery Department, Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
- Genetics and Development of Brain Tumors, CRICM Inserm U1127 CNRS UMR 7225, Paris Brain Institute, Paris, France
| | - Ghizlene Lahlou
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
- Technologies and Gene Therapy for Deafness, Hearing Institute, Pasteur Institute/Inserm /Université Paris Cité, Paris, France
| | - Hannah Daoudi
- ENT Department, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
- Technologies and Gene Therapy for Deafness, Hearing Institute, Pasteur Institute/Inserm /Université Paris Cité, Paris, France
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Ahmad JG, Lovin BD, Lee A, Nader ME, Gidley PW. Cochlear Implantation After Head and Neck Radiation: A Case Series, Systematic Review, and Meta-analysis. Otol Neurotol 2024; 45:352-361. [PMID: 38361317 PMCID: PMC10940186 DOI: 10.1097/mao.0000000000004127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To determine if cochlear implant (CI) is safe and effective in patients with radiation therapy (XRT)-induced sensorineural hearing loss and to discuss considerations in this population through a retrospective cohort review, systematic review, and meta-analysis. DATABASES REVIEWED PubMed, Cochrane Library, and Embase. METHODS We retrospectively reviewed all CI cases after head and neck (HN) XRT at our institution, noting intraoperative findings, postoperative complications, and hearing outcomes. Change in speech discrimination scores (SDSs) was the primary outcome measure. Systematic review was performed to identify all cases of CI after HNXRT. A meta-analysis was performed to assess SDS change. RESULTS The retrospective cohort review identified 12 patients who underwent CI after HNXRT. One patient with HN cancer (HNC) and one with central nervous system pathology (CNSP) received bilateral implants. Six had HNC, three had CNSP, and one had Langerhans cell histiocytosis. Eleven had abnormal findings during CI. There were no postoperative complications. Twenty articles with an additional 97 patients were suitable for systematic review inclusion. Of the 109 patients, 67 (61.5%) had HNC and 18 (16.5%) had CNSP. Abnormal intraoperative findings were common (30.3%), most frequently in the mastoid (66.7%). Postoperative complications, including wound dehiscence and infection with some requiring explantation, occurred in 10.1% of patients. Sixty-six patients were included in the meta-analysis. All demonstrated SDS improvement (mean increase, 56.2%). CONCLUSION Patients with prior HNXRT benefit from CI. Paying careful attention to surgical planning and technique, postoperative care, and patient expectations is imperative, as complications are not uncommon.
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Affiliation(s)
- Jumah G. Ahmad
- Department of Otorhinolaryngology – Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benjamin D. Lovin
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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McClenaghan F, Freeman S, Lloyd S, Stapleton E. Cochlear Implantation in Sporadic Vestibular Schwannoma and Neurofibromatosis Type II. Otolaryngol Clin North Am 2023; 56:587-598. [PMID: 37019773 DOI: 10.1016/j.otc.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Cochlear implantation offers significantly better hearing outcomes than auditory brainstem implantation in patients with vestibular schwannoma. Neither the primary treatment modality nor the cause of the tumor (neurofibromatosis type 2 related or sporadic) seems to have a significant effect on hearing outcome with cochlear implantation. Some uncertainty remains regarding long-term hearing outcomes; however, cochlear implantation in vestibular schwannoma serves to offer patients, with a functioning cochlear nerve, the probability of open set speech discrimination with a consequent positive impact on quality of life.
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