Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature

Cabral Junior, Francisco; Pinna, Mariana Hausen; Alves, Ricardo Dourado; Malerbi, Andrea Felice dos Santos; Bento, Ricardo Ferreira

doi:10.1055/s-0035-1559586

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International Archives of Otorhinolaryngology

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Systematic Reviews • Int. Arch. Otorhinolaryngol. 20 (1) • Jan-Mar 2016 • https://doi.org/10.1055/s-0035-1559586 copy

Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce oné s ability to localize sound.

Objectives

This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression.

Data Synthesis

We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data.

Conclusion

Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.

unilateral hearing loss; cochlear implantation; single-sided deafness; speech discrimination; sound localization; tinnitus

Database	Search	Terms	Results
PubMed	#1	Single-sided OR one-sided OR unilateral OR monoaural	162
	#2	Deafness OR hearing loss OR loss of hearing	−
	#3	Cochlear implant	−
	#4	#1 AND #2 AND #3	−
Cochrane	#1	Single-sided deafness	8
	#2	Unilateral hearing loss	−
	#3	Cochlear implant	−
	#4	#1 AND #3 OR #2 AND #3	−
Scielo	#1	Search strategy designed for Scielo in Title/abstract fields – “unilateral hearing loss,” “single-sided deafness,” cochlear implant	58

Level	Study design
Level I	- Systematic review (with homogeneity) of randomized control trials (RCT)- RCT with statistically significant difference or narrow confidence intervals
Level II	- Low quality RCT (e.g., <80% follow-up)- Systematic review of cohort studies- Prospective comparative study
Level III	- Case-control study- Systematic review of case-control study- Retrospective comparative study
Level IV	- Case series- Poor quality case-control studies
Level V	- Expert opinion

Authors	Study type	Evidence level	Implant type	Total no. of patients	Statistics	Follow-up	Outcomes
Authors	Study type	Evidence level	Implant type	Total no. of patients	Statistics	Follow-up	Sound localization	Speech perception	Tinnitus
Ramos et al ²³23 Ramos Á, Polo R, Masgoret E, et al. Cochlear implant in patients with sudden unilateral sensorineural hearing loss and associated tinnitus. Acta Otorrinolaringol Esp 2012;63(1):15-20	Prospective comparative	II	Nucleus	10	N/A	≥3 months	N/A	N/A	THI, VAS-distress
Arndt et al ¹⁶16 Arndt S, Aschendorff A, Laszig R, et al. Comparison of pseudobinaural hearing to real binaural hearing rehabilitation after cochlear implantation in patients with unilateral deafness and tinnitus. Otol Neurotol 2011;32(1):39-47	Prospective comparative	II	Nucleus	1-1	S ₀/N ₀- NSS _CI/N_HEp < 0.01 (CIxUnaided)p < 0.01 (CIxBAHA)p = 0.03 (CIxCROS)S _HE/N_CIp = 0.02 (CIxBAHA)p = 0.03 (CIxCROS)Sound localization:p < 0.01*Tinnitus: p< 0.01	6 months	7 loudspeakers in a 180° arch with intervals of 30°	HSM, OlSa	VAS-distress
Firszt et al ¹⁷17 Firszt JB, Holden LK, Reeder RM, Cowdrey L, King S. Cochlear implantation in adults with asymmetric hearing loss. Ear Hear 2012;33(4):521-533	Prospective comparative	II	Nucleus	10	Sound localization:p ≤ 0.05 (for all patients)Speech perception:TIMIT in quite p ≤ 0,05 ^b 12 months evaluation available only for prelingual participants.	6 and 12 months ^a **Bimodal scores for CNC words were significantly better than HA-condition alone in quiet for 3 patients and in noise for only one patient ( p < 0.05). Three patients demonstrate a significant improvement in localization in bimodal compared with HA-condition ( p < 0.0001).	15 loudspeakers arranged in an arc, 10° apart	CNC, HINT, TIMIT	N/A
Stelzig et al ²¹21 Stelzig Y, Jacob R,Mueller J. Preliminary speech recognition results after cochlear implantation in patients with unilateral hearing loss: a case series. J Med Case Reports 2011;5(5):343	Case series	IV	Med-El	4	N/A	6 months	N/A	HSM, OlSa	N/A
Tavora-Vieira et al ²²22 Távora-Vieira D, Marino R, Acharya A, Rajan GP. The impact of cochlear implantation on speech understanding, subjective hearing performance, and tinnitus perception in patients with unilateral severe to profound hearing loss. Otol Neurotol 2015;36(3): 430-436Távora-Vieira et al ⁹9 Távora-Vieira D, Marino R, Krishnaswamy J, Kuthbutheen J, Rajan GP. Cochlear implantation for unilateral deafness with and without tinnitus: a case series. Laryngoscope 2013;123(5):1251-1255	Prospective comparative	II	Med-El	28	S ₀/N ₀p< 0.001S ₀/N _HEp = 0.003S _CI/N _HEp < 0.001Tinnitus p = 0.011	12–24 months ^d Patients belong to both studies and are put together to avoid double counting of cases.	N/A	BKB-SIN	TRQ
Vermeire et al. ⁶6 Vermeire K, Van de Heyning P. Binaural hearing after cochlear implantation in subjects with unilateral sensorineural deafness and tinnitus. Audiol Neurootol 2009;14(3):163-171	Prospective comparative	II	Med-EL	20	S ₀/N ₀- NSS ₀/N_CIp = 0.03 (only HA group) ^e Speech perception follow-up was assessed 12 months after implantation; SSQ questionnaire and tinnitus distress were evaluated 24 months after CI surgery. S _CI/N₀: p = 0.04 (HA)p = 0.003 (HE)	12 months	N/A	LIST	N/A
Punte et al ⁷7 Punte AK, De Ridder D, Van de Heyning P. On the necessity of full length electrical cochlear stimulation to suppress severe tinnitus in single-sided deafness. Hear Res 2013;295:24-29	Proscpective comparative	II	Med-El	7	VAS p = 0.04 ^f The author separated the subjects in two groups: patients with hearing aid (HA) contralateral to the implanted ear and patients without any prosthesis in the hearing ear (HE). TQ p = 0.04 ^f The author separated the subjects in two groups: patients with hearing aid (HA) contralateral to the implanted ear and patients without any prosthesis in the hearing ear (HE).	1,3 and 6 months	N/A	N/A	VAS-loudnessTQ
Mertens et al ²⁴24 Mertens G, Kleine Punte A, De Ridder D, Van de Heyning P. Tinnitus in a single-sided deaf ear reduces speech reception in the nontinnitus ear. Otol Neurotol 2013;34(4):662-666	Proscpective comparative	II	Med-El	15	VAS: p < 0.01 ^g Data referent to 6 months after cochlear implantation.	12 months	N/A	N/A	VAS-loudnessTQ
Buechner et al ²⁰20 Buechner A, Brendel M, Lesinski-Schiedat A, et al. Cochlear implantation in unilateral deaf subjects associated with ipsilateral tinnitus. Otol Neurotol 2010;31(9):1381-1385	Prospective comparative	II	HiRes	5		12 months	N/A	OlSa	VAS-loudness and distress
Van de Heyning et al ²⁵25 Van de Heyning P, Vermeire K, Diebl M, Nopp P, Anderson I, De Ridder D. Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation. Ann Otol Rhinol Laryngol 2008;117(9):645-652	Prospective comparative	II	Med-El	22	VAS: p < 0.01TQ:p < 0.01	24 months			VAS-loudnessTQ
Cardieux et al ¹⁸18 Cardieux JH, Firszt JB, Reeder RM. Cochlear implantation in nontraditional candidates: preliminary results in adolescents with asymmetric hearing loss. Otol Neurotol 2013;34(3):408-415	Case series	IV	NucleusHiR5es (3 patients)	5	**	6 months	15 loudspeakers arranged in an arc, 10° apart	CNC, HINT, BKB-SIN

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[1] Address for correspondence Francisco Cabral Junior, MD, Department of Otolaryngology, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - 6° andar - sala 6167, São Paulo, Brazil 05403-000 (e-mail:fcabral@yahoo.com.br).