The auditory implant team in Manchester have implanted a cohort of children where audiological thresholds meet the NICE guidance for cochlear implantation (CI) in one ear only, and the other falls into moderate, severe or sloping loss. These children are therefore implanted unilaterally in their poorer hearing ear due to lack of adequate benefit from acoustic hearing aids. It is also in the spirit of the current NICE guidance of bilateral hearing for paediatric patients. The notes of 57 patients were examined retrospectively across four areas: a speech and language measure (Manchester Spoken Language Development Scale - MSLDS); an auditory performance measure (Categories of Auditory Performance - CAP); parental perception (Brief Assessment of Parental Perception - BAPP); and compliance.
All measures showed improvements over and above what was expected due to ageing. Furthermore, all but two patients were full time users of their CI, with only one of these patients rejecting their implant totally. High compliance with wearing the CI is suggestive of real benefit, with some children preferring their cochlear implant over their hearing aid.
These results are encouraging given that the children were implanted later, with the average age of implantation being 4.9 years. This study also raises an important question about how poor the good ear must be to achieve benefit from unilateral implantation. Previous work with unilaterally implanted patients with normal hearing in their better hearing ear showed mixed outcomes, indicating that not all single-sided deafness patients should be implanted and careful consideration should be given to the hearing thresholds in the better hearing ear. This is also a timely study given the review of the current NICE guidance. It will be interesting to see if the new guidance addresses each ear separately or uses ambiguous wording regarding this matter.