de Kleijn JL, et al. - Authors conducted a systematic review to identify audiologic thresholds (in dB HL) that could serve as an audiologic candidacy criterion for pediatric cochlear implantation using 4 domains of speech and language development as independent outcome measures (speech production, speech perception, receptive language, and auditory performance). For pediatric cochlear implantation, lower audiologic thresholds (≥80 dB HL) than are advised in current national and manufacturer guidelines would be appropriate as audiologic candidacy criteria.

Methods

• Experts searched the PubMed and Embase databases up to June 28, 2017, to identify studies comparing speech and language development between children who were profoundly deaf using cochlear implants and children with severe hearing loss using hearing aids, because no studies are available directly comparing children with severe HI in both groups.
• This outcome could support adjusting cochlear implantation candidacy criteria to lower audiologic thresholds if cochlear implant users with profound HI score better on speech and language tests than those with severe HI who use hearing aids.
• Using a predefined strategy they conducted a literature search, screening, and article selection.
• Four authors, independently in 2 pairs executed the article screening; consensus on article inclusion was reached by discussion between these 4 authors.
• They reported this study according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement.

Results

• As per data, title and abstract screening of 2,822 articles resulted in selection of 130 articles for full-text review.
• Findings suggested that for critical appraisal 21 studies were selected, resulting in the selection of 10 articles for data extraction.
• Audiologic thresholds (in dB HLs) at which children could qualify for cochlear implantation were formulated by 2 studies: (1) at 4-frequency pure-tone average (PTA) thresholds of 80 dB HL or greater based on speech perception and auditory performance subtests and (2) at PTA thresholds of 88 and 96 dB HL based on a speech perception subtest.
• Results demonstrated that in 8 of the 18 outcome measures, a similar performance of children with profound HI using cochlear implants to children with severe HI using hearing aids was seen.
• Researchers noted better performance of cochlear implant users with a picture-naming test and a speech perception in noise test.
• It was not possible to conduct a meta-analysis, owing to large heterogeneity in the study population and selected tests.