Benefits of Cochlear Implantation in Childhood Unilateral Hearing Loss (CUHL Trial)

Abstract

Objectives/Hypotheses: Children with unilateral sensory hearing loss (UHL) struggle to understand speech in noise and locate the origin of sound and have reduced quality of hearing. This clinical trial will determine the benefits of cochlear implantation in children with UHL.Study Design: Prospective clinical trial. Methods: Twenty children with at least moderate to profound sensory hearing loss and poor speech perception (word score <30%) in one ear and normal hearing in the contralateral ear participated in a Food and Drug Administration-approved clinical trial. Subjects were evaluated for speech perception in quiet, speech perception in noise, sound localization, and subjective benefits after implantation.Results: CNC word score perception in quiet significantly improved (1% to 50%, P < .0001) by 12 months after activation. Speech perception in noise by BKB-SIN significantly improved in all three noise configurations; there was a 3.6 dB advantage in head shadow (P < .0001), a 1.6 dB advantage in summation (P = .003), and a 2.5 dB advantage in squelch (P = .0001). Localization improved by 26 at 9 months (P < .0001). Speech, Spatial, and Qualities (SSQ) demonstrated significant improvements in speech (5.2 to 7.4, P = .0012), qualities of hearing (5.9 to 7.5, P = .0056), and spatial hearing (2.7 to 6.6, P < .0001). SSQ subscales associated with binaural hearing were significantly improved, as was listening effort (P = .0082). Subjects demonstrated a non-significant improvement in fatigue.Conclusions: This study demonstrates that children with UHL significantly benefit from cochlear implantation.

Impact of unilateral hearing loss in early development

“…Findings also reveal that consistent cochlear implant use can partially reverse these cortical effects of SSD in children [68]. A recent controlled prospective longitudinal clinical trial revealed substantial benefits of cochlear implant for SSD, with subjects showing rapid improvements in speech perception in quiet, and consistent improvements in masked speech perception and sound localization [15 ▪▪ ]. Subjects not only demonstrated a head shadow benefit, but also demonstrated a significant summation effect and squelch benefit [15 ▪▪ ].…”

“…A recent controlled prospective longitudinal clinical trial revealed substantial benefits of cochlear implant for SSD, with subjects showing rapid improvements in speech perception in quiet, and consistent improvements in masked speech perception and sound localization [15 ▪▪ ]. Subjects not only demonstrated a head shadow benefit, but also demonstrated a significant summation effect and squelch benefit [15 ▪▪ ]. These latter findings have not been consistently observed in adult cochlear implant patients, and may reflect the increased cognitive plasticity in children, enabling them to more rapidly integrate binaural cues to improve speech perception in noise.…”

“…Since the 2019 Food and Drug Administration approval for cochlear implant for children ages 5 and up with SSD, many additional recent publications have significantly bolstered an evolving body of evidence revealing the effectiveness and numerous potential benefits of cochlear implant use in pediatric recipients with SSD [15 ▪▪ ,48 ▪ ,65 ▪ ,69 ▪ ,70–74]. While there is not yet uniform consensus as to the ideal age for implantation in children with SSD, an accumulating body of evidence has demonstrated that shorter duration of deafness, ranging from less than 4–7 years, is associated with greater postimplantation performance [48 ▪ ,65 ▪ ,69 ▪ ].…”

“…UHL affects 3–6% of school-aged children in the USA [2,12,13] and may be caused by a number of congenital and acquired etiologies [14,15 ▪▪ ,16–18]. Most cases of UHL are congenital, or early onset [19] and are predominantly sensorineural in nature.…”

Cochlear implantation for paediatric and adult cases of unilateral and asymmetric hearing loss

“…There have been several recent original studies of cochlear implant use for children and adults with UHL/AHL. For children with UHL, Brown et al [22 ▪ ] reported the outcomes over the first 12 months of cochlear implant use for participants in the Children with UHL trial (CUHL Trial), a prospective FDA-approved clinical trial with repeated measures of monaural and binaural hearing abilities. With the cochlear implant alone, participants experienced significant improvements for speech recognition with CNC words at 3 months post-activation, reaching apparent asymptote at the 9-month interval.…”