University of Exeter Medical School, Exeter, UK.
Clin Otolaryngol. 2012 Oct;37(5):342-54. doi: 10.1111/coa.12011.
In the UK, approximately 10 000 people have cochlear implants, more than 99% with a unilateral implant. Evidence shows that adults implanted bilaterally may benefit from binaural advantages; however, systematic review evidence is limited.
To conduct a systematic review to discover the evidence for effectiveness and cost-effectiveness of using bilateral cochlear implants in adults with severe-to-profound hearing loss by comparing their effectiveness with unilateral cochlear implantation or unilateral cochlear implantation and acoustic hearing aid in the contralateral ear.
Systematic review.
This examined 16 electronic databases, plus bibliographies and references for published and unpublished studies.
Abstracts were independently assessed against inclusion criteria by two researchers, and disagreements were resolved. Selected papers were then retrieved and further independently assessed in a similar way. Included studies had their data extracted by one reviewer and checked by another.
Searches yielded 2892 abstracts producing 19 includable studies. Heterogeneity between studies precluded meta-analysis. However, all studies reported that bilateral cochlear implants improved hearing and speech perception: one randomised controlled trial found a significant binaural benefit over the first ear alone for speech and noise from the front (12.6 ± 5.4%, P < 0.001) and when noise was ipsilateral to the first ear (21 ± 6%, P < 0.001); and another found a significant benefit for spatial hearing at 3 and 9 months post-implantation compared with pre-implantation [mean difference (sd) scores: 3 months = 1.46 (0.83-2.09), P < 0.01].Quality of life results varied, showing bilateral implantation may improve quality of life in the absence of worsening tinnitus. Limited cost-effectiveness evidence showed that bilateral implantation is probably only cost-effective at a willingness-to-pay threshold above £62 000 per quality adjusted life year.
Despite inconsistency in the quality of available evidence, the robustness of systematic review methods gives weight to the positive findings of included studies demonstrating that bilateral implantation is clinically effective in adults but unlikely to be cost-effective.
在英国，大约有 10000 人植入了人工耳蜗，其中超过 99%的人植入了单侧人工耳蜗。有证据表明，双侧植入的成年人可能受益于双耳优势；然而，系统评价证据有限。
进行系统评价，通过比较双侧人工耳蜗植入与单侧人工耳蜗植入或对侧耳单侧人工耳蜗植入加声学助听器在重度至极重度听力损失成人中的效果，发现双侧人工耳蜗植入的有效性和成本效益证据。
系统评价。
该研究检查了 16 个电子数据库，以及已发表和未发表研究的参考文献和书目。
两名研究人员独立评估摘要是否符合纳入标准，有分歧的则进行解决。然后检索并以类似的方式进一步独立评估选定的论文。纳入的研究由一名审查员提取数据，由另一名审查员检查。
搜索共产生了 2892 个摘要，其中有 19 个可纳入的研究。由于研究之间存在异质性，因此无法进行荟萃分析。然而，所有研究都报告说双侧人工耳蜗植入改善了听力和言语感知：一项随机对照试验发现，在正面（12.6±5.4%，P<0.001）和当噪音来自第一只耳朵的同侧时（21±6%，P<0.001），双耳植入比第一只耳朵单独植入有显著的双耳优势；另一项研究发现，与植入前相比，植入后 3 个月和 9 个月的空间听觉有显著改善[平均差异（标准差）评分：3 个月=1.46（0.83-2.09），P<0.01]。生活质量结果各不相同，表明在不加重耳鸣的情况下，双侧植入可能会改善生活质量。有限的成本效益证据表明，双侧植入在支付意愿阈值高于每质量调整生命年 62000 英镑时可能具有成本效益。
尽管现有证据的质量不一致，但系统评价方法的稳健性为纳入研究的积极发现提供了依据，这些研究表明双侧植入在成人中具有临床效果，但不太可能具有成本效益。
