Speech Perception Outcomes in Cochlear Implant Users Undergoing Remote Versus In-Person Programming: A Systematic Review and Meta Analysis.

OBJECTIVE

Remote cochlear implant (CI) programming can address geographic disparities in CI care and improve patient convenience. While in-person programming is necessary in certain circumstances, it is important to determine the potential advantages in speech recognition outcomes. This study reviews the literature comparing speech recognition outcomes between remote versus in-person CI programming.

DATA SOURCES

PubMed, Scopus, CINAHL, and Cochrane databases were queried from inception to May 7, 2025.

REVIEW METHODS

Eligible studies included CI recipients ≥ 12 years of age who underwent remote programming, with a comparison group who underwent in-person programming, and reported speech recognition outcomes. Primary outcome was standardized mean differences (SMD) of speech recognition outcomes, stratified by sentence- or word-recognition measures, pooled with random effects models.

RESULTS

Of 1597 abstracts identified, seven studies were included with a total of 123 CI users (mean age 53.8 years [range: 12-88, 95% CI: 42.4-65.3]; 50.6% male [95% CI: 26.9-74.2]). Study designs included crossover within-subjects designs (n = 4), prospective cohorts (n = 2), and cross-sectional studies (n = 1). Speech recognition outcomes tested in quiet were similar between in-person programmed and remotely programmed CI users for word lists (SMD: -0.06 [95% CI: -0.37-0.35], p = 0.71) and for sentences (SMD: -0.28 [95% CI: -0.79-0.24], p = 0.29). No studies were designed as non-inferiority analyses.

CONCLUSION

Remote CI programming is not associated with detectable differences in speech recognition outcomes compared to in-person programming. Future studies comparing remote and in-person programming outcomes should evaluate non-inferiority of remote programming to continue to justify its expansion to improve convenience and mitigate geographic care disparities.