COCHLEAR IMPLANTS FOR ADULTS WITH SINGLE-SIDED DEAFNESS: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Author(s)
Connie Bulos, MSc, Laura Rouncivell, MSc, Joan Quigley, PhD, Roberta Gugles, MSc, Marie Carrigan, MLIS, Conor Teljeur, PhD, Patricia Harrington, PhD, Mairin Ryan, PhD.
Health Information and Quality Authority, Dublin, Ireland.
Health Information and Quality Authority, Dublin, Ireland.
OBJECTIVES: Single-sided deafness (SSD) is characterised by severe-to-profound hearing loss in one ear and normal or near-normal hearing contralaterally. Bone-conduction implants (BCI) route sound from the impaired ear to the hearing ear while cochlear implants (CI) aim to partially restore binaural hearing. The aim of this systematic review was to establish the clinical effectiveness of providing CI to adults with SSD compared with BCI and no treatment.
METHODS: Systematic database searches were conducted up to November 2025. Title and abstract screening, full text screening, and data extraction were performed independently by two reviewers. Only comparative studies were included. Risk of bias was assessed using the Newcastle-Ottawa Scale for non-randomised studies and RoB2 for RCTs. Network meta-analysis (NMA) was undertaken where sufficient homogeneity was observed; otherwise, findings were synthesised narratively.
RESULTS: Eighty-nine studies (one RCT) were included. Speech recognition in noise was pooled for three spatial configuration setups. At 12 months post-surgery, NMA showed CI improved speech recognition in noise compared with BCI in one configuration (Mean difference [MD] SNR=-2.5, 95% CI -3.8 to -1.1) and versus no treatment in the other two configurations (MD SNR=-1.4, 95% CI -2.0 to -0.7) and (MD SNR=-5.7, 95% CI -7.2 to -4.2). CI improved speech recognition in quiet (MD=31.2%, 95% CI 16.5 to 45.8), sound localisation (MD=-21.6°, 95% CI -25.6 to -17.5) and reduced tinnitus-burden (MD=-25.7, 95% CI -44.8 to -6.5) versus no treatment, and sound localisation versus BCI (MD=-20.9%, 95% CI -28.5 to -13.3). BCI effects were generally non-significant versus no treatment. Non-NMA studies were consistent with these findings. Subjective hearing benefit and quality-of-life data generally favoured CI and BCI, but were not meta-analysed.
CONCLUSIONS: CI generally demonstrated greater benefit across outcomes, particularly versus no treatment, with more consistent and robust effects than BCI. Direct comparative evidence between CI and BCI was limited.
METHODS: Systematic database searches were conducted up to November 2025. Title and abstract screening, full text screening, and data extraction were performed independently by two reviewers. Only comparative studies were included. Risk of bias was assessed using the Newcastle-Ottawa Scale for non-randomised studies and RoB2 for RCTs. Network meta-analysis (NMA) was undertaken where sufficient homogeneity was observed; otherwise, findings were synthesised narratively.
RESULTS: Eighty-nine studies (one RCT) were included. Speech recognition in noise was pooled for three spatial configuration setups. At 12 months post-surgery, NMA showed CI improved speech recognition in noise compared with BCI in one configuration (Mean difference [MD] SNR=-2.5, 95% CI -3.8 to -1.1) and versus no treatment in the other two configurations (MD SNR=-1.4, 95% CI -2.0 to -0.7) and (MD SNR=-5.7, 95% CI -7.2 to -4.2). CI improved speech recognition in quiet (MD=31.2%, 95% CI 16.5 to 45.8), sound localisation (MD=-21.6°, 95% CI -25.6 to -17.5) and reduced tinnitus-burden (MD=-25.7, 95% CI -44.8 to -6.5) versus no treatment, and sound localisation versus BCI (MD=-20.9%, 95% CI -28.5 to -13.3). BCI effects were generally non-significant versus no treatment. Non-NMA studies were consistent with these findings. Subjective hearing benefit and quality-of-life data generally favoured CI and BCI, but were not meta-analysed.
CONCLUSIONS: CI generally demonstrated greater benefit across outcomes, particularly versus no treatment, with more consistent and robust effects than BCI. Direct comparative evidence between CI and BCI was limited.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO135
Topic
Clinical Outcomes, Epidemiology & Public Health, Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin)