https://orcid.org/0000-0001-6964-1066
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Abstract
Background
Rapid advances in cochlear implantation has witnessed an expanding spectrum for candidacy worldwide. This includes a subgroup of adults with asymmetrical hearing loss who have a wide range in their hearing capacity between the two ears. As per guidelines they are not included in mainstream candidacy for CI across the world. Evidence is now emerging to support the benefits of CI in AHL.
Methods
This review analyzed literature regarding the outcomes of CI in AHL. Primary outcome measure was to assess audiological benefits and secondary outcome measure was to assess hearing related quality of life. 15 relevant articles, published worldwide between 2009 and 2019 were chosen. CASP checklist for systematic reviews was used to ascertain the quality of literature. The strength of recommendations from each study was analyzed and classified as strong, moderate, weak or none based on GRADE guidelines.
Results
Heterogeneity in samples was obvious and samples varied largely between the studies. The levels of evidence ranged from systematic review to expert opinion, but overall they reflected positively on both audiological and QOL benefits.
Conclusion
CI provides important auditory and QOL benefits in AHL, but there is no high level evidence as yet to strongly support CI for AHL. A long term multi-centric study is necessary to influence a change in practice for a growing population of AHL.
Trial registration: ClinicalTrials.gov identifier: NCT03052920.
Additional information
Notes on contributors
Raghunandhan Sampathkumar
Dr. Raghunandhan Sampathkumar is Consultant ENT Surgeon at Madras ENT Research Foundation (MERF), Chennai a premier tertiary referral ENT training Institute in South India. He specializes in Neuro-Otology, Auditory Implantation & Skull-Base Surgery having received higher surgical training from reputed centers in the UK namely Salford Royal Hospital in Manchester and Queen Elizabeth Hospital in Birmingham. He is a Fellow of the Royal College of Surgeons of Edinburgh, overseas member of ENT UK and the British Cochlear Implant Group. He is also a Honorary Senior Lecturer in ENT at Edge Hill University, Lancashire, UK. He has more than a decade of experience with Auditory Implants at MERF and he is currently the clinical lead for Otology at this Institute. He holds a PhD in Cochlear Implant Audiology and is also the Research Lead at MERF with keen interest in spearheading the various ongoing and future research programs of the institution. He has more than 130 publications in indexed medical journals and has presented research papers in International conferences around the world, where he has received prestigious international awards including the APSCI award, in Korea 2011; APCD award in Singapore, 2012 and BSBS award in Cardiff, UK 2017. He has authored 18 textbook chapters and is one of the very few Indian authors to have the privilege and honor to write chapters in the prestigious Scott-Brown and Logan-Turner. Apart from his passion to be a competent clinician and skilled surgeon, he dedicates his professional time to being a researcher, academic, medical leader, teacher and trainer for his peers and junior colleagues.
Axel Kaehne
Axel Kaehne was educated in Berlin at Free University and Humboldt University and subsequently studied at Aberdeen University and the University of Wales. In 2005 he took up a position of Research Fellow at the School of Medicine, Cardiff University and then joined Edge Hill University as a Senior Research Fellow in April 2013. He was appointed Reader in Health Service Research in 2016 and is currently Editor-in-Chief of the Journal of Integrated Care. Axel is Visiting Professor at the Department of Health and Social Management at the University of Eastern Finland, Kuopio and currently President of EHMA, the European Health Management Association (Brussels).
Nirmal Kumar
Professor Nirmal Kumar has been a consultant ENT surgeon at WWL NHS Foundation Trust, Lancashire, UK since 1999, after training in the West Midlands, UK. As Director of Medical Education he leads a simulation centre for medical training in Wigan and also leads the NW UK Training Programme for ENT. As Honorary Professor at Edge Hill University he conducts a MCh degree in Otolaryngology. Nationally, he is currently President of ENT UK and is on the Specialist Advisory Committee for otolaryngology. He examines for the intercollegiate FRCS exam and was recently awarded the Fellowship of the Academy of Medical Educators. Research interests include using Patient Reported Outcome Measures, AutoImmune Hearing Loss and other NIHR clinical trials. He is also a council member of the Royal college of surgeons of Edinburgh.
Mohan Kameswaran
Professor Mohan Kameswaran, Managing Director & Senior Consultant of Madras ENT Research Foundation, is the Visiting Professor of Rajah Muthiah Medical College Hospital, Annamalai University, Chidambaram and at Sri Ramachandra Medical University, Chennai. He has been a recipient of the ‘PADMA SHRI’ National Award by the Government of India in recognition of his distinguished and exceptional service in the field of Medicine in 2006. He was also awarded the prestigious ‘Indo-Australian Award’ for Meritorious Service by the Indo-Australian Association, and ‘For the sake of Honour Award’ by Rotary club of Madras Esplanade in 2006. He was the recipient of ‘Award for Excellence of Service’ in appreciation of contribution to Pioneering Cochlear Implant Program in Srilanka, by the President of Srilanka, in 2006, ‘Award for Service’ from Vidya Jyothi Sir Arthur C. Clarke, Srilanka in 2006 and Conferred ‘Award for Excellence’ in appreciation of outstanding contribution towards the Cochlear Implant Group of India, by His Excellency, the Governor of Kerala, in 2006. He was awarded the ‘Shri Shyam Lal Saxena Memorial Award 2005-2006’ by the National Academy of Medical Sciences for the best-published work in the field of bio-medical engineering by biomedical scientists. He is the only Indian to be elected as a Member of the Governing Body-Asia-Pacific Cochlear Implant Board, in 2007. He was conferred the prestigious ‘Tamilnadu Scientist Award-2007’ by the Tamil Nadu State Council for Science and Technology, Government of Tamil Nadu in 2008 and was also conferred ‘Doctor of Science (Honoris-Causa)’ by The Tamilnadu Dr. MGR Medical University in 2008. He has been elected as Member, Executive Board, International Federation of Otorhinolaryngological Societies (IFOS), Brazil representing South & West Asia & has been elected Board Member of the Politzer Society Inc. He is one of the pioneers of Cochlear Implant Surgery in India and was responsible for starting Cochlear Implant surgery in many cities in India, Sri Lanka & Nepal. He is the FIRST Surgeon in South and South East Asia to have performed the AUDITORY BRAINSTEM IMPLANT and the FIRST PAEDIATRIC BRAINSTEM IMPLANT in Asia, January 2009. He is also the FIRST surgeon in Asia Pacific region to have performed the TOTALLY IMPLANTABLE HEARING DEVICE surgery.
Richard Irving
Richard Irving holds the position of Consultant in Otology, Neurotology & Skull Base Surgery at The Queen Elizabeth Hospital NHS Foundation Trust and the Diana, Princess of Wales Hospital for Children, Birmingham. He was appointed in 1997 having completed his training in 1996 and spending a year as a Consultant Clinical Instructor at the University of California San Francisco. Richard provides a highly specialised service and offers expertise in otology, neurotology and base of skull surgery. His interests include hearing loss, chronic ear disease, tinnitus and vertigo. Richard manages a facial paralysis service and is also involved in treating tumours of the skull base and restoring hearing using middle ear and cochlear implants. Richard was trained in London, Cambridge and San Francisco and has a Doctorate in Medicine (MD) obtained from research on the genetic aspects of vestibular schwannoma. His research activity has resulted in grant awards of over £2 million for deafness research into translational projects involving bringing technology into clinical practice. He is an Honorary Professor in Bioengineering at Brunel University London. Richard has published over 150 papers and 20 book chapters on aspects of ear disease and is the Neurotology section editor of Scott Brown's Otolaryngology. As a national expert, he is regularly invited to give both national and international lectures on various aspects of ear disease. Richard serves on the Editorial Board of The Journal of Laryngology & Otology and Cochlear Implants International. He worked with NICE developing guidelines for the management of hearing loss in the UK. Throughout his career, Richard has been involved in teaching and training and runs a very successful otology fellowship program. He teaches annually on a number of national and international courses. Richard provides support to surgeons in developing countries and has operated in India, Nepal, Oman and Bangladesh in recent years. Richard provides support direct to patient groups as an advisor to the British Acoustic Neuroma Association and Facial Palsy. UK. Richard has served as the President of the British Society of Otology having previously been the founding secretary and is the current secretary of the British Society for the History of ENT. Richard has also served as the President of the Royal Society of Medicine Section of Otology and is the President-Elect of the British Skull Base Society.