Long-Term Outcomes of Pediatric Cochlear Implantation for Single-Sided Deafness: A Western Australian Perspective.

OBJECTIVES: To assess the outcomes of cochlear implantation (CI) for the management of pediatric single-sided deafness (SSD) in an Australian tertiary pediatric center. DESIGN: We performed a retrospective review of data from the Western Australian childhood hearing implant program between 2014 and 2023. Patients with SSD age below 16 yr and undergoing unilateral CI at Perth Children's Hospital were included. Data collected included demographics, history, pre-CI assessment, language ability, Bamford-Kowal-Bench (BKB)-Sentence in Noise (SIN) results, CI usage hours, localization, and Speech, Spatial and Qualities of Hearing Scale scores. Results were compared with and without CI where available. RESULTS: There were 22 patients who underwent CI for SSD in the 10-yr period. A total of 54.5% were male and 45.5% were female. The average age at diagnosis was 4.2 yr (0.0 to 15.1, SD: 4.8). Six patients (27.3%) were classified as late-onset SSD and 16 (72.7%) as early SSD. The average time to implantation was 1.3 yr (0.1 to 3.9 yr, SD: 1.3). Eleven patients (50%) were classified as early CI and 11 patients as late CI. The average age at implantation was 5.5 yr (1.0 to 15.6 yr, SD: 4.7). The etiology of the SSD was unknown in 8 patients (36.7%). Three of our patients showed improvement in language ability 1 yr after implantation. No patients scored poorer compared with their pre-CI language assessment. Six of the 22 subjects (27.27%) underwent localization testing. There was no significant difference identified between CI and without CI for localization (20% versus 24%; p = 0.93). Thirteen of 22 (59.09%) completed BKB-speech-in-noise (SIN) testing. Five patients performed better in their BKB-SIN with their CI and 12 performed worse with their CI. Of these 5 patients, 3 were in the early-onset SSD group and 2 in the late-onset SSD group. Of the same 5 patients, 4 were classified as early CI and 1 was classified as late CI. The majority of patients who benefited with BKB-SIN (80%) and localization testing (75%) were classified as early CI, that is, within 1 yr of onset. The average SNR loss in the early SSD group was 2.91 (1.3 to 6) with CI and 2.84 (0.5 to 5.5) without CI ( p = 0.462). For late-onset SSD, the average with CI was 3.72 (0.01 to 6) and 3.78 (0.1 to 7.7) without CI ( p = 0.475). The overall average for all patients, with and without CI, was 3.28 versus 3.28. Eight patients (34.78%) completed the Speech, Spatial and Qualities of Hearing Scale. The average CI usage was 4 hr/d (0 to 12.9, SD: 3.7). CONCLUSIONS: Despite a well-established newborn hearing screening program and equitable access to specialized services, our patients have variable long-term outcomes. While several patients showed benefit in speech in noise, high usage rates, and improved language skills, the challenge remains in consistently predicting and rehabilitating a heterogenous population of pediatric SSD patients. Patients who were classified as early CI recipients performed better, regardless of the onset of SSD.