Double Benefit? The case for bilateral cochlear implants

Since the advent of the cochlear implant more than 20 years ago, the devices have benefited thousands of patients. According to the U.S. Food and Drug Administration, as of April 2009, approximately 188,000 people worldwide have received cochlear implants. In the U.S., about 42,000 adults and 26,000 children have received them. Today, the fantasy of two implanted artificial cochlea is a reality.

At some institutions, it is standard operating procedure to place two implants. In a 2008 article in Current Opinion in Otolaryngology & Head and Neck Surgery, for example, Blake Papsin, MD, and colleagues published an article titled “Bilateral cochlear implants should be the standard for children with bilateral sensorineural deafness.” The authors wrote, “We recommend that simultaneous bilateral implantation be provided when possible and, if not, the inter-stage interval should be limited” (2008;16:69-74). Dr. Papsin is director of the Cochlear Implant Program at The Hospital for Sick Children and professor of otolaryngology at the University of Toronto.

Simultaneous or Sequential?

Bilateral cochlear implantation has been found to offer significant benefits to children with severe-to-profound hearing impairment. Where a single implant can enable a child to hear, two implanted simultaneously in a young child can give the child the gifts of song and music, and can significantly improve his or her ability to interact socially and to hear incidental sounds such as those in the back seat of a car, on the street, or on the playground. In a recent article in The Laryngoscope (2009;119:2444–2448), Dr. Papsin and coauthors demonstrated that simultaneous bilateral implantation in children was safe and effective in a series of 50 cases.

“Any parent will tell you that [the children] pick up stuff so much quicker [with bilateral simultaneous implants],” he said in an interview with ENT Today. “I have a video of a child actually singing the ABCs in tune.”

Dr. Papsin said bilateral implants are the standard of care in his hospital. “I think the key is if you have a funding structure that supports it, if you have a surgical team that can perform it, if you have an audiologic diagnosis that is dependable and if you have family who are willing to undergo that procedure, then I can’t imagine why you wouldn’t go for simultaneous bilateral or a bilateral implant,” he said.

Audie Woolley, MD, said studies show better sound localization and speech perception with bilateral implants. “They’re showing overall better listening skills, both for children in the classroom and in social situations,” said Dr. Woolley, associate clinical professor of otolaryngology and pediatrics at Children’s Hospital of Alabama and the University of Alabama Birmingham School of Medicine, where he is also medical director of the Pediatric Cochlear Implant Program.