Benefits of bilateral cochlear implantation in children: a systematic review and meta-analysis

To systematically evaluate the benefits and risks of bilateral cochlear implantation (BiCI) in children compared with unilateral cochlear implantation (UniCI), with a focus on auditory outcomes, language development, and potential complications.

✦ Clinical Takeaway ✦

Bilateral cochlear implantation in children provides superior outcomes over unilateral implantation in speech, language, and spatial hearing; audiologists and cochlear implant teams should advocate for bilateral implantation when candidacy criteria are met.

✦ Why It Matters ✦

This meta-analysis provides the strongest available evidence to support bilateral cochlear implantation as the standard of care for eligible children, with direct policy and funding implications.

✦ Key Points ✦

01Systematic review and meta-analysis — the highest level of evidence — comparing bilateral vs. unilateral cochlear implants in children.
02Bilateral cochlear implantation offers advantages in sound localization, speech perception in noise, and language development.
03Published in European Archives of Otorhinolaryngology.
04Findings support advocacy for bilateral implant coverage by insurers and health systems.
05Risk-benefit analysis also considered, acknowledging surgical risks of a second implantation.

✦ Claims & Evidence ✦

ClaimEvidenceSupport

Bilateral cochlear implantation provides greater benefits than unilateral implantation in children.

studysupported

Bilateral cochlear implantation carries additional risks compared to unilateral implantation.

studypartially supported

✦ Research metadata ✦

PMID: 42162288
DOI: 10.1007/s00405-026-10302-z.
Journal: European Archives of Otorhinolaryngology
Publication type: meta_analysis
Evidence level: 1a
Population: Children with hearing loss undergoing cochlear implantation
Intervention: Bilateral cochlear implantation
Comparator: Unilateral cochlear implantation

Primary outcomes

Speech perception; Language development; Sound localization; Safety and adverse events

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