Non-usage rates after paediatric cochlear implantation: A systematic review and meta-analysis.

Objective

To determine the prevalence of long-term cochlear implant (CI) non-use and partial use in paediatric recipients and identify factors associated with suboptimal adherence. DATA SOURCES A systematic search of major electronic databases including PubMed, Embase, and the Cochrane Library was performed to identify studies reporting CI usage patterns in paediatric populations. REVIEW

Methods

We conducted a systematic review and meta-analysis of 29 studies (n = 2595) following PRISMA guidelines. Pooled prevalence estimates were calculated using random-effects models with generalized linear mixed model.

Results

The pooled prevalence of non-use was 4.45% (95% CI: 2.21-8.78, p < 0.0001) and partial use (<8 h/day) was 8.99% (95% CI: 5.91-13.44, p < 0.0001). Non-use was highest in Oceania at 27.27% (95% CI = 9.05-58.57), and lowest in Europe at 1.99% (95% CI: 1.00-3.94). Compared to normal population, non-use rates are also significantly higher among specific clinical subgroups (16.29% vs 2.29%). Longer duration of hearing loss was associated with a higher prevalence of partial-use (coefficient 0.477, p < 0.001). Compared to 12-24 months, early implantation (=<12 months) was associated with reduced partial use (6.89% vs 16.81%). No significant associations were found with follow up duration, sex or implant laterality.

Conclusion

More than one-tenth of recipients demonstrated suboptimal long-term adherence, varying by region, clinical subgroups, hearing loss duration, and implantation age. Targeted, risk-stratified strategies are needed to improve adherence and long-term outcomes.