title: Prognostic indicators in paediatric cochlear implant surgery: a systematic literature review.
abstract: BACKGROUND
  Paediatric cochlear implantation (PCI) requires complex case evaluation and counselling, surgical intervention, and habilitation. Outcomes vary and many cases have sub-optimal outcomes as a result of a broad spectrum of adverse influences.
  
  
  OBJECTIVE
  To systematically review the literature to identify research papers that indicate a demonstrated outcome or prognostic factor in paediatric CI, the overall aim being to develop a prognostic index for clinical use.
  
  
  METHODS
  Six main literature domains were assessed: medical/surgical; audiology; psychology; speech/language; education; and family. Search strategies were applied to appropriate databases and journals. A strict inclusion criterion was utilized. A critical appraisal tool was administered to evaluate the final eligible citations.
  
  
  RESULTS
  The review identified 92 citations, of which 38 were eligible. Heterogeneity in study design prevented a quantitative meta-analysis of the data. Discussion While there are a large range of factors that impact PCI outcomes, well-constructed case control studies are limited in number and scope and relatively few demonstrated significant prognostic factors. Only four factors were identified as consistently influencing PCI outcomes: age at implantation, Connexin 26, inner ear malformations, and meningitis.
  
  
  CONCLUSIONS
  Evaluation of relevant adverse prognostic factors in paediatric CI remains a largely unreported field. Better identification of these factors is required for improving vital pre-operative counselling and resultant surgical expectations and outcomes.
authors.affiliation: School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia. jbblack@bigpond.com
authors.forename: Jane
authors.initials: J
authors.lastname: Black
authors.forename: Louise
authors.initials: L
authors.lastname: Hickson
authors.forename: Bruce
authors.initials: B
authors.lastname: Black
authors.forename: Chris
authors.initials: C
authors.lastname: Perry
mesh_terms: D000367:Age Factors; D016022:Case-Control Studies; D019929:Cochlear Implantation; D000072259:Connexin 26; D017630:Connexins / Q000378:metabolism; D007758:Ear, Inner / Q000002:abnormalities; D034381:Hearing Loss / Q000150:complications / Q000601:surgery; D006801:Humans; D008581:Meningitis / Q000150:complications; D010372:Pediatrics / Q000379:methods*; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D017630:Connexins; D000072259:Connexin 26