title: Bilateral cochlear implantation in children and the impact of the inter-implant interval.
abstract: OBJECTIVE
  To determine the effectiveness of simultaneous versus sequential bilateral cochlear implantation on postoperative outcomes in children with bilateral deafness and to evaluate the impact of the inter-implant interval and age at second implantation on postoperative outcomes in children who already received their first cochlear implant.
  
  
  METHODS
  PubMed, Embase, and Web of Science.
  
  
  METHODS
  All studies comparing the effects of simultaneous with sequential bilateral cochlear implantation on postoperative outcomes and those evaluating the impact of the inter-implant interval and age at second implantation were retrieved.
  
  
  RESULTS
  Four studies compared the effects of simultaneous with sequential bilateral cochlear implantation. All studies lacked randomization. Of these, three reported better speech perception and expressive language development at one year of bilateral experience for simultaneous cochlear implantation. Of the nineteen publications on the impact of the inter-implant interval on postoperative outcomes, the risk of bias was low-moderate for seven studies which were derived from five different study populations. In two of these populations no impact of the inter-implant interval was found, while in three a longer inter-implant interval was associated with poorer speech and language development.
  
  
  CONCLUSIONS
  Observational studies suggest that simultaneous implantation in children may be associated with improved speech and language development, and that a prolonged inter-implant interval between both implantations may have a negative impact on these postoperative outcomes. Randomized trials are, however, needed to demonstrate whether simultaneous implantation indeed is superior to sequential bilateral implantation in children with bilateral deafness.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Marc J W
authors.initials: MJ
authors.lastname: Lammers
authors.forename: Roderick P
authors.initials: RP
authors.lastname: Venekamp
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D002648:Child; D003054:Cochlear Implants; D003638:Deafness / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011474:Prosthesis Design; D013067:Speech Perception / Q000502:physiology*; D016896:Treatment Outcome
keywords: Cochlear implant; age at implantation; inter-implant interval; sequential; simultaneous; systematic review