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  • Lyazzat Kosherbayeva (a1), David Hailey (a2) and Laura Kozhageldiyeva (a3)


Objectives: The aim of this study was to evaluate the effectiveness of bilateral cochlear implantation (CI) compared with unilateral CI for deaf children in the context of the Republic of Kazakhstan health system.

Methods. A literature search was conducted, using the PubMed, Cochrane, and Embase data bases for studies that compared the effectiveness of bilateral and unilateral CI in children. The search included English language, publications from 2002–2012. Two reviewers independently evaluated all relevant studies. Administrative data relevant to CI in Kazakhstan were obtained from the Ministry of Health.

Results: Three relevant systematic reviews and an health technology assessment report were found. There was evidence of incremental benefits from bilateral CI but the quality of the available studies was poor and there was little information on longer term outcomes. No conclusions could be drawn regarding later incremental improvements to speech perception, learning, and quality of life. To date, in the Republic of Kazakhstan there is not full coverage of audiological screening due to the lack of medical equipment. This leads to late detection of hearing-impaired children and a long rehabilitation period, requiring more resources. Age of implantation in children is late and only a small minority attend general schools.

Conclusions: The clinical effectiveness of bilateral CI, an expensive health technology, requires further study. Given the current situation in Kazakhstan with audiological screening and access to unilateral CI, there appeared to be other priorities for improving services for children with profound hearing impairment.



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1. US Preventive Services Task Force. Universal screening for hearing loss in newborns: Recommendation Statement. Pediatrics. 2008;122:143148.
2. World Health Organization. Newborn and infant hearing screening. Current issues and guiding principles for action. Geneva: WHO Press; 2010. (accessed February 18, 2014).
3. Kosherbayeva, L, Hailey, D. Bilateral and unilateral cochlear implantation in children. Astana: Ministry of Public Health of the Republic of Kazakhstan; 2013.
4. Swedish Council on Technology Assessment in Health Care. Bilateral cochlear implantation (CI) in children (Alert). Stockholm: SBU; 2006.
5. Bond, M, Mealing, S, Anderson, R, et al. The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults: A systematic review and economic model. Health Technol Assess. 2009;13:1330.
6. Forli, F, Arslan, E, Bellelli, S, et al. Systematic review of the literature on the clinical effectiveness of the cochlear implant procedure in paediatric patients. Acta Otorhinolaryngol Ital. 2011;31:281298.
7. Johnston, JC, Durieux-Smith, A, Angus, D, O’Connor, A, Fitzpatrick, E. Bilateral paediatric cochlear implants: A critical review. Int J Audiol. 2009;48:601617.
8. Smulders, YE, Rinia, AB, Rovers, MM, van Zanten, GA, Grolman, W. What Is the effect of time between sequential cochlear implantations on hearing in adults and children? A systematic review of the literature. Laryngoscope. 2011;121:19421949.
9. May-Mederake, B, Kuehn, H, Vogel, A, et al. Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS) Auditory Questionnaire. Int J Pediatr Otorhinolaryngol 2010;74:11491155.



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