Introduction: In recent years, simultaneous bilateral cochlear implantation (CI) has become the preferred procedure for children with bilateral deafness. The aim of this study is to compare simultaneous bilateral CI with sequential bilateral CI concerning operation time, perioperative morbidity, mortality and anesthesia risk.

Methods: A retrospective data analysis was conducted on 132 children who were implanted between 2019 and 2024 and aged under 10 years at the time of either simultaneous or second CI. The age at implantation, duration of surgery and anesthesia, anesthesia risk, perioperative morbidity and mortality were compared between the simultaneous and the sequential implantation cohorts.

Results: Whilst simultaneous bilateral CI demonstrated a significant reduced anesthesia time (simultaneous CI: 221.7 ±- 41.4 min; sequential CI: 262.3 ± 37.11 min), the cumulative duration of surgery was longer (simultaneous CI: 157.3 ± 40.07 min; sequential CI: 131.8 ± 35.48 min). However, perioperative morbidity, mortality as well as anesthesia risk showed no significant differences. The cumulative duration of hospitalization was significantly longer for sequential CI (simultaneous CI: 5 ± 0.76 days; sequential CI: 10 ± 0.85 days).

Discussion: The study underlines the benefits of simultaneous bilateral CI, regarded as the gold standard, particularly concerning reduced anesthesia time and shortened hospital stays. However, the longer cumulative surgery time and the absence of significant differences in perioperative morbidity, mortality, and anesthesia risks must be considered. This makes sequential CI a viable treatment alternative and allows for an individualized treatment approach that accounts for existing comorbidities and individual patient and parental factors.

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