Effects of cochlear implantation on quality of life in patients with age-related hearing loss: a systematic review

Background: Age-related hearing loss (ARHL) is among the most prevalent sensory impairments in older adults. However, the magnitude and time course of quality-of-life (QoL) gains associated with cochlear implantation (CI) in ARHL, as well as potential differences across older age strata, have not been synthesized systematically. We conducted a systematic review to characterize QoL changes after CI in ARHL and to contrast the responsiveness of hearing/CI-specific instruments with that of generic QoL measures. Methods: Following PRISMA, we searched PubMed, Web of Science, Embase, the Cochrane Library, and CNKI from inception to 7 December 2025. Eligible studies enrolled adults aged ≥60 years meeting an ARHL definition, receiving CI, and reporting outcomes from validated QoL instruments. Two reviewers independently performed study selection and data extraction. Risk of bias in non-randomized studies was assessed using the ROBINS-I tool. Outcomes measured by different types of QoL instruments at each follow-up time point were synthesized narratively. Results: We included 16 studies (842 participants). According to ROBINS-I, most studies had at least moderate risk of bias, and approximately one third were judged to have a serious risk of bias. Across studies, hearing/CI-specific measures (e.g., Nijmegen Cochlear Implant Questionnaire, NCIQ and Glasgow Benefit Inventory, GBI) more consistently detected post-CI gains, particularly in domains related to sound perception and social support. In contrast, generic QoL instruments (e.g., WHOQOL-OLD) more often suggested a delayed benefit signal, typically becoming statistically apparent around 6 months after surgery and mainly involving sensory abilities, social participation, and mental health, while changes in physical-functioning domains were limited. Conclusion: On the basis of observational studies with predominantly moderate to serious risk of bias, current evidence suggests that QoL tends to improve after CI in adults with ARHL and that chronological age itself does not appear to be a major constraint on CI-related benefit. Future studies should prioritize CI-specific instruments (e.g., Cochlear Implant Quality of Life, CIQOL), harmonize follow-up schedules, and explicitly examine longer-term benefit trajectories in the oldest-old to strengthen evidence for expectation management and rehabilitation planning.