Design: Systematic review and meta-analysis of prevalence
Population: 29 studies, 2,595 children with cochlear implants
Primary outcome: Long-term non-use and partial use
Effect: Non-use 4.45% (95% CI 2.21 to 8.78); partial use 8.99% (5.91 to 13.44)

A meta-analysis pooled 29 studies including 2,595 children with cochlear implants to estimate how many stop using or under-use the device.

Pooled non-use was 4.45% (95% CI 2.21 to 8.78) and partial use, under eight hours a day, 8.99% (5.91 to 13.44). Non-use varied widely by region and was higher in some clinical subgroups. Longer duration of hearing loss before implantation was associated with more partial use, and implantation at or before 12 months with less partial use than at 12 to 24 months (6.9% vs 16.8%).

An implant that is not worn delivers none of its benefit. Tracking daily use, which many processors log, gives an early warning.

These are observational associations from studies of varying quality; the link with age at implantation may partly reflect other differences between children.

Check processor data-logging for daily wear at each follow-up.
Treat under eight hours a day as a prompt to explore barriers.
Earlier implantation was associated with fuller use.
Involve families and schools in supporting consistent wear.

Why it matters

Implantation is the start of the outcome, not the outcome itself.

The statistics, in plain English

Pooled prevalence estimates combine studies with different populations; the wide regional range shows the average hides large differences between programmes.