| Sumario: | Approximately 90 to 95 % of deaf children in Norway are offered a cochlear implant (CI) in one or both ears. CI is an advanced hearing aid aimed to recognize sounds. Parents of children with CI have to choose preferred communication mode for their child. In Norway there are mainly three approaches: use of both spoken language and sign language (bilingual communication), spoken language with sign support and spoken language alone (oral communication). The objective of this systematic review was to summarize recent studies comparing the effect of using spoken language and sign language, spoken language with sign support or spoken language alone. We have also looked at studies on total communication, a communication mode used in the U.S., consisting of different elements of spoken language, sign support or sign language. We included studies where children had CI implanted before the age of three and we tried to answer the following question: How does the chosen communication mode affect the children's sound and speech recognition, their speech and language perception and production, their quality of life, social participation and any other outcome? It is uncertain what effect using spoken language and sign language, spoken language with sign support or spoken language alone have on children who have been implanted with CI by the age of three. The quality of the documentation is very low. We found four studies that compared total communication with spoken language alone. The quality of the documentation was very low and the results had limited external validity. We found no studies on children who used both spoken language and sign language and no studies that measured the children's quality of life or social participation.
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