According to health care experts, cochlear implantation in senior citizens seems to be not cost effective, due to a belief that elderly patients perform poorly in the postoperative audiological rehabilitation process due to degenerative processes in the central and peripheral auditory system.
Other studies have found suggested that the auditory processing difficulties in elderly patients might be are a result of physiological changes within the cochlea; therefore bypassing the cochlea and stimulating the auditory nerve directly could reduce the clinical manifestations of the auditory processing problem.
The elderly do have concurrent physical, mental and psychosocial illnesses unrelated to hearing loss that could impact on the success of cochlear implantation. It is known that that flap/wound problems, device-related problems, and temporal bone/central nervous system problems are the three most common otological complications of cochlear implant surgery. Additionally cardiopulmonary diseases and related risk factors such as coronary artery disease and diabetes mellitus can protract the postoperative healing and rehabilitation process. One researcher has divided the complications into three categories: adverse reactions (postoperative complications resulting in a negative effect on the patient), surgical complications, such as flap breakdowns, and device related problems. In all three categories, children had fewer complications with cochlear implantation than adults.
The elderly patient’s quality of life and cost-effectiveness are important to assess cochlear implantation in these patients. A new study from Germany seeks to examine cochlear implantation in senior citizens age 65 years and older at the time of surgery, with an emphasis on preoperative findings, perioperative complications and postoperative speech perception. Their findings were to be compared with younger recipients between 18 and 50 years of age at time of implantation.
The authors of “Cochlear Implantation in Senior Citizens,” are Jan Haensel MD, Justus Ilgner MD, and Martin Westhofen MD, all from the Department of Otorhinolaryngology, Head and Neck Surgery Aachen University Hospital, Germany. Their findings are being presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.
This retrospective study entailed the analysis of 26 postlingually deaf patients over 65 years of age, who underwent cochlear implantation at a major medical center between 1986 and 2003. The 16 female and ten male patients averaged 69 years at time of implantation (range 65-80 years) with an average duration of deafness of 13 years (range one to-47 years). In 27 percent, the hearing loss was caused by recurrent SSHL (sudden sensorineural hearing loss), in 19 percent by meningitis, 12 percent by a trauma and eight percent by otosclerosis. In one in three subjects, the cause of the hearing loss was unknown.
Prior to cochlear implantation all patients received a conventional hearing aid on both ears, in use for at least three months. In all cases there were no objective and subjective benefit in hearing and speech perception even under best-aided conditions.
All patients underwent detailed preoperative medical, audiological and psychological examinations to determine candidacy. All postoperative complications and the length of hospitalization were recorded. Patients were analyzed with the open-set speech perception using multi- and monosyllabic word recognition (75 dB in quiet). The data of the senior patients was compared to a control group of 47 younger recipients. The control group had an average age of 37 years (range 18-50 years) at time of implantation and a medial duration of deafness of 13 years (range 1-40 years).
A questionnaire containing questions about quality of life after cochlear implantation and contentment with the procedure was sent to all patients to be answered at home. The scale had three response steps from yes, no to no opinion. All questionnaires were returned properly filled out.
Prior to operation all patients underwent an extensive vestibular testing. In 12 patients (46 percent) there was a normal vestibular function, whereas six patients (23 percent) showed a unilateral and eight patients (31 percent) a bilateral vestibular dysfunction.
All senior patients were dismissed from hospital after an average time of nine days (range six-23 days). In comparing length of hospitalization with the control group of 47 younger patients there was no significant difference, with the young recipients also registering an average of nine days in the hospital.
The speech perception in all patients was recorded one, three, six and 12 months after implantation. The researchers found no significant differences in the results of the multi- and monosyllabic word test (open-set) in the study group of senior citizens and the control group of younger patients at any time.
After one year, two elderly patients ceased using their cochlear implants. The remainder found that cochlear implant had a positive impact on their quality of life.
The findings of this study reveal that cochlear implantation is feasible in senior citizens without higher risks or costs in comparison to younger patients. No significant differences in speech perception between senior and younger recipients could be recorded in our study. In consideration of physical, mental and psychosocial unrelated illnesses, the researchers suggest that elderly patients and their impact on the surgical and rehabilitational procedure, cochlear implantation leads to a higher quality of life in these patients.