Objective: To determine the effects of cochlear implant (CI) hearing rehabilitation on quality of life in older patients (≥65 yr). Study design: Prospective observational study. Setting: Department of Oto-Rhino-Laryngology, Medical University Frankfurt/Main. Patients: Patients aged between 65 and 86 years who received unilateral CI therapy for the first time. Intervention: Unilateral cochlear implantation. Main Outcome Measures: In addition to audiological parameters, the World Health Organization Quality-of-Life Scale – old (WHOQL-OLD) was used to assess quality of life prior to surgery, at the time of first fitting of the audio processor (approx. 1 mo after surgery) and 6 months afterward. Dementia and depression were excluded using dementia detection test (DemTect) and geriatric depression scale. Results: Speech recognition improved significantly during the study period. Furthermore, the total WHOQL-OLD score showed a significant improvement of quality of life comparing the preoperative and the 6 months data (60.0 ± 15.7 to 66.8 ± 12.2 points) (p = 0.001). Only 6 months after surgery, comparable quality of life values were achieved compared to the corresponding population average of the same age group (67.96 ± 14.74 points). No statistically significant difference remained between the study group and the age-adjusted population average (p = 0.37). Conclusion: To achieve auditory rehabilitation, CI treatment in older patients can be strongly recommended, not only hearing rehabilitation, but also to improve quality of life.
Objective:To assess the effects of hearing rehabilitation with cochlear implants on a subset of cognitive domains in older patients (≥65 yr).Study Design:Prospective observational study.Setting:Department of Oto-Rhino-Laryngology, Goethe-University Frankfurt/Main.Patients:Patients aged between 65 and 86 years who have received unilateral cochlear implant (CI) therapy.Intervention:Unilateral cochlear implantation.Main Outcome Measures:The dementia screening test (DemTect) and the trail making test (TMT) were carried out on three occasions: previous to the surgery, at the initial fitting (about 1 month after surgery) and 6 months after surgery.Results:The average overall score on the DemTect scale increased significantly within 6 months of CI treatment (p = 0.049), with verbal aspects improving particularly markedly. The results of the trail making test showed that within 6 months of CI treatment, processing speed increased significantly (TMT A: p = 0.003; TMT B: p = 0.001).Conclusion:A pre-post comparison showed that aural rehabilitation with a CI results in an improvement in cognitive subdomains. Further comprehensive randomized-controlled studies may be necessary to evaluate possible confounding variables and to assess long-term results.
Zusammenfassung Hintergrund Tinnitus ist ein häufiges Begleitsymptom einer hochgradigen Hörminderung oder Ertaubung auch bei älteren Menschen. Die Hörrehabilitation dieser Patienten ist in der Regel nur noch mit einem Cochlea-Implantat (CI) möglich. In den letzten Jahren werden immer mehr ältere und sehr alte Patienten mit einem CI versorgt. Ziel dieser Studie war die Untersuchung des Einflusses der Hörrehabilitation mit einem CI auf die Tinnitus-Belastung älterer Menschen. Material und Methoden In diese prospektive Untersuchung wurden 34 Patienten zwischen dem 65. und 86. Lebensjahr eingeschlossen, die erstmalig unilateral mit einem CI versorgt wurden. 16 Patienten (47,1 %) hatten präoperativ einen Tinnitus. Zu je 3 Zeitpunkten (präoperativ, bei Erstanpassung und 6 Monate postoperativ) erfolgte bei den Patienten mit Tinnitus neben der Erfassung des Sprachverstehens die Erhebung der Tinnitus-Belastung mit dem Mini-Tinnitus-Fragebogen (Mini-TF12). Ergebnisse Sechs Monate postoperativ fanden wir eine hochsignifikante Verbesserung des Sprachverstehens von präoperativ 11,5 ± 17,4 auf 54,4 ± 28,1 % (p = 0,001), die von einer hochsignifikanten Reduktion der mit dem Mini-TF12-Fragebogen erfassten Tinnitus-Belastung von 6,9 ± 6,5 Punkten präoperativ auf 4,3 ± 3,3 Punkte nach 6 Monaten (p = 0,001) begleitet war. Schlussfolgerungen Die Hörrehabilitation mittels CI führt beim älteren Menschen zu einer hochsignifikanten Reduktion der subjektiven Belastung durch einen bereits präoperativ bestehenden Tinnitus.
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