Long‐term Use of Cochlear Implants in Older Adults: Results from a Large Consecutive Case Series

Abstract

INTRODUCTIONHearing loss is prevalent in one in three people over the age of 50, and two-thirds of those older than 70 years. 1 Hearing loss in older adults impairs verbal communication, contributes to social isolation, 2 and has been independently associated with poorer cognitive functioning [3][4][5] and incident dementia. [6][7] While hearing aids improve audibility for most individuals with mild to moderate hearing loss, those who suffer from severe to profound hearing loss generally may acquire greater benefit from electrical hearing provided by a cochlear implant (CI). 8 Currently, the number of older adults in the United States who would potentially meet audiologic criteria for a CI is approximately 150,000, 1 but less than 5% of these older adults are likely to have received a CI System. 9 Many factors could potentially account for the low rate of CI use in older adults, such as a general perception of hearing loss being an inconsequential part of aging and poor awareness of and access to cochlear implantation. Additionally, there are concerns about whether older adults could practically benefit from CI on a daily basis. Older adults can consistently acquire improved speech perception scores after CI in the clinical setting, 10 but patterns of CI use by older adults has received little review. Previous studies have reported results only in small cohorts of older adults with limited durations of follow-up. [11][12][13][14][15][16][17][18] The purpose of our study was to investigate long-term rates of CI use in a consecutive case series of older adults (≥60 years) who received their first CI from 1999-2011. MATERIALS AND METHODS STUDY COHORTWe queried the Johns Hopkins Listening Center database to retrieve all patients ≥ 60 years who received a first CI from 1999 to June 2011 (n = 447). The purpose of this study was to investigate rates of CI use in older adults which is generally defined by the United Nations as adults ≥ 60 years. 33 Of these patients, we were able to successfully obtain follow-up information from the patient or a proxy respondent for 397 individuals (89%) from June to August 2012, and these individuals comprise our analytic cohort. Characteristics of "responders" (n = 397) and "non-responders" (n = 50) did not differ significantly by age of implantation, onset of hearing loss, side of implantation, or manufacturer (data not shown). Non-responders were more likely to have been implanted earlier in the study time period than responders (p < .001). Of the 50 non-responders, 27 (54%) had died based on Social Security Death Index records. For these deceased non-responders, we were unable to obtain proxy information on their CI use at the time of death due to unavailable contact information for surviving family members. This study was approved by Johns Hopkins Institutional Review Board. DATA COLLECTION ON CI USEAs part of a quality assurance initiative at the Johns Hopkins Listening Center, we contacted all CI patients and their families to survey their daily CI use. Postal and email survey...

Long‐term outcomes of cochlear implantation in patients with high‐frequency hearing loss

“…Patient‐related factors such as age at implantation, duration and stability of SNHL, sex, and noise exposure should be considered when selecting appropriate candidates in order to maximize hearing preservation outcomes . Our data suggest that increasing age and longer duration of hearing loss have trends toward negative correlations with hearing preservation and speech perception outcomes, consistent with that seen in traditional cochlear implants . Further investigation is warranted in this population.…”

“…13,35,36 Our data suggest that increasing age and longer duration of hearing loss have trends toward negative correlations with hearing preservation and speech perception outcomes, consistent with that seen in traditional cochlear implants. 37,38 Further investigation is warranted in this population.…”

The Outcomes of Cochlear Implantation in Elderly Patients: A Single United Kingdom Center Experience

“…Interestingly, the authors also found an increased risk of nonuse with increasing age of the patient at time of implantation. 22 Our cohort included 2 nonusers, one in each age subgroup, as described earlier.…”

Improvement of Cognitive Function After Cochlear Implantation in Elderly Patients

“…A limitation of our study is the short postimplantation observation interval. A recent study 47 reported that at 13.5 years after implantation, 83% of elderly patients who received cochlear implants at age 60 years or older continued to use the implant consistently. In another study, 23 elderly patients with unilateral implants maintained their earlier speech perception ability in noise 10 years or more after receiving an implant.…”