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Cochlear implants in the older patient

Cochlear implants in the older patient. Mark Pyle MD Professor of surgery and Academic Vice Chair Division of Otolaryngology. Introduction. How do we define “ older” Iife expectancy 78.7 years Frailty , NOT AGE, is a consideration. Demographics. 41 million ( 2011) and increasing

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Cochlear implants in the older patient

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  1. Cochlear implants in the older patient Mark Pyle MD Professor of surgery and Academic Vice Chair Division of Otolaryngology

  2. Introduction • How do we define “ older” • Iife expectancy 78.7 years • Frailty , NOT AGE, is a consideration

  3. Demographics • 41 million ( 2011) and increasing • Increased incidence of hearing loss • Association with dementia

  4. UW Experience • 44 % of adult patients over 65 • Only one patient has been explanted for medical complication

  5. Special considerations • Loss of other special senses • Depression and dementia • Communication with caregivers including family and physicians

  6. Who is a candidate ? • Severe to profound bilateral sensorineural hearing loss • Limited benefit from hearing aid • History of auditory communication • “ nerve deafness “ is OK • No medical contraindication

  7. Am I healthy enough to have CI surgery ? • Collaboration with primary MD • Surgery itself is very well tolerated • Most medical problems are easily managed • Pain is usually minimal

  8. Evaluation • History , examination , audiogram • Audiologic CI evaluation including sentence testing • Imaging studies- MRI • Balance tests

  9. Financial questions • Medicare guidelines • Secondary Insurance • January 2014 ??

  10. Surgical Recovery • Hospital stay • Wound care • Audiology visits

  11. Complications • “ minor “ are most common • In one 445 patient study by Chen , et al , safety was comparable to younger patient population. • Imbalance greater than 1 month in 10% of patients over 75 and 5 % of patients 60-74. • 3.8% required device removal. 15 of these 17 patients were successfully reimplanted

  12. Summary • Cochlear Implants can be done safely in patients over 65 and 75. • They significantly improve quality of life and communication in this population.

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