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Cochlear implants in the older patient

This presentation discusses the role of cochlear implants (CIs) in older patients, highlighting the importance of frailty over age in candidates for surgery. With the increasing incidence of hearing loss among the aging population, CIs have been shown to improve communication and quality of life significantly. The findings are based on the experiences at the University of Wisconsin, where a substantial percentage of patients over 65 received CIs. The procedure is presented as safe and well-tolerated, demonstrating minimal complications compared to younger patients.

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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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