An End to Isolation: Cochlear implantation in the elderly is a viable, safe option
The average life expectancy in the United States has increased by nearly 10 percent over the past four years. Currently those over the age of 80 represent the fastestgrowing demographic. Individuals surpassing their 80th birthday have been found to live an average of up to nine additional years.
According to the Centers for Disease Control and Prevention, hearing loss is one of the most common conditions among seniors. One in three adults older than age 60 and half of people older than age 85 experience hearing loss.
Age-related hearing loss, or presbycusis, is one cause. This is a gradual worsening of function of the hair cells inside the cochlea that allow you to hear. There seems to be a genetic component for this type of hearing loss, although no specific genes have been identified. Repeated exposure to loud noises also damages hair cells, as does smoking. These factors have led to an expanding field of older adults who require hearing assistance.
Cochlear implants are electronic devices implanted in the cochlea, or inner ear, to restore hearing in those who are profoundly hearing impaired. Much has been discussed regarding the risks and benefits of cochlear implants for people of advanced age, and not surprisingly, concerns have arisen regarding overall benefit and life expectancy to realize the benefit.
The elderly are more likely to have other illnesses and conditions, such as heart disease, which may increase the risk for surgery. Another valid question is whether the elderly have auditory systems capable of using the technology contained within the implant, given longer durations of deafness and central hearing losses.
The need for the elderly to communicate has never been questioned. Hearing loss often isolates elderly patients who frequently have associated visual deficits as well. This compounds the difficulty in communicating with family, friends, and loved ones as well as people encountered during everyday life. Associated visual loss can make patients more dependent on hearing and less capable of other forms of communication, such as lip reading.
Our experience at Vanderbilt University, where we do about 140 implants a year, has been that implantation in patients in their 80s and 90s remains a safe and effective procedure. Careful preoperative evaluation by anesthesiologists is essential. Clearance by the patient's internists, cardiologists, and other medical professionals is important prior to surgery.
In experienced hands and at centers that do a high volume of cochlear implantation, the surgery is quite routine, mostly performed as an outpatient procedure. The surgery is completed in about 90 minutes. Elderly patients are more likely to require an overnight stay to manage issues that arise during and after the surgery. In summary, cochlear implantation in the elderly remains a viable option. Restoration of hearing in this group is particularly beneficial given the isolation that hearing loss can cause for these patients. Cochlear implantation is proven to be a safe and effective procedure for all age groups, even for patients in their 90s. The risk and benefit profile for cochlear implantation is one of the most favorable profiles for operations done in America. The benefit that hearing restoration brings to these patients is often indescribable, having a positive effect on not only the patients but also on friends and family.
David S. Haynes, M.D., FACS, is a professor in the Department of Otolaryngology and in the Department of Hearing and Speech Sciences at the Vanderbilt Medical Center in Nashville, Tenn. His appointments include director of the Otology Group of Vanderbilt, the Division of Otology/Neurotology, and the Adult and Pediatric Cochlear Implant Program. He also serves as medical director of Vanderbilt Hearing and Balance Center and is president of Deafness Research Foundation's Centurions.
Healthy? You're a Good Candidate for a Cochlear Implant
Cochlear implantation can overcome the limitations of using a hearing aid. Cochlear implants (CIs) are able to enhance recognition of environmental sounds and restore clarity of hearing.
But despite being appropriate candidates for CIs, the elderly are infrequently referred for cochlear implantation. This is because of concerns about the risks of general anesthesia and potentially poorer rehabilitative outcome. While several studies have shown significant improvement in hearing and quality of life in the elderly following cochlear implantation, anesthetic risk had not been previously investigated.
According to a February 2009 study that was published in The Laryngoscope, researchers at the New York University Langone Medical Center found that older patients undergoing cochlear implantation tolerated general anesthesia well.
Researchers Daniel Coelho, Joseph Yeh, Jung Kim, and Anil Lalwani reviewed the anesthesia records of 70 patients older than 70 years who underwent cochlear implantation. The average age at implantation was 77.2 years and the range of ages was from 70 to 92 years. They classified patients based on preexisting medical conditions using the American Society of Anesthesiologist classification system. Not surprisingly, many of the elderly patients had other medical problems not related to their hearing, including high blood pressure, coronary artery disease, low thyroid function, and high cholesterol.
The investigators found that relatively healthy elderly patients had no anesthesia-related complications. The preexisting conditions of the patientand not advanced age aloneare more significant risk factors in patients undergoing cochlear implantation with general anesthesia. The study concluded that age alone should not be a contraindication when determining candidacy for this life-changing technology.
Cochlear Implants Changed My Life
by John C. Ayers
I'm 78 years old and received my first cochlear implant at age 73.
At age 50, as I admitted I could hear less and less, I gave in and got hearing aids. Like most people, I didn't want people to know I couldn't hear, so I purchased devices that I wore deep in my ear canal. My father came from a family of 16 children, half of them men. The men all had hearing loss later in life, so I figured this would happen to me, too.
After I retired, I took up doing construction projects with my church, and realized that perspiration and hearing aids do not mix. I started taking them out before working. Then one day when I reinserted them in my ears, my left ear still could not hear, even after changing the battery. This brought on an attack of vertigo. At the ear, nose, and throat doctor the next day, I learned I'd become deaf in one ear. Most likely, a virus caused the hair cells in my left ear to stop working properlyand permanently.
I walk three miles six days a week, and it was during this time that I came to terms with my new condition. A doctor I found via an Internet search told me I was a strong candidate for a cochlear implant in my left ear. I continued to use a hearing aid in my right ear, but eventually this ear too lost its functionality.
I have been very fortunate with both CIs. Both activations were seamless. Getting CIs at an older age has helped me continue to be active and productive. To seniors who believe they are too old to get them, I say think again.
I admit my two devices are not perfect. I have occasional problems regarding directionality--figuring out which direction sounds come from. For example, say I'm distracted and my car keys don't make it into my pocket. I will hear the clink as the keys hit the pavement but I won't know what direction it has come from, and will not realize it was coming from my keys as they dropped onto the ground.
The other issue is being bombarded with many sounds all at once, as in a meeting or restaurant. Normal-hearing individuals can tune out people and music they don't want to listen to. But I've learned that some speech processors have programs that can change the microphone range from 360 degrees to 90 degrees, which can reduce many extraneous sounds.
Since getting the CIs, I've become very involved with providing feedback about them to researchers and manufacturers. I'm participating in four university studies around the country, and regularly speak about my experiences to churches, schools, hospitals, implant support groups, and industry meetings. You can say CIs have changed my life.
John C. Ayers lives in Dallas.
