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. 2023 Oct 1;44(9):866-872.
doi: 10.1097/MAO.0000000000003983. Epub 2023 Aug 23.

Longitudinal Auditory Benefit for Elderly Patients After Cochlear Implant for Bilateral Hearing Loss, Including Those Meeting Expanded Centers for Medicare & Medicaid Services Criteria

Sarek Shen  1 , Zahra Sayyid, Nicholas Andresen, Courtney Carver, Rachel Dunham, Dawn Marsiglia, Jennifer Yeagle, Charley C Della Santina, Steve Bowditch, Daniel Q Sun
Affiliations

Longitudinal Auditory Benefit for Elderly Patients After Cochlear Implant for Bilateral Hearing Loss, Including Those Meeting Expanded Centers for Medicare & Medicaid Services Criteria

Sarek Shen et al. Otol Neurotol. .

Abstract

Objective: To examine the effect of patient age on longitudinal speech understanding outcomes after cochlear implantation (CI) in bilateral hearing loss.

Study design: Retrospective cohort study.

Setting: Tertiary academic center.

Patients: One thousand one hundred five adult patients with bilateral hearing loss receiving a unilateral CI between 1987 and 2022InterventionsNone.

Main outcome measures: Postoperative speech recognition outcomes, including AzBio sentences, consonant-nucleus-consonant word, and Hearing in Noise Test in quiet were analyzed at short-term (<2 yr), medium-term (2-8 y), and long-term (>8 yr) term postoperative intervals.

Results: Eighty-six very elderly (>80 yr), 409 elderly (65-80 yr), and 709 nonelderly (18-65 yr) patients were included. Short-term postoperative AzBio scores demonstrated similar magnitude of improvement relative to preoperative scores in the very elderly (47.6, 95% confidence interval [CI], 28.9-66.4), elderly (49.0; 95% CI, 39.2-58.8), and nonelderly (47.9; 95% CI, 35.4-60.4). Scores for those older than 80 years remained stable after 2 years after implant, but in those 80 years or younger, scores continued to improve for up to 8 years (elderly: 6.2 [95% CI, 1.5-12.4]; nonelderly: 9.9 [95% CI, 2.1-17.7]) after implantation. Similar patterns were observed for consonant-nucleus-consonant word scores. Across all age cohorts, patients with preoperative Hearing in Noise Test scores between 40 and 60% had similar scores to those with preoperative scores of less than 40%, at short-term (82.4, 78.9; 95% CI, -23.1 to 10.0), medium-term (77.2, 83.9; 95% CI, -15.4 to 8.2), or long-term (73.4, 71.2; 95% CI, -18.2 to 12.2) follow-up.

Conclusions: Patients older than 80 years gain significant and sustained auditory benefit after CI, including those meeting expanded Centers for Medicare & Medicaid Service criteria for implantation. Patients younger than 80 years demonstrated continued improvement over longer periods than older patients, suggesting a role of central plasticity in mediating CI outcomes as a function of age.

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Conflict of interest statement

The authors disclose no conflicts of interest.

Figures

Figure 1.
Figure 1.
Pre- and post-operative cochlear implant AzBio test scores. Very Elderly: >80 yrs, Elderly: 65-80 yrs, Non-elderly: <65 yrs. Short term: 0.5-2 yrs, Medium term: 2-8 yrs, Long term: >8yrs
Figure 2.
Figure 2.
Pre- and post-operative cochlear implant CNC-w test scores. Very Elderly: >80 yrs, Elderly: 65-80 yrs, Non-elderly: <65 yrs. Short term: 0.5-2 yrs, Medium term: 2-8 yrs, Long term: >8yrs
Figure 3.
Figure 3.
Pre- and post-operative cochlear implant HINT test scores. Very Elderly: >80 yrs, Elderly: 65-80 yrs, Non-elderly: <65 yrs. Short term: 0.5-2 yrs, Medium term: 2-8 yrs, Long term: >8yrs
Figure 4.
Figure 4.
Pre- and post-operative HINT scores stratified by pre-operative scores and age. Very Elderly: >80 yrs, Elderly: 65-80 yrs, Non-elderly: <65 yrs. Short term: 0.5-2 yrs, Medium term: 2-8 yrs, Long term: >8yrs
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