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Cochlear implants in the older patient

Mark Pyle MD

Professor of surgery and Academic Vice Chair Division of Otolaryngology

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Introduction

• How do we define “ older”

• Iife expectancy 78.7 years

• Frailty , NOT AGE, is a consideration

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Demographics

• 41 million ( 2011) and increasing

• Increased incidence of hearing loss

• Association with dementia

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UW Experience

• 44 % of adult patients over 65

• Only one patient has been explanted for medical complication

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Special considerations

• Loss of other special senses

• Depression and dementia

• Communication with caregivers including family and physicians

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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

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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

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Evaluation

• History , examination , audiogram

• Audiologic CI evaluation including sentence testing

• Imaging studies- MRI

• Balance tests

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Financial questions

• Medicare guidelines

• Secondary Insurance

• January 2014 ??

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Surgical Recovery

• Hospital stay

• Wound care

• Audiology visits

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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

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Summary

• Cochlear Implants can be done safely in patients over 65 and 75.

• They significantly improve quality of life and communication in this population.