Cochlear implants in the older patient

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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.