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- Title
Outcomes of CI Users Implanted over 60 Years Old.
- Authors
Lachowska, Magdalena; Wiśniewska, Dominika; Niemczyk, Kazimierz
- Abstract
Background: Most of the hearing-impaired elderly have difficulties with speech perception that negatively impacts their social life. Some of them suffer from severe-to-profound hearing loss and appropriately fitted conventional hearing aids provide very limited benefit, which may lead to social isolation, loneliness and depression. In such cases, cochlear implantation might be a method of choice for the treatment of hearing loss. Aim: The aim of this study was to determine the results of cochlear implantation in an elderly population (patients over 60 years old) based on audiological and psychological assessments. Materials and Methods: A retrospective review of cases at our clinic yielded a total of 24 patients with postlingual, profound hearing loss for further examination through this study. All were implanted unilaterally with a multichannel cochlear implant for at least six months (10 CochlearNucleus", 12 Digisonic", 2 Advanced Bionics). Before the surgery, all patients underwent very careful multidisciplinary evaluation to determine candidacy for cochlear implantation. Inclusion criteria were severe-to-profound bilateral sen-sorineural hearing loss, postlingual onset of hearing loss, limited benefit from appropriately fitted hearing aids (i.e., rely heavily on lipreading), social isolation due to deafness, no medical or radiological contraindications, desire to improve hearing, good motivation and realistic expectations for benefits from cochlear implant. The mean age at the time of the surgery was 71.09 years old (SD = 7.06; range = 85-60). All patients underwent the implantation in the Department of Otolaryngology at the Medical University of Warsaw, Poland. There were no perisurgical or postsurgical complications. The speech processors were activated one month after the surgery in all cases. Almost all patients continue to use their CI at least eight hours a day. All patients return to the Department for regular follow-up and fitting sessions. The majority of them undergo aural rehabilitation. Postoperative evaluation during follow-up visits includes pure-tone audiometry in free field, speech recognition in free field measured using the Polish phonetically balanced monosyllabic word test in quiet, speech perception tests performed by speech therapists and a psychological assessment. Results: The postoperative mean pure-tone threshold (PTA) for 500, 1000, 2000 and 4000 Hz was 42 dB. In analyzed patients, two groups can be distinguished: poor- (no or limited) benefits group and good-benefits group. The first group of patients present no auditory-verbal communication and is the minority (20.8%). In those cases, the cochlear implant provides a sense of sounds, or sound detection, but does not improve communication skills. Their social life remains reduced to minimum interactions. Their mean PTA is 55.25 dB, with no monosyllabic word recognition at 65 dB intensity level. In the second group of patients (79.2%) with good benefits, the cochlear implant enables them to hear sounds and provides better communication for better contact with household members, relatives and friends. The mean PTA is 39.3 dB, with 53.1% mean monosyllabic word recognition. In the second group, there are three patients who demonstrate very good understanding of spoken language through the auditory-sensory modality. In these cases, the cochlear implant provides great help to spoken communication; conversations on the phone are also possible. Their mean monosyllable word recognition score in free field reaches 63.3%, and the aided mean PTA in the free-field is 25.6 dB. They are more socially active, often meet with other people, neighbors and friends and are open to make new acquaintances. The results of free-field audiometric testing and monosyllabic word for the two groups are found in Figures 1 and 2, respectively. Conclusion: The results of this study demonstrate that cochlear implantation in the severe-to-profoundly deafened adult population over 60 years old provides improvement in auditory performance, increased well-being, better self-esteem and enhanced social and daily activity. It is one more proof that cochlear implantation is indeed a successful treatment for improving speech recognition and the quality of life in the deaf elderly population. They can be considered good candidates for cochlear implantation and they should not be denied it on the basis of age alone. Eventual neural degeneration aspects and inefficient or reduced central auditory processing in the elderly should be taken into account in the preoperative assessment when determining CI-candidacy.
- Subjects
HEARING impaired; SPEECH perception; SOCIAL isolation; MENTAL depression; LONELINESS; PATIENTS
- Publication
Audiology & Neurotology, 2012, Vol 17, p17
- ISSN
1420-3030
- Publication type
Article