Is Cochlear Implantation Safe and Effective in the Elderly?

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit


Significant hearing loss is prevalent among patients aged ≥ 65 years and is increasingly recognized as having unique implications for physical, social, and cognitive health. It is estimated that 25% of individuals aged 65 to 75 years, and up to 80% of those aged > 75 years, experience hearing loss. Up to 10% of these individuals experience hearing loss too severe for adequate rehabilitation with conventional hearing aids (HAs). As the proportion of the population in this cohort continues to increase, due to improved overall longevity and other demographic trends, both the individual and public health burden of hearing loss will continue to grow in scope and importance.

To date, research suggests that elderly individuals with poor word understanding (despite amplification with conventional HA) may benefit from cochlear implantation (CI) Reticence to subject the elderly individuals to general anesthesia for elective procedures (e.g. CI) may reflect a misperception of perioperative risk in this population, thereby unnecessarily restricting this technology from older hearing-impaired adults. In addition, suspicion regarding neuronal loss and degenerative processes in the central and peripheral auditory systems has led to concerns regarding postoperative performance in this aging population.

Best Practice

Overall, current data supports a high level of perioperative and long-term safety for elderly patients undergoing CI. Rates of CI-specific complications, including wound healing, device extrusion, failure rates, operative time, and facial nerve injury are low and mimic those found in younger patients. Elderly patients benefit significantly from CI with respect to speech outcome and quality of life. Thus, advanced age should not limit candidacy for CI. Additional research is needed on elderly speech performance in noise, side of implantation, and the overall relationship between auditory rehabilitation, functional status and cognition in older adults. (Laryngoscope. 2015;125:783–784).