Cochlear Implants Effective in Older Patients with Age-Related Hearing Loss

A generation ago, hearing aids were the treatment of choice for age-related hearing loss. Today, there is increasing recognition that cochlear implants can not only help older adults regain their hearing, but can also allow them to fully participate in life. According to a 2012 article in Medicine, the number of adults aged 60 and older who have received a cochlear implant at Johns Hopkins in Baltimore has increased annually over the last decade. Nearly 60 percent of those adults were over age 70; the oldest was nearly 95 (2012;91:229-241).

Other institutions report similar increases, but awareness of cochlear implantation as a treatment for age-related hearing loss is still lacking in both the general public and some segments of health care, and that lack of awareness may be unnecessarily inhibiting the health of scores of older adults.

“If we look at ballpark numbers, only about 5 percent of older adults who qualify for cochlear implants are getting them,” said Frank Lin, MD, PhD, assistant professor of otology, neurotology and skull base surgery at Johns Hopkins. Too many people, Dr. Lin said, mistakenly think that presbycusis isn’t a particularly harmful effect of aging. “They think, if age-related hearing loss is so common, how can it be so important? I compare it to blood pressure,” Dr. Lin said. “Twenty years ago, the accepted norm was 140 plus your age for systolic blood pressure; if it was below that, it wasn’t treated. So, if you were a 70-year-old man back in 1991 and your systolic blood pressure was 210, it wasn’t treated because back then, the attitude was that hypertension was something we all get as we age. Then the SHEP [Systolic Hypertension in the Elderly Program] study came out and proved that if you treat hypertension in older adults, you drop the rates of heart attacks and strokes. “The SHEP study demonstrated that just because something is common and a normal part of aging, it doesn’t mean it’s not without consequences,” he added.

Presbycusis is linked to a host of psychosocial and physical maladies, including depression, social isolation and dementia, and research strongly suggests that untreated age-related hearing loss may quicken physical decline (J Am Geriatr Soc. 2012;60:1936-1945). Treating presbycusis with cochlear implantation can drastically improve older adults’ quality of life—and may improve their overall health as well.

Determining the Right Time

Although Medicare currently covers cochlear implantation when a patient’s Hearing in Noise Test (HINT) score drops below 40 percent with best-possible amplification, many patients and physicians don’t consider cochlear implantation until a patient is “stone cold deaf,” Dr. Lin said. That may be a mistake, because the available evidence consistently shows that older adults do better when they are implanted early.