According to a 2013 study, patients older than age 80 fare more poorly on speech perception tests after cochlear implantation than do patients aged 60 to 69 (Laryngoscope. 2013;123:1952-1956). Research suggests that this difference may be due, at least in part, to age-related changes in central auditory processing. A study of forward masking in elderly cochlear implant users found that older patients experienced significantly slower psychophysical recovery than younger implant users, despite the fact that both groups had similar auditory nerve recovery times after electrical stimulation (Otol Neurotol. 2012;33:355-363).
Explore This IssueOctober 2013
“The evidence argues for earlier implantation, as soon as candidacy criteria are met, because at that point, the brain is more capable of interpreting the new auditory signals,” said David Friedland, MD, PhD, professor and vice chair of otolaryngology and communication sciences at the Medical College of Wisconsin in Milwaukee. “Patients with better residual hearing at the time of implantation do better post-implantation.”
Bruce Gantz, MD, head of the department of otolaryngology at the University of Iowa Carver College of Medicine, uses a common sense rule for determining initial eligibility for cochlear implantation: “My bottom line is that if an adult can’t communicate effectively on a telephone with hearing aids, it’s time to start thinking about an implant,” he said.
“When someone does not understand even 50 percent of a conversation without using visual cues, they miss a lot of information. There is an increased liklihood of becoming socially isolated and having more fatigue at the end of the day, as understanding speech becomes a mentally challenging task. There’s a higher tendency for depression,” said Ronna Hertzano, MD, PhD, assistant professor of otorhinolaryngology at the University of Maryland School of Medicine in Baltimore. “When someone reaches that point, there is no reason to wait another five or 10 years, because things will only get worse.”
Earlier May Be Even Better
Unfortunately, the current Medicare guidelines leave out a lot of adults who could benefit from cochlear implantation. “By FDA criteria, we typically say people are candidates for cochlear
implantation when their HINT score is below 60 percent. So, the conundrum we face in our clinic is people who are 65 years old or so, with speech scores around 58 percent and a lot of trouble functioning,” Dr. Lin said. “Do we tell them, ‘Well, you qualify for cochlear implants, but by Medicare criteria, you don’t, so come back in several years?’ If they come back five or 10 years later, they probably won’t do as well as if they had been implanted earlier. We’re losing out on that five-to-10 year window when people could really benefit from cochlear implantation.”