Cochlear implantation in older adults: 15 years' experience of a tertiary centre in a developing country.

INTRODUCTION: Cochlear implant (CI) is a viable option of treatment for older patients with severe to profound deafness in resource-rich countries. Implantation is limited in developing countries. OBJECTIVE: To review factors and outcomes of elderly patients that underwent CI in a pioneer centre in a developing country. MATERIAL AND METHODS: An observational retrospective review of patients older than 60, implanted between 2005 to 2020. RESULTS: Eleven patients were included. Patient were aged 60-74 years old with median of 66 years old. Average duration of deafness prior to implantation is 22 years. All implantation was unilateral except for one case that was implanted sequentially after 5 years Three patients were privately funded. Analysis of the hearing aided level with CI and hearing aid showed substantial improvement provided by the CI. The Categories of Auditory performance (CAP-II) scale were in the range of 6-9. DISCUSSION: Cochlear implant is safe and stable intervention in providing improvement of hearing and self-esteem in the elderly patients. Social isolation and depression also improved with better hearing and communication. CONCLUSION: Awareness of the CI in elderly patients must be advocated among policy- makers, clinicians, and patients to mitigate the clinical and public health burden of hearing loss among older patients.

Surgical management of cochlear implant in chronic otitis media patients: safe and sound.

INTRODUCTION: Cochlear implantation (CI) in cases with chronic otitis media (COM) was previously contraindicated but recent advances have made it possible. OBJECTIVE: To review surgical and audiological outcomes of COM patients that underwent CI. MATERIAL AND METHODS: Retrospective review of patients above 18 years old. RESULTS: Ten patients with complete data were included. Patients were aged 24-69 years old. Tympanoplasty and mastoidectomy were performed before CI. Imaging was performed to rule out ossifications. Eight patients underwent a standard canal wall up with either cochleostomy or round window approach. One patient had additional canalplasty and tympanoplasty and another one had blind sac procedure respectively. Analysis of the hearing aided level with CI and hearing aid showed significant benefit provided by the CI (Z = 2.803, p = .005). DISCUSSION: Creating a dry and safe ear is important prior to CI. Definite hearing improvement is seen in all our cases that helped them to become independent again in their daily life. Hearing aid usage pre-CI might not be important as the hearing aids may continue to cause discharging ears and the benefits of hearing aids in severe to profound hearing loss are very minimal. CONCLUSIONS: Cochlear implant is safe and effective in COM patients.

Self-Perceived Hearing Loss, Hearing-Help Seeking and Hearing Aid Adoption Among Older Adults in Malaysia.

INTRODUCTION: The aims of this study were to examine the validity of self-perceived hearing loss in detecting hearing loss and factors associated with self-perceived hearing loss and hearing-help seeking and to report hearing aid adoption among a group of community-dwelling older adults in Malaysia. METHODS: A total of 301 older adults (⩾60 years of age) participating in a study on aging had their hearing tested using pure-tone audiometry. Self-perceived hearing loss was assessed using a single question. Sociodemographic profile, otologic history, and general cognitive status were also obtained. RESULTS: A single question had low sensitivity in detecting actual hearing loss: 31.3% for 4-frequency average > 25 dBHL and 48.8% for 4-frequency average > 40 dBHL. Besides hearing level, history of otorrhea and tinnitus were factors that were associated with self-perceived hearing loss among older adults with at least mild hearing loss. Hearing-help-seeking behavior was not associated with any of the tested variables. The hearing aid adoption rate was 2.7% and 7.3% among participants with 4-frequency averages > 25 dBHL and > 40 dBHL, respectively. CONCLUSION: The underestimation of hearing loss in the majority of older adults in this study poses a potential barrier to hearing loss intervention.

A Preliminary Study Investigating the Association Between Hearing Acuity and a Screening Cognitive Tool.

OBJECTIVES: Studies in cognitive aging demonstrated inconsistent association between hearing and cognition in older adults. Furthermore, it is still unclear if hearing loss at high frequencies, which is the earliest to be affected, is associated with cognitive functioning. This study aimed to determine the association between global cognitive status and pure tone average (PTA) at 0.5, 1, and 2 kHz (PTA low) and PTA at 4 and 8 kHz (PTA high). METHODS: This study involved 307 adults aged 60 years and older. Participants had their hearing and cognition measured using pure tone audiometry and Mini Mental State Examination (MMSE), respectively. RESULTS: Pure tone average (low) accounted for significant but minimal amount of variance in measure of MMSE. Multiple regression analyses were also performed on normal and impaired hearing cohorts and cohorts with younger (60-69 years) and older (≥70 years) groups. The results revealed a significant relationship between PTA (low) and MMSE only in the younger age group. In contrast, no significant relationship was found between PTA (high) and cognition in any of the cohorts. CONCLUSION: Pure tone average (low) is significantly but minimally related to measure of general cognitive status. Similar relationship is not observed between high-frequency hearing and cognition. Further research using a more comprehensive cognitive test battery is needed to confirm the lack of association between high-frequency hearing and cognition.