Cochlear implant outcomes in the very elderly.

PURPOSE: Managing hearing health in older adults has become a public health imperative, and cochlear implantation is now the standard of care for aural rehabilitation when hearing aids no longer provide sufficient benefit. The aim of our study was to compare speech performance in cochlear implant patients ≥80 years of age (Very Elderly) to a younger elderly cohort between ages 65-79 years (Less Elderly). MATERIALS AND METHODS: Data were collected from 53 patients ≥80 years of age and 92 patients age 65-79 years who underwent cochlear implantation by the senior author between April 1, 2017 and May 12, 2020. The primary outcome measure compared preoperative AzBio Quiet scores to 6-month post-activation AzBio Quiet results for both cohorts. RESULTS: Very Elderly patients progressed from an average AzBio Quiet score of 22% preoperatively to a score of 45% in the implanted ear at 6-months post-activation (p < 0.001) while the Less Elderly progressed from an average score of 27% preoperatively to 60% at 6-months (p < 0.001). Improvements in speech intelligibility were statistically significant within each of these cohorts (p < 0.001). Comparative statistics using independent samples t-test and evaluation of effect size using the Hedges' g statistic demonstrated a significant difference for average improvement of AzBio in quiet scores between groups with a medium effect size (p = 0.03, g = 0.35). However, when the very oldest patients (90+ years) were removed, the statistical difference between groups disappeared (p = 0.09). CONCLUSIONS: When assessing CI performance, those over age 65 are typically compared to younger patients; however, this manuscript further stratifies audiometric outcomes for older CI recipients in a single-surgeon, high-volume practice. Our data indicates that for speech intelligibility, patients between age 65-79 perform similarly to CI recipients 80-90 years of age and should not be dismissed as potential cochlear implant candidates.

Decentralized Cochlear Implant Programming Network Improves Access, Maintains Quality, and Engenders High Patient Satisfaction.

OBJECTIVE: Cochlear implants have become a powerful tool in managing patients with moderate to profound sensorineural hearing loss and lack of benefit from hearing aids. Currently, less than 10% of people who would benefit from a CI receive the treatment. This lack of access is multi-factorial yet largely due in part to an inadequate referral system. The purpose of the current study was to evaluate speech outcomes and patient satisfaction for adult cochlear implant (CI) recipients in a single-surgeon, high volume CI center that uses a decentralized network (DCN) of private practice programming audiologists. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otology/neurotology practice. PATIENTS: Adult CI recipients implanted between April 2017 and August 2019. INTERVENTIONS: Surgical/rehabilitative. MAIN OUTCOME MEASURES: Speech outcomes (AzBio quiet) were evaluated 6-months post implantation. Patients were surveyed to determine satisfaction with programming services, surgical services, and CI benefit. RESULTS: The senior author (A.J.) performed 223 CI operations: 136 (61%) were programmed at the CI center and 84 (38%) at outside audiology clinics through a DCN. The 6-month speech outcomes (AzBio, quiet) revealed similar scores regardless of where programming services were received; CI center: 25% pre-op versus 55% post-op; DCN: 24% pre-op versus 59% post-op. Additionally, patients reported high-levels of satisfaction with programming services, surgical services, and CI benefit. CONCLUSION: A decentralized network of well-trained private practice audiologists who identify CI candidates and program their devices after surgery 1) improves patient access to cochlear implantation, 2) maintains excellent speech outcomes, and 3) engenders high levels of patient satisfaction.

Cochlear Implant Outcomes in Elderly Recipients During the COVID-19 Pandemic.

OBJECTIVE: To evaluate the potential significance of social distancing and quarantine precautions for COVID-19 on speech outcomes, missed appointments, wear time, and exposure to various sound environments in the first 6 months following activation for elderly cochlear implant (CI) recipients. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary private practice. PATIENTS: Fifty cochlear implant recipients ≥65 years were evaluated. A Control Group consisted of 26 patients implanted between November 2, 2018 and February 18, 2019 while the Pandemic Group included 24 patients implanted between November 1, 2019 and February 17, 2020. INTERVENTION: Rehabilitative. MAIN OUTCOME MEASURES: Preoperative and 6-month postoperative AzBio sentence scores in quiet were compared between groups along with the number of missed appointments as well as datalogged information regarding average CI wear time and average hours in various sound environments such as quiet, speech, and speech-in-noise. RESULTS: The Control Group averaged 36.5% improvement for AzBio in quiet scores while the Pandemic Group averaged only 17.2% improvement, a difference that was both statistically and clinically significant (p = 0.04; g = 0.64). Patients in the Pandemic Group were nearly twice as likely to miss CI programming appointments than the Control Group. The Pandemic Group wore their CI 1.2 less hours per day on average, and while the Pandemic Group spent similar times in quiet and speech environments to the Control Group, the Pandemic Group spent less time in speech with presence of background noise. CONCLUSIONS: While social distancing and quarantine measures are crucial to limiting spread of COVID-19, these precautions may have negatively impacted early speech performance for elderly cochlear implant recipients. Missed CI programming appointments, decreased sound processor wear time, and reduced exposure to complex listening environments such as speech in the presence of background noise were more common in the Pandemic Group than in the Control Group operated the year prior.

Early Osia® 2 bone conduction hearing implant experience: Nationwide controlled-market release data and single-center outcomes.

PURPOSE: Bone conduction hearing devices are a well-established treatment option for conductive or mixed hearing losses as well as single-sided deafness. The Osia® 2 System is an active osseointegrated device where a surgically implanted titanium fixture supports a newly developed piezoelectric actuator that is placed under the skin. METHODS: Nationwide data collected during a controlled-market release (CMR) of the Cochlear™ Osia® 2 System as well as outcomes at single, tertiary-level private practice Otology/Neurotology center were retrospectively reviewed. Key learnings from surgeons and audiologists are discussed. RESULTS: During the CMR period, 23 surgeons performed 44 operations on 43 recipients. The mean age of recipients was 44 years and mean surgery duration was 52 min. The most commonly used incision was postauricular but anterior to the device (78%). Five complications were observed during the CMR, none of which were device related. Twenty-one audiologists performed 33 Osia® 2 activations during the CMR. The mean age of this group was 47 years, and the mean duration of each activation appointment was 55 min. Single-center data at the authors' institution demonstrated an average additional PTA4 gain with the Osia® 2 patients of 9.6 dB compared to Baha Attract and 10.2 dB compared to Baha Connect. CONCLUSION: The Cochlear™ Osia® 2 System represents a significant advance in auditory osseointegrated implant technology. Digital piezoelectric stimulation delivers high power outputs, improves high frequency gain for optimal speech perception, and maintains safety while providing excellent patient satisfaction.

Hearing Preservation in Elderly Cochlear Implant Recipients.

OBJECTIVE: Examine hearing preservation rates in cochlear implant recipients 72 years and older. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otology/neurotology practice. PATIENTS: Cochlear implant recipients 72 years and older who are candidates for hearing preservation and were implanted between April 2017 and June 2018 INTERVENTION:: Surgical/rehabilitative. MAIN OUTCOME MEASURES: Hearing was measured preoperatively and 6 months after cochlear implantation. RESULTS: Between April 2017 and June 2018, 125 cochlear implant operations were performed by the senior author (A.J.). Of these patients, 62 were over age 72 and comprehensive pre- and postoperative residual hearing data were available on 24 patients. Although several methods for calculating hearing preservation are evaluated, our practice has found that hearing preservation techniques should be used in all patients having even a single frequency ≤85 dB HL between 125 and 2000 Hz before surgery. Using this method, 60% of recipients had at least one postoperative threshold ≤85 dB HL, and more importantly, over 80% of these patients subsequently used an electroacoustic MAP. CONCLUSION: Despite concerns about cochlear fragility in elderly patients, preservation of residual hearing is feasible in cochlear implant recipients 72 years and older. This suggests that the vast majority of patients, including an elderly cohort, can benefit from soft surgery techniques.