Hearing Results Following Type 1 Tympanoplasty in Elderly Patients.

BACKGROUND/AIM: The outcomes of type 1 tympanoplasty in elderly patients remain controversial. Therefore, more studies are needed to clarify the prognosis of elderly patients after tympanoplasty. The purpose of this study was to evaluate the clinical outcomes of type 1 tympanoplasty in elderly patients. PATIENTS AND METHODS: We retrospectively analyzed data from 116 patients who underwent type 1 tympanoplasty due to chronic otitis media. Seventy-one of the 116 patients were elderly individuals aged 65 years or older (study group). Forty-five patients were younger than 65 years (control group). Due to cochlear intolerance by aging in the study group, we used dexamethasone soaked gelfoam packing in the middle ear and intraoperative dexamethasone injection. To compare the outcomes between groups, we determined the mean hearing levels by averaging the hearing thresholds. The differences in the air-bone gaps before and after tympanoplasty were compared between groups. RESULTS: In the study group, 54 patients had an underlying disease (76%). Hypertension was the most common underlying disease. The postoperative air conduction (AC) and bone conduction (BC) improved in both the study group and the control group. In the control group, postoperative air-bone gap (ABG) was significantly higher than preoperative ABG. Although the postoperative ABG improved in the study group, the improvement was insignificant. CONCLUSION: Although significant improvement of ABG was not achieved, postoperative AC and BC were improved. Intraoperative dexamethasone injection and dexamethasone soaked gelfoam packing in the middle ear was effective to prevent deterioration of BC after operation.

Is there an age limit for cochlear implantation?

OBJECTIVES: We evaluated the quality of life following cochlear implantation in elderly postlingually deaf adults. METHODS: Data were studied concerning demographics and audiometric evaluation in postlingually deaf adults at least 60 years of age who underwent cochlear implantation in 3 institutions. The Glasgow Benefit Inventory was used to quantify the quality of life. The patients were divided into 2 groups (those less than 70 years of age and those at least 70 years of age), and the results were also compared to those of younger adult cochlear implant recipients (less than 60 years of age). RESULTS: Eighty-one patients were included in this study. The mean age at implantation was 68 years (range, 60 to 82 years). Cochlear implantation significantly improved the patients' audiometric outcomes (pure tone average and speech perception; p < 0.05). The Glasgow Benefit Inventory showed a benefit overall (+36) and on the individual subscales (+49, +20, and +1). The difference in quality of life was not significant between those less than 70 and those at least 70 years of age (p = 0.90). The results were similar to those of younger postlingually deaf implant recipients. CONCLUSIONS: Elderly cochlear implant users experience an improvement in their quality of life, with outcomes similar to those achieved in younger adults. Particular attention must be paid to the possibility of age-related conditions in the elderly that may increase the risks of surgery.

Cochlear implant in an ambulatory surgery center.

Presbycusis, or sensorineural hearing loss in the elderly population, affects approximately 40% to 50% of people over the age of 75. A variety of devices are available to those with hearing loss. Cochlear implants, for example, are especially useful for those with severe-to-profound hearing loss. The population is aging, so the demand for cochlear implantation in ambulatory surgery centers will likely increase. Ambulatory surgery centers (ASC) can provide a more convenient and less expensive location for cochlear implant surgery than hospital-based operating facilities. Patient selection using standard ASC criteria, coupled with an understanding of the unique surgical and anesthetic needs of cochlear implant patients, are key to bringing this once exotic inpatient procedure into the ASC.

Cochlear implantation in older patients: outcomes and comparisons.

OBJECTIVES: A review of adults receiving cochlear implants (Cls) at the Yorkshire Cochlear Implant Service (YCIS) was performed to assess whether age affects use or outcomes. METHODS: A retrospective analysis of all patients over the age of 50 implanted and habilitated at the YCIS was undertaken. Outcome measures included quality of life (QoL) questionnaires and speech perception tests: CUNY sentences and BKB sentences. Comparisons were made between patients implanted age 50 to 59 (A), 60 to 69 (B) and 70 and over (C). Patients with English as a second language and those implanted for less than 9 months were excluded. Data was analysed using a repeated measure regression model. RESULTS: 80 adults were included; A, 31; B, 29; C, 20. Significant improvements were seen in speech perception scores in all groups from pre-implant to 3 months. No statistically significant difference was found between the 3 groups in any outcome measure. QoL scores overall showed increased independence and greater participation in social activities with all patients feeling their implant had been successful. DISCUSSION: Increased life expectancy and availability of cochlear implants (Cls) has led to greater numbers of older patients being eligible for implantation. Our results show improved speech perception and QoL outcomes in all groups. The lack of statistically significant differences between age groups supports the benefits of Cls in the older population. Older age should not be a discriminating factor in candidacy for cochlear implantation and referral of older patients to implant centres should be encouraged.

Treatment of age-related hearing loss in dogs with the vibrant soundbridge middle ear implant: short-term results in 3 dogs.

BACKGROUND: Age-related hearing loss (ARHL), or presbycusis, is the most common form of acquired hearing loss in dogs. Middle ear implants have been used successfully in people with ARHL who cannot benefit from conventional hearing aids. HYPOTHESIS: Audibility improves in dogs with ARHL after implantation of the Vibrant Soundbridge (VSB) middle ear implant. ANIMALS: Three Beagle dogs with ARHL, mean age 11.1 years. METHODS: The dogs were assessed pre- and postoperatively by brainstem-evoked response audiometry (BERA), otoscopy, and computed tomography scans of the ears. A VSB middle ear implant was implanted unilaterally. Three months later the functionality of the implants was assessed by auditory steady-state responses (ASSRs), after which the dogs were euthanized for histopathological examination. RESULTS: The VSB was implanted successfully in all dogs. Recovery from surgery was uneventful, except for transient facial nerve paralysis in 2 dogs. ASSRs showed that hearing improved after activation of the implants with a mean of 20.7, 13, and 16.3 dB at 1, 2, and 4 kHz, respectively. The implantation procedure did not affect residual hearing (with inactive implants) as measured by BERA. CONCLUSIONS AND CLINICAL IMPORTANCE: Implantation of the VSB resulted in lower ASSR thresholds, but only at the higher gain settings of the audioprocessor. As in humans, a more powerful audioprocessor is required to treat sensorineural hearing loss exceeding 20 dB in dogs. A substantial improvement in patient-owner communication will have to be demonstrated in future studies before the procedure can be recommended in clinical practice.

Neural response telemetry results with the nucleus 24 contour in a perimodiolar position.

OBJECTIVE: The purpose of the study was to analyze changes in neural response telemetry using the Cochlear Nucleus 24 Contour before and after stylet removal in a human model. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Twelve patients (23-72 years old) undergoing cochlear implantation, using the Nucleus 24 Contour implant, secondary to congenital and age-related hearing loss. INTERVENTION: Cochlear implantation with Cochlear Nucleus 24 Contour implant. MAIN OUTCOME MEASURE: Neural response telemetry thresholds were recorded initially with the stylet in and then with the stylet out during the implant procedure. RESULTS: Stimulus levels to obtain neural response telemetry threshold after stylet removal were statistically lower after the stylet was removed. CONCLUSION: The Nucleus 24 Contour achieves a perimodiolar position once the stylet is removed, and this leads to reduction in the current required to elicit a threshold neural response telemetry response.