Stability of audiometric measures and challenges in long-term management of the elderly cochlear implant patient.

ABSTRACT

OBJECTIVE: To determine the long-term audiometric stability and the types and frequency of management challenges encountered when working with elderly cochlear implant users. STUDY DESIGN: Retrospective chart review. SETTING: University hospital. PATIENTS The final sample is 23 cochlear implantees over the age of 60, followed an average of 8.4 years. INTERVENTION Rehabilitative (cochlear implantation for clinical purposes, audiologic management). MAIN CLINICAL OUTCOME MEASURES: Warble tone thresholds, spondee thresholds, speech recognition scores, and frequency counts of management problems. RESULTS: Warble tone thresholds were stable over the study period. Speech recognition performance was not significantly changed statistically over the study period, but examination of individual results showed that 26% improved in performance, 17% participants decreased, and 17% remained the same. Thirteen percent of the sample had noteworthy thinning of the flap, including one individual whose flap deteriorated and required explantation.Management challenges relating to failing health, broken and lost equipment, thinning of the skin flap, critical judgment and emotional difficulties during programming sessions, and the need for repeated instructions on device use were noted with varying frequencies. CONCLUSION: Cochlear implantation is beneficial for elderly patients with severe-profound sensorineural hearing loss as demonstrated by long-term stability of function, with the caveat that some individuals may experience significant decreases in speech recognition over time. However, unique management challenges resulting from age-related cognitive decline, health problems, and/or reduced dexterity may present themselves. Audiologists must keep these issues in mind during preoperative counseling and when structuring postoperative follow-up sessions.