Proceedings

Audiology
Published online: February 20, 2015
Neurotology

Audiol Neurotol 2014;19(suppl 1):40–44 cantly in recent years, unfortunately, in these patients, even the
DOI: 10.1159/000371609 most modern hearing aids are not able to provide adequate bene-
fits when it comes to speech understanding. In these patients, the
Benefits of Cochlear Implantation in Deafened method of choice is cochlear implantation.
Adults In elderly patients with severe-to-profound bilateral sensori-
neural hearing loss, hearing aids usually provide little benefit and
Magdalena Lachowska, Agnieszka Pastuszka, Paulina Glinka, elderly patients isolate themselves from other people, leading to
Kazimierz Niemczyk loneliness and sometimes depression. In activities such as going
Hearing Implant Center, Department of Otolaryngology, out for shopping or doctor’s appointments, they become depen-
Medical University of Warsaw, Warsaw, Poland dent on others. These factors negatively affect their quality of life
[Dalton et al., 2003; Hallam et al., 2006; Knutson et al., 2006; Pois-
sant et al., 2008; Scherer and Frisina, 1998]. Cochlear implants are
more and more frequently being used in these patients [Eshragi et
Key Words al., 2009; Lachowska et al., 2013; Leung et al., 2005; Francis et al.,
Elderly · Hearing loss · Deafness · Hearing aid · Cochlear implant · 2002; Migirov et al., 2010; Poissant et al., 2008; Sterkers et al., 2004;
Audiometry · Speech perception Yeagle et al., 2010].

Subjects and Methods

Abstract The data of 30 elderly patients (13 females, 17 males) with post-
Aim: The objective was to retrospectively analyze the benefits of co- lingual bilateral severe-to-profound hearing loss were analyzed.
chlear implantation in deafened elderly (>65 years old). Method: Data Mean patients’ age at the time of implantation was 76 years old
from 30 elderly patients with a unilateral cochlear implant were in- (SD = 6.0; min = 66 years; max = 87 years). All were implanted
cluded and analyzed. Audiometric threshold and speech data in aided unilaterally (16 right, 14 left) with a multichannel cochlear im-
and unaided conditions were examined at pre- and postimplant in- plant. In all cases, the speech processors were activated 1 month
tervals at 3, 6, and 12 months after activation of the sound processor after the surgery. For this study purpose, the data were analyzed
and compared. Results: All patients demonstrated hearing benefits for the following time intervals: before cochlear implantation and
after implant and over time with results ranging from very good, at 3, 6, and 12 months after activation of the speech processor. The
good, to limited performance in a few cases. The mean postimplanta- mean follow-up time was 2.74 years (range 12 months – 7.34
tion follow-up time was 2.74 years (minimum 1 year). Our study co- years). Audiological evaluation before implantation included pure
hort demonstrates that cochlear implantation is a successful treat- tone audiometry, speech audiometry, and free-field audiometry.
ment method for improving speech perception in the auditory alone Evaluation after implantation included free-field audiometry and
or auditory-visual mode for the majority of elderly patients. No cor- speech perception tests (Ling’s six-sound test, syllable discrimina-
relations were observed between postimplant outcomes and age, or tion, monosyllabic and multisyllabic word recognition in open
preimplant hearing thresholds and speech audiometry. Conclusion: set). Speech perception tests were conducted using live voice at the
Age is not a determining or limiting factor for post-CI outcome per- presentation level of about 65–70 dB SPL. Results from speech per-
formance in deafened elderly patients. Counselling should consider ception tests performed routinely assist in the sound processor
the patient as a whole and include explanation of the risk for a minor- mapping procedure (fitting) and ensure the best possible perfor-
ity of elderly patients who may demonstrate poor outcomes after im- mance outcomes for the individual during the fitting sessions. In
plant, despite presenting as good candidates before implantation. addition, patients were asked (via interview) about their everyday
© 2015 S. Karger AG, Basel activities and the influence of cochlear implantation on their ev-
eryday lives, i.e. communication with a familiar and unfamiliar
person, necessity of lipreading, using the phone, interactions with
Introduction household members, relatives and friends, independence in every-
In cases of bilateral severe-to-profound hearing loss, even the day activities, and speech perception in noisy environments. The
most powerful hearing aids are no longer sufficient and the patient patients’ responses to those issues were very helpful in evaluating
experiences difficulties associated with residual hearing. It mani- benefits of cochlear implantation in everyday life.
fests itself mainly as significant problems with speech understand- Data were tested for normality, parametric and nonparametric
ing even in quiet environment and situations where only one per- criteria. The t test, repeated-measures ANOVA and correlation
son speaks. One of the reasons for this phenomenon is significant- analysis were used for statistical analysis; p values < 0.05 were con-
ly narrowed dynamics of hearing that leads to distorted sound sidered statistically significant. Statistics software STATISTICA
perception. Although hearing aid technology has evolved signifi- (StatSoft Inc. 2011, version 10) was used.

© 2015 S. Karger AG, Basel

1420–3030/15/0197–0040$39.50/0
E-Mail karger@karger.com This is an Open Access article licensed under the terms of the
www.karger.com/aud Creative Commons Attribution-NonCommercial 3.0 Un-
ported license (CC BY-NC) (www.karger.com/OA-license),
applicable to the online version of the article only. Distribu-
tion permitted for non-commercial purposes only.
 Frequency (Hz)

0
0
0

0
0
0

00
00
00

00

00
00
50
0
5

0
0
12

50

75
25

6,

8,
1,

1,

3,

4,
2,
20
30
40
50
60

HL (dB)
70
80
90
100
110
120
Unaided before CI
Hearing aid aided before CI
Fig. 1. Free-field pure-tone audiometry
CI aided 3 months after implantation
mean results in elderly patients (n = 30) be- CI aided 6 months after implantation
fore and 3, 6, and 12 months after cochlear CI aided 12 months after implantation
implantation. The results present improve-
ment with time.

100

90

80

70 Ling’s six-
sound test
60
Syllable
Percent

50 discrimination
Monosyllabic
40 word
recognition
30
Fig. 2. Speech perception test mean results Multisyllabic
20 word
(Ling’s six-sound test, syllable discrimina- recognition
tion, monosyllable and multisyllablic word 10
recognition tests) before and 3, 6, and 12
months after cochlear implantation for all 0 Before CI After After After
30 analyzed patients. The results present 3 months 6 months 12 months
improvement with time.

Results groups of patients based on the level of benefit for speech percep-
All patients showed hearing improvement over time. Aided tion with their CI (fig. 3, 4). To group the patients, we used the
thresholds improved significantly (p < 0.01) from a mean of 62.3 criteria presented in table 1.
dB HL with the preimplant hearing aid to a mean of 39.2 dB HL at The first subgroup of implanted elderly (6 patients, 20%) –
3 months after implantation and 36.3 dB HL at 12 months after showing very good benefits – also displayed very good percep-
implantation (fig. 1). Speech perception tests also presented high- tion of spoken language through the auditory-sensory modality
ly significant improvements (p < 0.01) over time (fig. 2). with familiar and unfamiliar speakers without assistance from
Looking at individual results, we observed a range of outcomes lipreading, and with a little help from lipreading in noisy envi-
with some patients showing very good benefits, some showing ronments. Most of them were able to have a conversation over
good results and a few with very poor results using their CI. Using the phone. After implantation, these elderly became more active
speech perception as a main criterion, we distinguished three sub- in everyday life, often met with neighbors and friends, and were

Proceedings Audiol Neurotol 2014;19(suppl 1):40–44 41

DOI: 10.1159/000371609
 Frequency (Hz)

0
0
0

0
0
0

00
00
00

00

00
00
50
0
5

0
0
12

50

75
25

6,

8,
1,

1,

3,

4,
2,
0
10
20
30
40

HL (dB)
50
60
70
Fig. 3. Mean results of free-field pure-tone
80
audiometry in elderly patients before and
after cochlear implantation with regard to 90
the three groups of patients (according to 100
implantation benefits): very good (6 pa- Very good results Good results Poor results
tients), good (20 patients) and poor (4 pa-
tients) performers.

Table 1. Criteria used to classify patients into one of the three groups: very good, good, and poor results of cochlear implantation

Very good results Good results Poor results

Speech perception benefits good perception of spoken perception of spoken language only detection of sounds,
language through the through the auditory-sensory no auditory-verbal
auditory-sensory modality, modality, a little help from communication, only
no lipreading lipreading lipreading
Free-field audiometry result PTA ≤30 dB HL 30 dB HL <PTA <50 dB HL PTA ≥50 dB HL

open to meet new people. The mean implant-aided free-field No correlation was shown between age and postoperative per-
audiometric threshold was <30 dB HL. The oldest patient was 87 formance for speech recognition tasks or aided thresholds (p >
years old. 0.05). There were no perisurgical complications and no major
The second subgroup of implanted elderly (20 patients, 67%) postsurgical complications.
showing good benefits – also demonstrated good perception of
spoken language through the auditory-sensory modality with a
little help from lipreading. The cochlear implant provided better Discussion
communication and enabled improved contact with other people Our study demonstrates that age is not a determining and lim-
leading to increased independence in everyday life. Their mean iting factor for outcome performance with the cochlear implant in
implant-aided free-field audiometric threshold was between 30 deafened elderly patients. The vast majority of our patients
and 50 dB HL. The oldest patient was 87 years old. achieved good and very good benefits following implantation. This
The third subgroup of implanted elderly (4 patients, 13%) – is consistent with subjective statements made by some such as ‘they
showing poor benefits – represented the minority. These patients could not imagine living without a cochlear implant’. The aided
presented no auditory-verbal communication ability. The cochle- audiological results and speech perception improved significantly
ar implant provided sensations of sounds which did not lead to after cochlear implantation. Adaptation to hearing through the co-
improved communication skills. They were still dependent on oth- chlear implant took them relatively little time, the majority report-
ers in their everyday life activities; their social life activities re- ed notable difference after 2–3 months of implant use with further
mained relatively reduced to minimum interactions. Those pa- progressive improvement over time. Our studies and the studies
tients presented some symptoms of dementia that started to de- of other authors show that recently there has been a growing inter-
velop. Their mean implant-aided free-field audiometric threshold est in cochlear implantation in deafened elderly [Eshragi et al.,
was >50 dB HL. The oldest patient was 81 years old. 2009; Francis et al., 2002; Lachowska et al., 2013; Leung et al., 2005;

42 Audiol Neurotol 2014;19(suppl 1):40–44 Lachowska/Pastuszka/Glinka/Niemczyk

DOI: 10.1159/000371609
 100

90

80

70 Ling’s six-
sound test
60
Syllable

Percent
50 discrimination
Monosyllabic
40 word
recognition
30
Multisyllabic
20 word
recognition
10

0
Before CI After After After
a 3 months 6 months 12 months

100

90

80

70 Ling’s six-
sound test
60
Syllable
Percent

50 discrimination
Monosyllabic
40 word
recognition
30
Multisyllabic
20 word
recognition
10

0
Before CI After After After
b 3 months 6 months 12 months

100

90

80

70 Ling’s six-
sound test
60
Syllable
Percent

50 discrimination
Monosyllabic
40 word
recognition
Fig. 4. Speech perception test mean results 30
of Ling’s six-sound test, syllable discrimi- Multisyllabic
20 word
nation, monosyllable and multisyllabic recognition
word recognition tests before and 3, 6, and 10
12 months after implantation for the three
0
subgroups of patients (according to im- Before CI After After After
plantation benefits): very good (6 patients; c 3 months 6 months 12 months
a); good (20 patients; b), and poor (4 pa-
tients; c) performers.

Proceedings Audiol Neurotol 2014;19(suppl 1):40–44 43

DOI: 10.1159/000371609
Migirov et al., 2010; Poissant et al., 2008; Sterkers et al., 2004; Yea- References
gle et al., 2010]. A review of the literature provides supporting ev- Dalton DS, Cruickshanks KJ, Klein BEK, Klein R, Wiley TL, Nondahl DM:
idence of improved hearing and speech perception ability in el- The impact of hearing loss on quality of life in older adults. Gerontologist
derly cochlear implant recipients as shown in our study cohort. 2003;43:661–668.
In our study, the majority of our patients achieved very good Eshraghi AA, Rodriguez M, Balkany TJ, Telishi FF, Angeli S, Hodges AV,
Adil E: Cochlear implant surgery in patients more than seventy-nine
and good results. Through examination of individual patient out-
years old. Laryngoscope 2009;119:1180–1183.
comes, patients could be assigned to three different subgroups Francis HW, Chee N, Yeagle J, Cheng A, Niparko JK: Impact of cochlear
based on their postoperative performance on speech perception implants on the functional health status of older adults. Laryngoscope
measures in the auditory-alone modality and auditory-visual 2002;112:1482–1488.
mode (lipreading assistance): very good, good and poor benefits. Hallam R, Ashton P, Sherbourne K, Gailey L: Acquired profound hearing
Even though the poor results group was in the minority, the po- loss: mental health and other characteristic of large sample. Int J Audiol
tential for only limited benefits exists and should be discussed with 2006;45:715–723.
patients and their families prior to surgery during counselling. A Knutson JF, Johnson A, Murray KT: Social and emotional characteristics of
possible contributing factor in obtaining poor benefits might be a adults seeking a cochlear implant and their spouses. Br J Health Psychol
2006;11:279–292.
certain degree of dementia progressing with time and/or eventual Lachowska M, Pastuszka A, Glinka P, Niemczyk K: Is cochlear implant a
neural degeneration aspects and/or inefficient central auditory good treatment method for profoundly deafened elderly? Clin Interv Ag-
processing. Consultation before implantation should therefore ad- ing 2013;8:1339–1346.
dress the range of potential real-life benefits of implantation rang- Leung J, Wang NY, Yeagle JD, Chinnici J, Bowditch S, Francis HW, Niparko
ing from very good to very limited results. In any case, as shown in JK: Predictive models for cochlear implantation elderly candidates. Arch
our study, age alone is not an excluding factor when selecting can- Otolaryngol Head Neck Surg 2005;131:1049–1054.
didates for cochlear implantation. Migirov L, Taitelbaum-Swead R, Drendel M, Hildesheimer M, Kronenberg
J: Cochlear implantation in elderly patients: surgical and audiological
outcome. Gerontology 2010;56:123–128.
Poissant SF, Beaudoin F, Huang J, Brodsky J, Lee DJ: Impact of cochlear im-
Conclusion plantation on speech understanding, depression, and loneliness in the
Our study demonstrated that cochlear implants are an effective elderly. J Otolaryngol Head Neck Surg 2008;37:488–494.
aid in speech perception and communication for the majority of Scherer MJ, Frisina DR: Characteristic associated with marginal hearing loss
older people with severe-to-profound bilateral sensorineural hear- and subjective well-being among a sample of older adults. J Rehabil Res
ing loss. Without an implant, an older person may still be depen- Dev 1998;35:420–426.
dent on others in even simple activities of daily life. However, there Sterkers O, Mosnier I, Ambert-Dahan E, Herelle-Dupuy E, Bozorg-Grayeli
is a minority group that presents poor results, even if they were A, Bouccara D: Cochlear implants in elderly people: preliminary results.
good candidates before implantation. In the future, we plan to in- Acta Otolaryngol 2004;(suppl)552:64–67.
Yeagle JD, Ceh KM, Francis HW: Geriatric cochlear implantation. Oper
vestigate the postimplant speech perception results from extended Tech Otorhinolaryngol 2010;21:266–271.
numbers of elderly patients in each subgroup using the same eval-
uation protocol, and to determine evidence of correlations be-
tween outcomes and patient-specific characteristics, including
preimplant hearing threshold levels. Future research involving
larger implanted elderly populations is needed to better under-
stand the differences in outcomes resulting from cochlear implant
treatment in this group and, in turn, support counselling and pa-
Corresponding author:
tient management.
Magdalena Lachowska, MD, PhD
Hearing Implant Center, Department of Otolaryngology
Medical University of Warsaw
Disclosure Statement ul. Banacha 1a
The authors state that there is no conflict of interest including PL–02-097 Warsaw (Poland)
any financial interest or financial support to be disclosed. E-Mail mlachowska @ wum.edu.pl

44 Audiol Neurotol 2014;19(suppl 1):40–44 Lachowska/Pastuszka/Glinka/Niemczyk

DOI: 10.1159/000371609