Loss of hearing is a great frustration for many aging people, affecting about a third of Americans between the ages of 65 and 74 and nearly half of those 75 and older. Hearing aids can help, but aren’t useful for all forms of hearing loss. Though cochlear implants can provide a solution for hearing loss that ranges from severe to profound, they haven’t often been used for elderly patients because of concern about the risks involved with surgery. New research has revisited the issue -- resulting in news that may be music to the ears of elderly patients who thought they’d have to live the rest of their lives in silence.
WHAT IS A COCHLEAR IMPLANT?
About 10% of elderly people with hearing loss have impairment sufficient to qualify them for a cochlear implant. These complex electronic devices are implanted under the skin behind the ear. They send messages about sound (but not the sound itself) to the brain. I asked Anil Lalwani, MD, Mendik Foundation professor of otolaryngology and chairman of the department of otolaryngology at the New York University School of Medicine, for more information. He told me that a cochlear implant is very different from a hearing aid -- it’s more like a new way of hearing. Hearing aids work by amplifying sound, while cochlear implants are designed to bypass damaged areas of the inner ear. They transmit signals directly to the brain via undamaged parts of the auditory nerve.
Following implant surgery, patients work with speech language pathologists and audiologists to learn how to interpret the messages generated by the devices, which are "heard" in a different way. Patients typically can adapt to their new hearing system within three to six months after the surgery, says Dr. Lalwani.
OLDER PEOPLE BENEFIT FROM COCHLEAR IMPLANTS
Cochlear implant surgery generally takes about two hours and requires general anesthesia. In the past, doctors deemed it dangerous to expose elderly individuals to these risks, since many have other medical problems such as heart disease or diabetes or take multiple medications.
To determine if this is actually a valid concern, Dr. Lalwani and his colleagues examined the medical charts of 70 NYU patients over age 70 who received cochlear implants under general anesthesia between 1984 and 2007, dividing the patients into different levels of risk and examining which experienced the most complications. They found that most patients tolerated the procedure well and had few if any complications related to the operation or to general anesthesia, and that pre-existing conditions were more predictive of difficulty than age alone. Where safety concerns had kept many older patients from having cochlear implants, Dr. Lalwani says this study demonstrates that most can undergo the procedure without undue risk. The research was published in the February 2009 issue of The Laryngoscope.
ARE YOU A GOOD CANDIDATE FOR A COCHLEAR IMPLANT?
Generally, an individual is a good candidate for a cochlear implant if he/she cannot benefit from hearing aids... has intact auditory nerves... and experiences hearing loss ranging from severe to profound. Research suggests that it’s best to receive the implant as soon as possible after the onset of hearing impairment since the hearing nerves begin to function less well over time.
The implants are designed to last a lifetime, but if they fail they can be easily replaced. Cost, however, may be a factor. The implant surgery ranges from $40,000 to $60,000. Many, but not all, insurance plans cover it. As always, check and double-check this as you should before any surgery.