Outcomes After Cochlear Implantation in the Very Elderly

Objective: To evaluate the outcomes after cochlear implantation (CI) in the elderly population, with a particular emphasis on perioperative complications, dizziness, and speech perception outcomes. Study Design: A retrospective cohort study of elderly cochlear implant patients. Setting: Tertiary referral center (Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne). Patients: All patients aged 75 and above at the time of first cochlear implant (N = 150). Comparison was made between groups aged 85+ to 80–84, and 75–79. Interventions: All patients received Nucleus devices (either CI512 or CI24RE(CA)). Main Outcome Measures: Speech recognition scores both pre- and postimplantation, symptomatic dizziness and effects upon independent living after surgery, and the incidence of perioperative medical and surgical complications. Complications were classified as major (intrinsic device failure, device migration, extracochlear insertion, meningitis, surgical site infection requiring reoperation, wound breakdown, permanent facial nerve paralysis) and minor (tinnitus, transient facial nerve palsy, facial nerve stimulation, taste disturbance, delayed wound healing). Results: All three cohorts had poor preoperative speech perception. There was significant improvement in postoperative word scores at 3 and 12 months across all groups. There was no statistically significant difference between the three cohorts in terms of speech recognition outcomes at 3 and 12 months. After surgery, more than 20% of patients at all ages experienced transient imbalance, although the incidence did not differ significantly between age groups (p = 0.71). In total, there were 13 major complications in 7 patients (4.7%), and 28 minor complications in 25 patients (16.7%). Conclusion: Postoperative disequilibrium was commonly observed in this elderly population, yet patients still benefited with improved speech perception after cochlear implantation. Elderly patients can benefit from cochlear implantation, and age should not be a limitation for CI surgery. Cochlear implantation can be done safely and provides significant patient benefits.

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