Among elderly patients with profound hearing loss, age at time of receipt of an electronic hearing device known as a cochlear implant does not predict subsequent hearing ability, according to a study in the December issue of Archives of Otolaryngology - Head & Neck Surgery, one of the JAMA/Archives journals.

Among the 35 million people in the United States aged 65 and older, between 250,000 and 400,000 have severe to profound hearing loss. Psychological disturbances, social and emotional handicaps, and significant reductions in mental and physical functioning are known to be associated with advanced levels of hearing loss in elderly people, according to background information in the article. A question of growing importance is whether cochlear implantation can address these concerns for elderly patients. A cochlear implant is a small, complex electronic device that includes a microphone, a speech processor, a transmitter and receiver/stimulator, and electrodes. It is implanted and connected to the inner ear to help people with certain types of hearing loss to hear.

Janice Leung, A.B., and colleagues at The Johns Hopkins Hospital, Baltimore, Md., examined the performance of multichannel cochlear implant recipients in a large database of adult subjects. The researchers analyzed data on 749 adolescents and adults with profound hearing loss who underwent implantation at The Johns Hopkins Hospital and in two clinical trials at the Cochlear Corporation, Englewood, Colo., and Advanced Bionics, Sylmar, Calif. The authors used statistical modeling techniques to identify factors that predict outcomes after cochlear implantation. They examined the difference between baseline performance on monosyllabic word recognition, and performance within the first year of implantation.

The authors found that "age at implantation carried relatively little predictive value for postoperative performance in subjects 65 years and older," and that postoperative word scores were widely variable across all age groups.

"This study illustrated that age has little predictive value in determining postoperative performance with a cochlear implant, as increasing age seems to have a negligible effect on postoperative word scores," the authors write. "In fact, duration of profound deafness, along with the percentage of life lived deaf, hold greater predictive power than age, demonstrating that residual hearing capacity and language abilities may hold the key to postoperative success in the elderly cochlear implant recipient."

"Elderly patients should therefore not be discriminated against in assessments for cochlear implant candidacy," they conclude.

(Arch Otolaryngol Head Neck Surg. 2005;131:1049-1054.)

Gary Stephenson
JAMA and Archives Journals
www.jamamedia