AAO-HNS: Cochlear Implants Found Worthwhile in the Elderly
By John Gever
CHICAGO, 29 sept 2008--Cochlear implants for older patients led to better hearing as well as improvements in quality of life, researchers said here. Among 31 patients ages 57 to 85 given cochlear implants, two-thirds reported good or excellent satisfaction with the devices, said Patrick Maiberger, M.D., of Virginia Commonwealth University in Richmond, at the American Academy of Otolaryngology -- Head and Neck Surgery meeting here. Patients also had positive scores on the social support and general subscales of the Glasgow Benefit Inventory, reflecting improvement in quality of life. Patients with multiple comorbidities were no less satisfied with the implants than those in better overall health, Dr. Maiberger added.
But the efficacy of cochlear implants in these patients was significantly less than in a control group of patients ages 36 to 49, he said.
Cochlear implantation is common in older patients. Nevertheless, there is debate about the actual benefits, which have not been well studied in controlled trials, Dr. Maiberger said.
He noted that implant performance in audiologic testing does not necessarily correlate with quality of life.
Dr. Maiberger and colleagues gave two surveys, the Glasgow inventory and a questionnaire specific for quality of life in older cochlear implant recipients, to patients at least 55 years old receiving implants at Virginia Commonwealth. Questionnaires were given at least six months after implantation.
Mean age of the sample was 69.5 (SD 6.6).
The researchers also gave the questionnaires to a control group of 11 younger patients (mean age 43.6, SD 4.2).
Patients with bilateral implants were excluded. Only English-speaking recipients with full electrode insertion were included.
On the overall satisfaction component of the cochlear implant quality-of-life instrument, four of the 31 participants reported excellent results, 16 said they were good, and 11 reported fair or poor satisfaction.
In contrast, all control participants reported good or excellent satisfaction (P=0.02).
The older patients were most pleased with the improvement in hearing in quiet places, with 22 reporting good or excellent satisfaction.
In noisy environments, good or excellent satisfaction was reported by only seven older participants, compared with all 11 of the younger patients (P<0.0001). href="http://www.medpagetoday.com/Geriatrics/Dementia/tb/10197" target="blank">Hearing Test May Measure Cognitive Decline)
The satisfaction results were about the same in 18 participants with one or zero comorbidities as in the 13 with two or more, Dr. Maiberger reported.
On the Glasgow survey, which was completed by 22 of the older participants, mean scores on the social support and general subscales in the older patients were 13.99 (SD 31.66) and 12.49 (SD 31.06), respectively.
Older participants showed negative scores on the physical health component (-7.55, SD 11.15). This component reflects participants' overall physical health and declines would be expected in an elderly sample, Dr. Maiberger said.
The control group had positive physical health scores and much higher scores than the older group on the social support and general subscales.
Dr. Maiberger said the small sample size and potential for selection bias were limitations to the study. On the other hand, he said, its use of objective and validated instruments for evaluating quality of life and strict inclusion and exclusion criteria were strengths.
Rick A. Friedman, M.D., Ph.D., an otolaryngologist at the House Ear Clinic in Los Angeles, said the results confirmed his own experience with older patients.
"Everybody would agree that elderly cochlear implant users probably don't fare as well as younger post-lingual recipients," said Dr. Friedman, who was not involved with the study.
"I think it's not surprising but it's reassuring to see it documented that the quality of life is improved in the elderly patients, even with other comorbid illnesses."
The authors noted that the study was limited by its small size and should be repeated in future studies with larger sample sizes able to identify other factors that may impact performance in elderly cochlear implant patients.
The study had no external funding.
Dr. Maiberger and colleagues reported no potential conflicts of interest.
Dr. Friedman has received a speaker's honorarium from Alcon.
But the efficacy of cochlear implants in these patients was significantly less than in a control group of patients ages 36 to 49, he said.
Cochlear implantation is common in older patients. Nevertheless, there is debate about the actual benefits, which have not been well studied in controlled trials, Dr. Maiberger said.
He noted that implant performance in audiologic testing does not necessarily correlate with quality of life.
Dr. Maiberger and colleagues gave two surveys, the Glasgow inventory and a questionnaire specific for quality of life in older cochlear implant recipients, to patients at least 55 years old receiving implants at Virginia Commonwealth. Questionnaires were given at least six months after implantation.
Mean age of the sample was 69.5 (SD 6.6).
The researchers also gave the questionnaires to a control group of 11 younger patients (mean age 43.6, SD 4.2).
Patients with bilateral implants were excluded. Only English-speaking recipients with full electrode insertion were included.
On the overall satisfaction component of the cochlear implant quality-of-life instrument, four of the 31 participants reported excellent results, 16 said they were good, and 11 reported fair or poor satisfaction.
In contrast, all control participants reported good or excellent satisfaction (P=0.02).
The older patients were most pleased with the improvement in hearing in quiet places, with 22 reporting good or excellent satisfaction.
In noisy environments, good or excellent satisfaction was reported by only seven older participants, compared with all 11 of the younger patients (P<0.0001). href="http://www.medpagetoday.com/Geriatrics/Dementia/tb/10197" target="blank">Hearing Test May Measure Cognitive Decline)
The satisfaction results were about the same in 18 participants with one or zero comorbidities as in the 13 with two or more, Dr. Maiberger reported.
On the Glasgow survey, which was completed by 22 of the older participants, mean scores on the social support and general subscales in the older patients were 13.99 (SD 31.66) and 12.49 (SD 31.06), respectively.
Older participants showed negative scores on the physical health component (-7.55, SD 11.15). This component reflects participants' overall physical health and declines would be expected in an elderly sample, Dr. Maiberger said.
The control group had positive physical health scores and much higher scores than the older group on the social support and general subscales.
Dr. Maiberger said the small sample size and potential for selection bias were limitations to the study. On the other hand, he said, its use of objective and validated instruments for evaluating quality of life and strict inclusion and exclusion criteria were strengths.
Rick A. Friedman, M.D., Ph.D., an otolaryngologist at the House Ear Clinic in Los Angeles, said the results confirmed his own experience with older patients.
"Everybody would agree that elderly cochlear implant users probably don't fare as well as younger post-lingual recipients," said Dr. Friedman, who was not involved with the study.
"I think it's not surprising but it's reassuring to see it documented that the quality of life is improved in the elderly patients, even with other comorbid illnesses."
The authors noted that the study was limited by its small size and should be repeated in future studies with larger sample sizes able to identify other factors that may impact performance in elderly cochlear implant patients.
The study had no external funding.
Dr. Maiberger and colleagues reported no potential conflicts of interest.
Dr. Friedman has received a speaker's honorarium from Alcon.
Primary source: American Academy of Otolaryngology-Head and Neck SurgerySource reference:Georgolios A, et al "Performance and QOL after geriatric cochlear implantation" Otolaryngology -- Head and Neck Surgery 2008; 139: S109-10.
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