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cochlear implant

Indications: - sensorineural hearing loss - speech understanding score of <= 40% (CMS threshold) [3] - *hearing aids not effective [1,3] - cochlear implants improve quality of life [4] - cochlear implants may attenuate cognitive decline [19] - duration of hearing loss not a factor - severe to profound bilateral hearing loss - cochlear implants can benefit people who have gone long periods with hearing loss.without hearing aids [18] - cochlear implants improve cognitive functioning & speech perception in noise in elderly with severe hearing loss at risk for mild cognitive impairment [20] * Requirements for beneficial outcome: - *functional auditory nerve - *good speech, language & communication skills - *realistic expectations of benefit - *likelihood of aural rehabilitation success after cochlear implant - *appropriate support services - *adequate cognition & motivation [3] Contraindications: - active infection - middle ear pathology [3] - long-standing cochlear damage not a contraindications [3] - inability to tolerate general anesthesia * age alone should not be used to rule out cochlear implants in adults both older & younger adults experience improved speech recognition & quality of life with implants Procedure: - electrodes implanted into the scala tympani are connected to a receiver on the surface of the temporal bone, which receives input transcutaneously from an externally worn speech-processing coil - the implant should be inserted as soon as possible after hearing loss for best results - arrays of electrodes bypass the damaged hair cells directly stimulate the auditory nerve - unilateral cochlear implant for bilateral sensorineural hearing loss with new hearing aid in other ear superior to cochlear implant alone* [3] - cochlear implant is placed in the more impaired ear - the better ear is fit with a hearing aid - if hearing loss progresses in the better ear, consider bilateral cochlear implants - surgery requires anesthesiologist - surgery takes ~ 3 hours * initial cochlear implant is unilateral * image [20] Radiology: - magnetic resonance imaging (MRI) may be painful for patients with cochlear implants & cause complications [11] - 5 of 18 patients unable to complete MRI due to pain - complication with implant's internal magnet in 2 of 18 - complications not restricted to brain MRI [11] - artifacts observed in brain MRI images [11] Complications: - infectious complications - 5.2 per 1000 person-years in adults [16] - 8.1 per 1000 person-years in children [16] - 55% of infectious complications in children occur within 180 days of implantation [16] - meningitis (rare) [3] - elderly have a higher incidence of comorbidities; however, surgical complications are not more frequent in elderly vs yonger patients & there is no need for additional intensive postoperative care [8,13] - non-surgical complications including cardiac arrhythmia, delirium & urinary retention requiring hospitalization (2-4%) are more common in the elderly [13] Management: - pneumococcal vaccines (both PneumoVax plus Prevnar) recommended (see pneumococcal vaccine) Notes: - auditory sensation is not likely to be truly speech-like - pre-operative counseling, realistic expectations, & regular post-operative aural rehabilitation is important. [2] - outcome depends on neural plasticity - age at implantation has minimal impact on postoperative outcome [10] - post-op performance scores in elderly on standard hearing tests better than pre-op, but not as good in younger patients [9] - implants improve speech recognition in both quiet & moderate-noise environments in adults [18] - cochlear implant approved for high-frequency hearing loss [5] - Medicare covers cochlear implants & surgery (but does not cover hearing aids)

Related

cochlea ENT surgery; otorhinolaryngologic surgery; ear, nose & throat surgery hearing aid; digital hearing aid sensorineural hearing loss

General

implant

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. The Merck Manual of Geriatrics, 3rdh ed, Merck & Co, Rahway NJ, 2000 # 1326
  3. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Gaylor JM Cochlear Implantation in Adults. A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2013 Feb 21 PMID: 23429927 http://archotol.jamanetwork.com/article.aspx?articleid=1655350
  5. FDA News Release: March 20, 2014 FDA approves first implantable hearing device for adults with a certain kind of hearing loss. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm389860.htm
  6. Friedland DR1, Runge-Samuelson C, Baig H, Jensen J Case-control analysis of cochlear implant performance in elderly patients. Arch Otolaryngol Head Neck Surg. 2010 May;136(5):432-8 PMID: 20479370
  7. Gifford RH, Dorman MF, Shallop JK, Sydlowski SA. Evidence for the expansion of adult cochlear implant candidacy. Ear Hear. 2010 Apr;31(2):186-94. PMID: 20071994
  8. Alice B, Silvia M, Laura G, Patrizia T, Roberto B Cochlear implantation in the elderly: surgical and hearing outcomes. BMC Surg. 2013;13 Suppl 2:S1. PMID: 24267394
  9. Chatelin V, Kim EJ, Driscoll C, Larky J, Polite C, Price L, Lalwani AK. Cochlear implant outcomes in the elderly Otol Neurotol. 2004 May;25(3):298-301. PMID: 15129109
  10. Lachowska M et al Is cochlear implantation a good treatment method for profoundly deafened elderly? Clinical Interventions in Aging 2013:8 PMID: 24124356
  11. Kim BG et al Adverse Events and Discomfort During Magnetic Resonance Imaging in Cochlear Implant Recipients. JAMA Otolaryngol Head Neck Surg. November 20, 2014 PMID: 25411817 http://archotol.jamanetwork.com/article.aspx?articleid=1936465 - Kanal E Magnetic Resonance Imaging in Cochlear Implant Recipients. Pros and Cons. JAMA Otolaryngol Head Neck Surg. November 20, 2014 PMID: 25412437 http://archotol.jamanetwork.com/article.aspx?articleid=1936463
  12. O'Donoghue G. Cochlear implants-science, serendipity, and success. N Engl J Med. 2013;369:1190-1193 PMID: 24015974
  13. Clark JH, Yeagle J, Arbaje AI, et al. Cochlear implant rehabilitation in older adults: literature review and proposal of a conceptual framework. J Am Geriatr Soc. 2012;60:1936-1945 PMID: 22974240
  14. Budenz CL, Cosetti MK, Coelho DH et al The effects of cochlear implantation on speech perception in older adults. J Am Geriatr Soc. 2011 Mar;59(3):446-53. Epub 2011 Mar 1. PMID: 21361884
  15. Lin FR, Chien WW, Li L, Clarrett DM, Niparko JK, Francis HW. Cochlear implantation in older adults. Medicine (Baltimore). 2012 Sep;91(5):229-41. PMID: 22932787 Free PMC Article
  16. Lander DP, Durakovic N, Kallogjeri D et al Incidence of Infectious Complications Following Cochlear Implantation in Children and Adults. JAMA. 2020;323(2):182-183. Jan 14 PMID: 31935017 https://jamanetwork.com/journals/jama/article-abstract/2758588
  17. Carlson ML Cochlear Implantation in Adults. N Engl J Med 2020; 382:1531-1542. April 16 PMID: 32294347 https://www.nejm.org/doi/full/10.1056/NEJMra1904407
  18. Buchman CA, Gifford RH, Haynes DS et al Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss. A Systematic Review and Consensus Statements. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020 PMID: 32857157 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2769941 - Wick CC, Kallogjeri D, McJunkin JL et al Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older. A Secondary Analysis of a Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020 PMID: 32857114 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2769939 - Zwolan TA, Kallogjeri D, Firszt JB et al Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition. A Multicenter Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020 PMID: 32857106 PMCID: PMC7453340 Free PMC article https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2769940 - Buchman CA, Herzog JA, McJunkin JL et al Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users. A Nonrandomized Controlled Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020 PMID: 32857113 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2769938 - Lalwani AK. Cochlear Implant Today...Pill Tomorrow JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020 PMID: 32852524 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2769932
  19. Yeo BSY, Song HJJMD, Toh EMS et al Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia. A Systematic Review and Meta-analysis. JAMA Neurol. Published online December 5, 2022. PMID: 36469314 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799139 - Denham MW, Weitzman RE, Golub JS Hearing Aids and Cochlear Implants in the Prevention of Cognitive Decline and Dementia - Breaking Through the Silence. JAMA Neurol. Published online December 5, 2022 PMID: 36469311 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799142
  20. George J Cognitive Functioning Improves After Cochlear Implant. Clinically meaningful improvement in older adults at risk for mild cognitive impairment. MedPage Today February 16, 2023 https://www.medpagetoday.com/neurology/dementia/103141 - Andries E, Bosmans J, Engelborghs S et al Evaluation of Cognitive Functioning Before and After Cochlear Implantation in Adults Aged 55 Years and Older at Risk for Mild Cognitive Impairment. JAMA Otolaryngol Head Neck Surg. 2023. Online Feb 16 PMID: 36795400 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2801794
  21. Cosetti MK, Lalwani AK. Is cochlear implantation safe and effective in the elderly? Laryngoscope. 2015;125(6):1279-1281 PMID: 25423907
  22. Lally JW, Adams JK, Wilkerson BJ. The use of cochlear implantation in the elderly. Curr Opin Otolaryngol Head Neck Surg. 2019;27(5):387-391 PMID: 31460986
  23. Cochlear Implants http://www.nidcd.nih.gov/health/hearing/coch.asp