Cochlear Implantation in Adults with Post-lingual Deafness ... · PDF fileKyle McMullen, MD...
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Transcript of Cochlear Implantation in Adults with Post-lingual Deafness ... · PDF fileKyle McMullen, MD...
Cochlear Implantation in Adults with Post-lingual Deafness:
The Effects of Age and Duration of Deafness on Post-operative Speech Recognition
Kyle McMullen, MD Ohio State University Wexner Medical Center
Columbus, OH
§ Disclosures: None
§ Thanks: § Aaron Moberly, MD principal investigator § Jason A. Beyea, MD, PhD, FRCSC, Michael S. Harris,
MD, Derek M. Houston, PhD, Oliver F. Adunka, MD § Jennifer Martin, BA, Virginia A. Bolster, BA,
§ Funding: None
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Age and Duration of Deafness in Adult CI
Outcomes of Adult CI § Cochlear implants benefit adults with acquired SNHL
§ 60% spoken words; 70% words in sentences in quiet § Substantial variability with outcomes § Identified factors:
§ residual hearing § partial electrode insertion § congenital malformation / etiology § age § duration of deafness
3 Firszt JB, et al. Ear Hear. 2004; Gifford RH et al. Audiol Neurootol. 2008; Holden LK et al. Ear Hear. 2013
Aging and Implantation § Implanting older adults
§ Older age = poorer performance
§ However, this is not universal § Outcome methods vary (CNC, CID, HINT….) § Duration of deafness not accounted for in many
studies
4 Haensel et al. Acta Otolaryngol. 2005; Labadie et al. Otolaryngol Head Neck Surg. 2000
Duration of Deafness and Implantation § When duration of deafness examined, it appears to
affect outcomes more than age § Limitations:
§ lack of sentence testing (mono/multi-syllabic words used)
§ Some adults may have pre-lingual deafness
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Leung J, et al. Arch Otolaryngol Head Neck Surg. 2005. ; Lazard DS, et al. PLoS One. 2012; Budenz CL, et al. J Am Geriatr Soc. 2011.
Hypothesis § Increasing age and duration of deafness would be
independently associated with poorer speech recognition outcomes in post-lingually deafened adults
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Study Methods § Retrospective, single institution study examining
cohort of adult CI recipients between 1983 – 2014 § Inclusion: Adults with bilateral severe-profound
SNHL, post-lingual deafness § Post-lingual: defined as hearing loss after > 12 § Post-operative testing > 12 months (mean 6.4 yrs) § Candidacy determined at the time of implant
§ Exclusion: § Partial CI electrode insertion § Congenital inner ear malformation
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Results § 51 patients met inclusion criteria
§ HINT (31), AzBio (28) § No differences in AzBIO, HINT
§ Gender, side of implant § Use of hearing aid prior to OR after surgery § Better or worse ear implanted § Unilateral vs. bilateral § Early vs. late implant (median, October 2005)
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Results § Partial correlation
§ each analysis done controlling for the other
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Age at testing Duration of deafness
r p r p
AzBio (n=28) -0.66 0.001 0.57 0.007
HINT (n=31) -0.18 0.412 -0.16 0.462
• Increasing age = worse on challenging sentences • Longer duration of deafness = better on challenging sentences
Findings § Older adults performing more poorly is not surprising
§ Correlation on AzBio, “more difficult” test § “hang the air freshener from your rearview mirror”
§ No correlation on HINT: “easier” test § “the fire was very hot”
§ One factor that may explain = natural cognitive decline
10 Gifford et al. Audiol Neurootol. 2008
Findings § Longer duration of deafness = better outcomes (AzBio)
§ Paradoxical? – Not entirely
§ Adaptive strategies to cope with deafness § Better use of linguistic skills and context within sentences
11 Leung et al. Arch Otol Head Neck Surg. 2005
Limitations § Retrospective § Small sample size § Duration of deafness calculated from age at onset of
hearing loss, not age at severe-profound loss § Post-op testing measures changed during period
(HINT à AzBIO)
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Conclusions § In post-lingually deafened adults: § Older age = poorer sentence recognition (AzBio),
independent of duration of deafness § Duration of deafness = improved sentence
recognition (AzBio), independent of age
13 Yankner BA et al. Annu Rev Pathol. 2008. Park et al, J Am Acad Audiol 2011.
Conclusions § Consider normal aging process in CI
§ decline in working memory, processing abilities, and verbal memory recall
§ May affect post-op outcomes and testing § Prospective studies currently underway examining
influence of age and cognition in normal hearing and CI adults
14 Yankner BA et al. Annu Rev Pathol. 2008. Park et al, J Am Acad Audiol 2011.