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.