Predictive factors of cochlear implant outcomes in the elderly

Isabelle Mosnier (1, 2) , Jean-Pierre Bebear (3) , Mathieu Marx (4, 5) , Bernard Fraysse (5) , Eric Truy (6, 7) , Geneviève Lina-Granade (7) , Michel Mondain (8) , Françoise Sterkers-Artières , Philippe Bordure (9) , Alain Robier (10) , Benoit Godey (11, 12) , Bernard Meyer (1, 13) , Bruno Frachet (14) , Christine Poncet (15) , Didier Bouccara (16) , Olivier Sterkers (17, 16)

1 Service d'oto-rhino-laryngologie
2 (IFR_2) - Institut Claude Bernard - Physiologie et Pathologie
3 Hôpital Pellegrin
4 CERCO - Centre de recherche cerveau et cognition
5 Service ORL, otoneurologie et ORL pédiatrique [CHU Toulouse]
6 Neurosciences Sensorielles Comportement Cognition
7 Département d'ORL, chirurgie cervico-maxillo-faciale et d'audiophonologie [Hôpital Edouard Herriot - HCL]
8 Centre de référence des affections sensorielles d'origine génétique
9 CHU Nantes - Centre Hospitalier Universitaire de Nantes
10 Service ORL et chirurgie cervico-faciale [Tours]
11 Service d'ORL et de chirurgie maxillo-faciale [Rennes] = ENT Head and Neck Surgery [Rennes]
12 LTSI - Laboratoire Traitement du Signal et de l'Image
13 CHU Tenon [AP-HP]
14 Service ORL [Avicenne]
15 ISA - Institut Sophia Agrobiotech
16 CHU Pitié-Salpêtrière [AP-HP]
17 Réhabilitation Chirurgicale mini-Invasive et Robotisée de l'Audition

Objective - To analyze predictive factors of cochlear implant outcomes and postoperative complications in the elderly. Study design - Prospective, longitudinal study performed in 10 tertiary referral centers. Methods - Ninety-four patients aged 65-85 years with a profound, postlingual hearing loss were evaluated before implantation, at time of activation, and 6 and 12 months after cochlear implantation. Speech perception and lipreading were measured using disyllabic word recognition in quiet and noise, and lipreading using disyllabic words and sentences. The influence of preoperative factors on speech perception in quiet and noise at 12 months was tested in a multivariate analysis. Complications, presence of tinnitus and of vestibular symptoms were collected at each evaluation. Results - The effect of age was observed only in difficult noisy conditions at SNR 0 dB. Lipreading ability for words and sentences was negatively correlated with speech perception in quiet and noise. Better speech perception scores were observed in patients with shorter duration of hearing deprivation, persistence of residual hearing for the low frequencies, the use of a hearing aid before implantation, the absence of cardiovascular risk factors, and in those with implantation in the right ear. General and surgical complications were very rare, and the percentage of vestibular symptoms remained stable over time. Conclusion - This study demonstrates that cochlear implantation in the elderly is a well-tolerated procedure and an effective method to improve communication ability. Advanced age has a low effect on cochlear implant outcome. Analyses of predictive factors in this population provide a convincing argument to recommend treatment with cochlear implantation as early as possible in elderly patients with confirmed diagnosis of a severe-to-profound hearing loss and with only limited benefit from hearing aid use in one ear.

Domaines: Ingénierie biomédicale

Isabelle Mosnier, Jean-Pierre Bebear, Mathieu Marx, Bernard Fraysse, Eric Truy, et al.. Predictive factors of cochlear implant outcomes in the elderly. Audiology and Neurotology, 2014, 19 Suppl 1 (1), pp.15--20. ⟨10.1159/000371599⟩. ⟨hal-01218183⟩