Long-Term Use of Cochlear Implants in the Older Adult Population

Hearing loss affects 60-70% of elderly people, with ∼10% of these potentially eligible for cochlear implantation (CI). While outcomes in older adults have been positive, concerns remain regarding long-term auditory performance due to higher incidence of comorbidities, reduced cortical plasticity, and cognitive decline. This study evaluates 10-year speech perception outcomes and potential mediating factors in adults ≥60 years old at implantation.

A retrospective chart review identified 98 patients implanted between 2006 and 2014 who were ≥60 years old at surgery with ≥10 years of follow-up. The primary outcome was unilateral (CI-only) Consonant-Nucleus-Consonant (CNC) word scores in quiet at 10 years, also measured preoperatively and at one and 5 years postoperatively.

Mean age at implantation was 70.2 years (standard deviation [SD]: 6.4, range: 60.1-85.3), and mean CI experience was 12.6 years (SD: 2.5, range: 10.0-20.1). CNC scores improved significantly from preoperative levels at one (d: 54.2%, q = 31.70, p < 0.001), five (d: 56.5%, q = 31.8, p < 0.001), and 10 years (d: 60.0%, q = 34.67, p < 0.001), without significant differences among postoperative time points. CNC scores did not differ significantly between patients implanted ≥70 versus <70 years old (F(1, 96) = 1.1, p = 0.306). Greater average daily CI use at most recent appointment correlated with higher CNC scores at all postoperative intervals (r = 0.435-0.595, p < 0.001). Inability to live independently was associated with significantly lower scores at 5 years (d = 15.2, p = 0.003).

Speech perception outcomes were stable in most elderly CI users 10 years post-implantation. Performance was not associated with age at implantation but was positively related to consistent device use and independent living. Limitations include some missing data, especially 10 years postoperatively, and inability to assess the impact of cognitive function on outcomes.