Considering a Cochlear Implant? You’re Never Too Old.

Is there  an age limit for cochlear implant recipients? I asked this question of several cochlear implant surgeons around the country. Their answer? Never.

All have implanted patients in their 90s and, as Anil Lalwani, of New York-Presbyterian/Columbia University Irving Medical Center said, he “routinely” operates on patients over 80. His oldest patient is 93.

Surgeon Jay Rubinstein, at the University of Washington Medical Center, has performed cochlear implant surgery on a 96-year-old. Like the others, he thinks chronological age is -not the issue, it’s a person’s overall health.

In other words, it’s not so much how many years you’ve lived as how well your body has held up. In April 2014, Mollie Smith, 99, became the oldest cochlear implant recipient in Europe.

Cochlear implant surgery takes about two to three hours and requires general anesthesia or heavy sedation, so the ability to tolerate anesthesia is essential. Even so, a 2009 study by Dr. Lalwani and others, found that cochlear implantation in the elderly carries minimal risk from anesthesia.

One of the important preexisting conditions that may preclude surgery is moderate or severe heart and/or lung disease, which could make anesthesia potentially dangerous, said Rick Hodgson, a surgeon with Head and Neck Surgical Associates in Portland, Ore. The oldest patient he has implanted was 92 and he’s doing well, Dr. Hodgson said, noting that as a surgeon he looks more at “biologic age than chronological age.”

Darius Kohan, an otologist-otolaryngologist in New York (who was my cochlear implant surgeon at New York Eye and Ear Infirmary), told me he implanted a patient who was 95 years 6 months old. The patient is still using the implant 21/2 years after surgery.

Even dementia may not be a disqualifier, the surgeons said, assuming that the patient is not violent or likely to destroy the external parts of the implant. A study published last summer on implantees with dementia found a significant cognitive improvement a year later. The patients also received regular auditory rehabilitation. It was not clear from the study whether it was the implant itself or the aural rehab that made the difference in improved cognitive abilities.

Jack Wazen, a surgeon and  partner at the Silverstein Institute and director of research at the Ear Research Foundation in Sarasota, Fla. (and a fellow board of trustees member with me for the Hearing Loss Association of America), was the most conservative of those interviewed on the question of dementia, saying he routinely implants those with mild to moderate cognitive decline, but not those with severe decline.

All agree on the importance of auditory rehab for older patients. As Dr. Hodgson put it, “Auditory rehab helps get the most out of the process. This is amazing and life-changing technology, so why wouldn’t we want to maximize the impact on someone’s life?” He added that younger implant recipients might still be in the workforce and get stimulation from their everyday environment. The older recipients are less likely to get that stimulation. Also important, as all the surgeons agreed, is a social support system. This doesn’t necessarily mean a companion in the home, but a regular conversation partner is essential. Social interaction is important in general for quality of life.

The one issue on which the surgeons differed was which ear to implant: the worse or the better one. With younger implantees, the decision is usually to implant the worse ear, to preserve the natural hearing in the good ear, often using a hearing aid in the good ear. But an elderly person may have been deaf for some time in the bad ear, and thus less likely to benefit from the implant.

Although most said that they would consider implanting the deaf ear, they might not if the ear had been deaf for a long period of time. Dr. Wazen specified five years or more. Dr. Hodgson pointed out that “the longer the duration of hearing loss, the higher the chance of diminished benefit due to deterioration of sensory elements in the inner ear.”

Both Dr. Lalwani and Dr.  Kohan said they would implant the worse ear. Dr. Kohan’s reasoning is that if the patient is still able to hear with the hearing aid ear, there may still be enough plasticity in the brain, with crossover from the nonhearing ear, to make an implant in the deaf ear function. Dr. Lalwani went further: “I would always implant the deaf ear. One does not lose anything from doing so. If the outcome is less than satisfactory, the other ear could always be implanted down the road.”

As for outcomes, all the physicians agreed that older recipients do well with cochlear implants. Dr. Kohan mentioned benefits like delayed mental deterioration, better quality of life and more independence.

Dr. Wazen is completing a study comparing the results among patients over 80 with those under 80. The study found no differences in healing or complication rates. All patients did better with the cochlear implant than they had with a hearing aid. The study did find that speech recognition scores with implants were better in the younger group. This may be due to a number of factors, Dr. Wazen said, “including length of deafness, poorer cognitive function [in the older group] and aging changes in the brain.”

So if your doctor recommends an implant, go for it, no matter what your age. “When elderly patients tell me they are too old for a CI,” Dr. Rubinstein said, “I tell them age is not important unless they are a cheese.”

This post first appeared on AARP Health on February 22, 2016.

12 thoughts on “Considering a Cochlear Implant? You’re Never Too Old.

  1. My understanding of a cochlear implant is that they put a electronic processor under your skin to connect to. Since that doesn’t get removed or replaced, I actually have the opposite question – should you wait as long as possible before getting an implant? I’m 66 years old – my mom lived to 92. Should I be lucky enough to have that longevity, would I want a 20+ year old processor in my head, or should I wait as long as possible to have the most advanced device available? I wouldn’t want to be using a 20 year old computer or cell phone today. Is this a good analogy?

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    • That’s a good question that I’ve asked myself from time to time. The answer I’ve gotten is that it is the processor that gets upgraded, not the implanted device. The processor is the part that goes behind the ear and receives and transmits the signal to the implanted device in the brain. The three FDA approved cochlear implant makers offer upgrades on processors on a regular basis. I got a new processor last year, five years after my original implant. It was a noticeable improvement.

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      • That’s good to know. I go for a workup this summer – I’m borderline for needing a cochlear implant so thinking about it a lot. Don’t want to do it too quickly but see so many positive comments.

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  2. Good morning Katherine. I was 84 last May when I received my CI. I had no idea that I was a candidate and considered age to be a prohibiting factor. When my ENT told me that he was referring me to a surgeon I was excited and nervous. Now, at almost 10 months post surgery, I can not imagine life without my CI. The difference it has made in my life is amazing.

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  3. My mom got her cochlear implant in her 80s. I wish she’d gotten it earlier. Her hearing had dropped to 5% comprehension by then and she was so withdrawn ,understandably, from life around her. The implant helped. It wasn’t magic. She never came fully back to interacting or wanting to interact because of her hearing. But I’d say her comprehension went up to maybe 40% and that made all the difference in the day to day. I’m grateful, even as those last years were hard for all kinds of reasons….

    >

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  4. A friend wrote me yesterday about her own father’s experience after reading this column. I asked if I could reprint it here.

    Thanks so much for sharing this post. I just came back from visiting my parents in Pittsburgh, the first time I have seen my dad since his cochlear implant last fall at the age of 88.
    I cannot tell you how wonderful it is to see my father once again engaging with the family, full of stories and also sharp analytical commentary on current affairs.
    My mother says she has seen such a transformation in my dad. He is no longer angry, frustrated. And he is talking all the time. Plus, while he used to have my mom handle all the basic household affairs, calling for information, etc., he now is handling calls and dealing with basics of bill paying, household management once again.
    I cannot thank you enough for helping me convince my dad it was worth doing even at his age. He still works out twice a week in the gym, even though both parents aren’t quite as active as they used to be. And he is now feeling part of society once again. He has a training session coming up, thanks to your recommendation on March 8th.

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