Outcomes After Cochlear Implantation in the Very Elderly

Wong, Daniel Jun Yi; Moran, Michelle; O’Leary, Stephen

doi:10.1097/mao.0000000000000920

Cited by 61 publications

(73 citation statements)

References 23 publications

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“…Mey et al distinguished between patients with postoperative vertigo starting 24 hours to 1 week (12.7%), 1 week to 6 months (9.1%), and more than 6 months (5.4%) . We searched for all studies reporting on postoperative vertigo quality and possible changes compared with their preoperative state to detect a further subgroup of patients that suffer an impact of cochlear implantation on their vestibular function . Hence, up to one‐fourth of patients either suffer a new onset of vertigo or a change in vertigo quality after cochlear implantation.…”

Section: Discussionmentioning

confidence: 99%

“…Nystagmography and cVEMP tests revealed a significant increase of the hSCC and saccular impairment after cochlear implantation. Further vestibular tests were rare or reported without sufficient data and therefore not systematically evaluated (e.g., head impulse test, 5,20,23,25,30,61,63,[88][89][90][91][92][93][94][95] subjective haptic vertical testing, 15,89 and ocular vestibular-evoked myogenic potentials 8,25,80,92,96 ).…”

Section: Discussionmentioning

confidence: 99%

“…102 We searched for all studies reporting on postoperative vertigo quality and possible changes compared with their preoperative state to detect a further subgroup of patients that suffer an impact of cochlear implantation on their vestibular function. 17,[19][20][21]23,24,[26][27][28][29][30] Hence, up to one-fourth of patients either suffer a new onset of vertigo or a change in vertigo quality after cochlear implantation. However, vestibular disease may also progress as a result of deafness etiology.…”

Section: Discussionmentioning

confidence: 99%

“…Two patients complained about new onset of sway vertigo. Additionally, six studies reported on altered quality of vertigo, [19][20][21]23,28,29 whereas five studies did not observe any change in vertigo quality 17,24,26,27,30 (altered vertigo in 11.6%, 77 of 663 patients). In this subgroup of studies, 19.5% (129 of 663 patients) complained about new onset of vertigo after cochlear implantation.…”

Section: Vertigo Qualitymentioning

confidence: 93%

“…A total of 16.8% (446 of 2,651) suffered from vertigo after cochlear implantation. 12,16,18,19,[21][22][23]26,30,42,44,46,47, Figure 2 shows the mean age-correlated occurrence of vertigo after cochlear implantation. The majority of patients were children younger than 9 years and adults between 30 to 59 years.…”

Section: Age and Vertigomentioning

confidence: 99%

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Meta‐analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

et al. 2018

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Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Vertigo Qualitymentioning

confidence: 93%

Section: Age and Vertigomentioning

confidence: 99%

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Meta‐analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

et al. 2018

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Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Cases

et al. 2020

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Objective To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA‐CS). Methods Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA‐CS at a tertiary care center between August 2013 and January 2020. An age‐matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. Results Cochlear implant surgery under LA‐CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA‐CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake‐up from anesthesia was required in one patient (1%) from the LA‐CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA‐CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA‐CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). Conclusion Cochlear implant surgery under LA‐CS offers many benefits and is a safe, feasible, and cost‐effective alternative to GA when performed by experienced CI surgeons. Level of Evidence 3 Laryngoscope, 131:E946–E951, 2021

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Cognitive Assessment in Elderly Cochlear Implant Recipients: Long‐Term Analysis

et al. 2022

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ObjectivesTo examine long‐term speech and cognition outcomes in older adult cochlear implant (CI) recipients. First, by evaluating if CI performance was maintained over an extended follow‐up period regardless of preoperative cognitive status. Secondly, by evaluating if there was a difference in the rate of cognitive decline between preoperative mild and normal cognition following CI over an extended period of time.Study Design and SettingRetrospective cohort study.MethodsCI recipients ≥65 years of age implanted between 2009 and 2014 with 4+ years follow up. Pre‐ and postoperative audiometric and speech outcome assessments were collected. Cognitive status was measured using the mini mental status examination (MMSE) at numerous time points.ResultsFifty‐three patients met inclusion. Patients were divided into two groups based on preoperative MMSE with scores considered normal (28–30) and those with mildly impaired cognition (MIC, scores 25–27). Audiometric and speech performance improved significantly at one‐year post implantation and this was maintained without significant change at 4+ years, regardless of cognitive status. Mixed modeling analysis controlling for age demonstrated no significant difference in the rate of cognitive decline at 4+ years post implantation between the normal cognition cohort (1.74; 95%CI 0.89–2.6) and MIC (2.9; 95%1.91–3.88).ConclusionSpeech performance was significantly improved and sustained after CI in both normal cognition and MIC patients. The rate of cognitive decline in older adult CI patients appears to be similar regardless of preoperative cognitive status. Although results demonstrate rates of cognitive decline following CI did not differ between cognition groups over 4+ years, future studies will need to further investigate this over extended time periods with a more comprehensive cognitive testing battery.Level of Evidence4 Laryngoscope, 133:2379–2387, 2023

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Outcomes After Cochlear Implantation in the Very Elderly

Cited by 61 publications

References 23 publications

Meta‐analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

Meta‐analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Cases

Cognitive Assessment in Elderly Cochlear Implant Recipients: Long‐Term Analysis

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