12/6/20151 cochlear implants in the older patient mark pyle md professor of surgery and academic...
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Cochlear implants in the older patient
Mark Pyle MD
Professor of surgery and Academic Vice Chair Division of Otolaryngology
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Introduction
• How do we define “ older”
• Iife expectancy 78.7 years
• Frailty , NOT AGE, is a consideration
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Demographics
• 41 million ( 2011) and increasing
• Increased incidence of hearing loss
• Association with dementia
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UW Experience
• 44 % of adult patients over 65
• Only one patient has been explanted for medical complication
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Special considerations
• Loss of other special senses
• Depression and dementia
• Communication with caregivers including family and physicians
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Who is a candidate ?
• Severe to profound bilateral sensorineural hearing loss
• Limited benefit from hearing aid
• History of auditory communication
• “ nerve deafness “ is OK
• No medical contraindication
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Am I healthy enough to have CI surgery ?
• Collaboration with primary MD
• Surgery itself is very well tolerated
• Most medical problems are easily managed
• Pain is usually minimal
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Evaluation
• History , examination , audiogram
• Audiologic CI evaluation including sentence testing
• Imaging studies- MRI
• Balance tests
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Financial questions
• Medicare guidelines
• Secondary Insurance
• January 2014 ??
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Surgical Recovery
• Hospital stay
• Wound care
• Audiology visits
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Complications
• “ minor “ are most common• In one 445 patient study by Chen , et al , safety
was comparable to younger patient population.• Imbalance greater than 1 month in 10% of
patients over 75 and 5 % of patients 60-74.• 3.8% required device removal. 15 of these 17
patients were successfully reimplanted
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Summary
• Cochlear Implants can be done safely in patients over 65 and 75.
• They significantly improve quality of life and communication in this population.