Hearing Loss and the Cochlear Implant Solution

Introduction to Hearing Loss

Kitty Grutzmacher had contended with poor hearing for a decade, but the problem had worsened over the past year. Even with her hearing aids, “There was little or no sound,” she says. Her condition led to social isolation, as she avoided group activities and social gatherings due to her inability to hear and engage in conversations.

The Limitations of Hearing Aids

“I was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.” Her audiologist was unable to offer Grutzmacher, a retired nurse in Elgin, a solution. But she found her way to the cochlear implant program at Northwestern University. Krystine Mullins, an audiologist there who assesses hearing and counsels people about their options, says surgically implanting this electronic device usually substantially improves a person’s ability to understand speech.

Cochlear Implantation and Age

That Grutzmacher was 84 was immaterial. “As long as you’re healthy enough to undergo surgery, age is not a concern,” Mullins says. Another recent Northwestern implant patient was 99. This highlights that age alone is not a barrier to receiving a cochlear implant, opening up possibilities for older adults who may have been told they are too old for such procedures.

The Process and Outcomes of Cochlear Implantation

Some people need to consider that, after the operation, clearer hearing still requires months of practice and adaptation, and the degree of improvement is hard to predict. But Grutzmacher didn’t hesitate. “I couldn’t go on the way I was,” she says by phone after the implant procedure — an interview that involved repetition that frustrated her but that would have been impossible a few weeks earlier. “I was completely isolated.” The process involves surgically implanting an internal receiver beneath the scalp and inserting electrodes into the inner ear, which stimulate the auditory nerve. Patients also wear an external processor behind the ear.

Hearing Loss Among Older Adults

Hearing loss among older adults remains vastly undertreated. Federal government epidemiologists have estimated that it affects 1 in 5 people 65 to 74 and more than half of those over 75. “The inner-ear mechanisms weren’t built for longevity,” says Dr. Cameron Wick, an ear, nose and throat specialist at University Hospitals in Cleveland. Though hearing loss can contribute to depression, social disconnection, and cognitive decline, fewer than one-third of people over 70 who could benefit from hearing aids have worn them.

Expansion of Cochlear Implant Coverage

Twenty-five years ago, “It was a novelty to implant people over 80,” says Dr. Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. “Now, it’s pretty routine practice.” Cochlear implantation can cost $100,000 or more. Until recently, Medicare covered the procedure only for people with extremely limited hearing who could correctly repeat less than 40% of the words on a word-recognition test. However, in 2022, Medicare expanded cochlear implant coverage to include older adults who could identify up to 60% of words on a speech-recognition test.

Commitment and Outcomes

Cochlear implantation requires commitment. The surgeon implants an internal receiver beneath the scalp and inserts electrodes, which stimulate the auditory nerve, into the inner ear. Patients also wear an external processor behind the ear. Clinical trials of an entirely internal device are underway. Many adults undergo surgery on one ear and continue using a hearing aid in the other. Some later get a second implant. Two or three weeks later, after the swelling recedes, and the patient’s stitches have been removed, an audiologist activates the device. “When we first turn it on, you won’t like what you hear,” Wick says. Voices initially sound robotic, mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.

Conclusion

For Grutzmacher, the choice seemed clear. Her initial testing found that, even with hearing aids, she understood only 4% of words on the AzBio Sentence Test. Two weeks after Mullins turned on the cochlear implant, Grutzmacher could understand 46% using a hearing aid in her other ear. After a few rough days, her ability to talk by phone had improved. And, instead of turning the television volume up to 80, “I can hear it at 20,” she says. This improvement in hearing has significantly enhanced her quality of life, enabling her to reconnect with friends and community.

FAQs

1. Q: What is a cochlear implant?
   A: A cochlear implant is an electronic device that is surgically implanted to improve the ability to understand speech for individuals with severe to profound hearing loss.

2. Q: Is age a factor for cochlear implantation?
   A: No, as long as the individual is healthy enough to undergo surgery, age is not a concern.

3. Q: How long does it take to adjust to a cochlear implant?
   A: It takes several weeks for the brain to adjust to the new sound quality, and significant improvement can be seen within one to three months, with continued improvement possible for up to a year or longer.

4. Q: Does Medicare cover cochlear implants?
   A: Yes, Medicare has expanded its coverage to include older adults who can identify up to 60% of words on a speech-recognition test, making it more accessible to those in need.

5. Q: What kind of commitment is required for cochlear implantation?
   A: Cochlear implantation requires a surgical procedure, post-operative care, and several months of practice and adaptation to achieve optimal outcomes. Patients must also be willing to learn how to use and adjust the device.