Kitty Grutzmacher had contended with poor hearing for a decade, but the problem had worsened over the past year. Even with her hearing aids, 鈥渢here was little or no sound,鈥 she said.
鈥淚 was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.鈥
Her audiologist was unable to offer Grutzmacher, a retired nurse in Elgin, Illinois, a solution. But she found her way to the cochlear implant program at Northwestern University.
There, Krystine Mullins, an audiologist who assesses patients鈥 hearing and counsels them about their options, explained that surgically implanting this electronic device usually substantially improved a patient鈥檚 ability to understand speech.
鈥淚 had never even thought about it,鈥 Grutzmacher said.
That she was 84 was, in itself, immaterial. 鈥淎s long as you鈥檙e healthy enough to undergo surgery, age is not a concern,鈥 Mullins said. One recent Northwestern implant patient had been 99.
Some patients need to ponder this decision, given that after the operation, clearer hearing still requires months of practice and adaptation, and the degree of improvement is hard to predict. 鈥淵ou can鈥檛 try it out in advance,鈥 Mullins said.
But Grutzmacher didn鈥檛 hesitate. 鈥淚 couldn鈥檛 go on the way I was,鈥 she said in a postimplant phone interview 鈥 one that involved frustrating repetition, but would have been impossible a few weeks earlier. 鈥淚 was completely isolated.鈥
Hearing loss among older adults remains vastly undertreated. have estimated that it affects about 1 in 5 people ages 65 to 74 and more than half of those over 75.
鈥淭he inner ear mechanisms weren鈥檛 built for longevity,鈥 said Cameron Wick, an ear, nose, and throat specialist at University Hospitals in Cleveland.
Although hearing loss can contribute to , , and , fewer than a third of people over 70 who could benefit from hearing aids have worn them.
For those who do, 鈥渋f your hearing aids no longer give you clarity, you should ask for a cochlear implant assessment,鈥 Wick said.
Twenty-five years ago, 鈥渋t was a novelty to implant people over 80,鈥 said Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. 鈥淣ow, it鈥檚 pretty routine practice.鈥
In fact, a study published in 2023 in the journal Otology & Neurotology reported that cochlear implantation was increasing at a higher rate in patients over 80 than in any other age group.
Until recently, Medicare covered the procedure for only those with extremely limited hearing who could correctly repeat less than 40% of the words on a word recognition test. Without insurance 鈥 cochlear implantation can cost $100,000 or more for the device, surgery, counseling, and follow-up 鈥 many older people don鈥檛 have the option.
鈥淚t was incredibly frustrating, because patients on Medicare were being excluded,鈥 Della Santina said. (Similarly, traditional Medicare doesn鈥檛 cover hearing aids, and Medicare Advantage plans with hearing benefits still leave patients .)
Then, in 2022, Medicare expanded cochlear implant coverage to include older adults who could identify up to 60% of words on a speech recognition test, increasing the pool of eligible patients.
Still, while the estimates that implants are increasing by about 10% annually, public awareness and referrals from audiologists . Less than 10% of eligible adults with 鈥渕oderate to profound鈥 hearing loss receive them, the alliance says.
Cochlear implantation requires commitment. After the patient receives testing and counseling, the surgery, which is an outpatient procedure, typically takes two to three hours. Many adults undergo surgery on one ear and continue using a hearing aid in the other; some later go on to get a second implant.
The surgeon implants an internal receiver beneath the patient鈥檚 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.)
Two or three weeks later, after the swelling recedes and the patient鈥檚 stitches have been removed, an audiologist activates the device.
鈥淲hen we first turn it on, you won鈥檛 like what you hear,鈥 Wick cautioned. Voices initially sound robotic, mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.
鈥淎 cochlear implant is not something you just turn on and it works,鈥 Mullins said. 鈥淚t takes time and some training to get used to the new sound quality.鈥 She assigns homework, like reading aloud for 20 minutes a day and watching television while reading the captions.
Within one to three months, 鈥渂oom, the brain starts getting it, and speech clarity takes off,鈥 Wick said. By six months, older adults will have reached most of their enhanced clarity, though some improvement continues for a year or longer.
How much improvement? That鈥檚 measured by two hearing tests: The CNC (consonant-nucleus-consonant) test, in which patients are asked to repeat individual words, and the AzBio Sentence Test, in which the words to be repeated are part of full sentences.
At Northwestern, Mullins tells older prospective patients that one year after activation, a 60% to 70% AzBio score 鈥 correctly repeating 60 to 70 words out of 100 鈥 is typical.
A of about 1,100 adults, published in 2023, found that after implantation, patients 65 and older could correctly identify about 50 additional words (out of 100) on the AzBio test, an increase comparable to the younger cohort’s results.
Participants over 80 showed roughly as much improvement as those in their late 60s and 70s.
鈥淭hey transition from having a hard time following a conversation to being able to participate,鈥 said Della Santina, an author of the study. 鈥淒ecade by decade, cochlear implant results have gotten better and better.鈥
Moreover, an analysis of 70 older patients鈥 experiences at 13 implantation centers, for which Wick was the lead author, found not only 鈥渃linically important鈥 hearing improvements but also .
Scores on a standard cognitive test climbed, too: After six months of using a cochlear implant, 54% of participants had a passing score, compared with 36% presurgery. Studies that focus on people have shown that those with mild cognitive impairment also benefit from implants.
Nevertheless, 鈥渨e鈥檙e cautious not to overpromise,鈥 Wick said. Usually, the longer that older patients have had significant hearing loss, the harder they must work to regain their hearing and the less improvement they may see.
A minority of patients feel dizzy or nauseated after surgery, though most recover quickly. Some struggle with the technology, including phone apps that adjust the sound. Implants are less effective in noisy settings like crowded restaurants, and since they are designed to clarify speech, music may not sound great.
For those at the upper end of Medicare eligibility who already understand roughly half of the speech they hear, implantation may not seem worth the effort. 鈥淛ust because someone is eligible doesn鈥檛 mean it鈥檚 in their best interests,鈥 Wick said.
For Grutzmacher, though, the choice seemed clear. Her initial testing found that even with hearing aids, she understood only 4% of words on the AzBio. Two weeks after Mullins turned on the cochlear implant, Grutzmacher could understand 46% using a hearing aid in her other ear.
She reported that after a few rough days, her ability to talk by phone had improved, and instead of turning the television volume up to 80, 鈥淚 can hear it at 20,鈥 she said.
So she was making plans. 鈥淭his week, I鈥檓 going out to lunch with a friend,鈥 she said. 鈥淚鈥檓 going to play cards with a small group of women. I have a luncheon at church on Saturday.鈥
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