Kitty Grutzmacher struggled with poor hearing for ten years, but over the past year the problem has gotten worse. Even with hearing aids, she said, “there was little or no sound.”
“I avoided gathering in groups. I stopped playing cards, I stopped going to Bible study, and I stopped even going to church.”
Her audiologist couldn't offer a solution to Grutzmacher's problem, a retired nurse from Elgin, Illinois. But she found her way to the cochlear implant program at Northwestern University.
There, Christine Mullins, an audiologist who evaluates patients' hearing and counsels them on their options, explained that surgically implanting this electronic device usually significantly improves a patient's ability to understand speech.
“I never even thought about it,” Grutzmacher said.
The fact that she was 84 years old did not in itself matter. “As long as you're healthy enough to have surgery, age doesn't matter,” Mullins said. One recent patient who received a Northwestern implant was 99 years old.
Some patients may need to consider this decision, given that clearer hearing still requires months of practice and adaptation after surgery, and the degree of improvement is difficult to predict. “You can’t try it out in advance,” Mullins said.
But Grutzmacher didn't hesitate. “I couldn’t continue living the way I was,” she said in a telephone interview after the implantation, which included a depressing repetition but would have been impossible a few weeks ago. “I was completely isolated.”
Hearing loss among older adults remains undertreated. Federal epidemiologists It is estimated that it affects about 1 in 5 people aged 65 to 74 years and more than half of people over 75 years of age.
“The mechanisms of the inner ear are not designed to last,” said Cameron Wick, an ear, nose and throat specialist at University Hospitals Cleveland.
Although hearing loss may contribute depression, social disunityAnd cognitive declineless than a third of people over 70 who could benefit from hearing aids wore them.
For those who do, “if your hearing aids are no longer providing clarity, you should seek a cochlear implant evaluation,” Wick said.
Twenty-five years ago, “implanting people over 80 was a novelty,” said Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. “It’s a pretty routine practice now.”
In fact, a study published in 2023 in the journal Otology & Neurotology found that cochlear implantation is increasing at a higher rate in patients over 80 years of age than in any other age group.
Until recently, Medicare covered the procedure only for people with severe hearing loss who could correctly repeat fewer than 40% of the words on a word recognition test. Without insurance—cochlear implantation can cost $100,000 or more for the device, surgery, consultation and follow-up—many older adults don't have that option.
“It was incredibly frustrating because patients were excluded from Medicare,” Della Santina said. (Similarly, traditional Medicare does not cover hearing aids, and Medicare Advantage plans with hearing benefits still leave patients I pay most of the bill.)
Then, in 2022, Medicare expanded cochlear implant coverage to include older adults who could recognize up to 60% of words on a speech recognition test, increasing the number of eligible patients.
However, while American Cochlear Implant Alliance It is estimated that the number of implants is increasing by approximately 10% annually, public awareness and referrals from audiologists stay low. Fewer than 10% of eligible adults with “moderate to profound” hearing loss receive them, according to the alliance.
Cochlear implantation requires commitment. After the patient undergoes testing and consultation, the surgery, which is an outpatient procedure, usually takes two to three hours. Many adults have surgery on one ear and continue to use hearing aids on the other; some later receive a second implant.
The surgeon implants an internal receiver under the patient's scalp and inserts electrodes into the inner ear that stimulate the auditory nerve; patients also wear an external processor behind the ear. (Clinical trials of an all-internal device are currently underway.)
Two to three weeks later, after the swelling has subsided and the patient's stitches have been removed, the audiologist will activate the machine.
“When we first turn it on, you won’t like what you hear,” Vic warned. The voices initially sound robotic and mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.
“A cochlear implant is not something you just turn on and it works,” Mullins said. “It takes time and some preparation to get used to the new sound quality.” She assigns homework such as reading aloud for 20 minutes a day and watching TV while reading subtitles.
Within one to three months, “boom, the brain begins to understand and speech clarity increases dramatically,” Wick said. By six months, older adults achieve most of their mental clarity, although some improvement persists for a year or longer.
How much improvement? This is measured using 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 repeated words are part of complete sentences.
At Northwestern, Mullins tells potential older patients that a year after activation, an AzBio score of 60% to 70%—repetition of 60 to 70 words out of 100 correctly—is typical.
A Johns Hopkins study of about 1,100 adults, published in 2023, showed that after implantation, patients 65 years of age and older could correctly identify about 50 additional words (out of 100) on the AzBio test, which is comparable to the results of the younger cohort.
Participants over 80 years old showed about the same improvement as participants aged 60 to 70 years.
“They go from having difficulty following a conversation to being able to participate,” said Della Santina, an author of the study. “Decade after decade, the results of cochlear implantation are getting better and better.”
Moreover, an analysis of the experience of 70 elderly patients at 13 implant centers, of which Wick was the lead author, found not only “clinically important” improvements in hearing, but also higher quality of life scores.
Scores on a standard cognitive test also increased: After six months of cochlear implant use, 54% of participants achieved a passing score, compared with 36% before surgery. People-centered research in his 80s and 90s showed that the implants also benefit people with mild cognitive impairment.
Still, “we're careful not to overpromise,” Vick said. Typically, the longer older patients suffer from significant hearing loss, the harder they have to work to regain their hearing, and the less improvement they may see.
A minority of patients feel dizzy or nauseated after surgery, although most recover quickly. Some have difficulty with technology, including phone apps that control volume. The implants are less effective in noisy places, such as crowded restaurants, and because they are designed for speech clarity, music may not sound very good.
For those at the upper end of Medicare eligibility who already understand about half the speech they hear, implantation may not seem worth the effort. “Just because someone has the right to do it doesn’t mean it’s in their best interest,” Wick said.
For Grutzmacher, however, the choice seemed obvious. Her initial testing showed that even with hearing aids, she only understood 4% of the words on AzBio. Two weeks after Mullins had her cochlear implant turned on, Grutzmacher could understand 46 percent of voices using the hearing aid in her other ear.
She reported that after a few difficult days, her ability to talk on the phone had improved, and instead of turning the TV volume up to 80, “I can hear it at 20,” she said.
So she made plans. “I’m going to have lunch with a friend this week,” she said. “I'm going to play cards with a small group of women. I'm having lunch at church on Saturday.”
New Old Age is created in collaboration with New York Times.
KFF health news is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of health policy research, polling and journalism. Find out more about KFF.
USE OUR CONTENT
This story may be republished free of charge (details).
