Kitty Grutzmacher had contended with poor hearing for a decade, but the problem had worsened over the past year. Even with her hearing aids, \u201cthere was little or no sound,\u201d she said.<\/p>\n
\u201cI was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.\u201d<\/p>\n
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.<\/p>\n
There, Krystine Mullins, an audiologist who assesses patients\u2019 hearing and counsels them about their options, explained that surgically implanting this electronic device usually substantially improved a patient\u2019s ability to understand speech.<\/p>\n
\u201cI had never even thought about it,\u201d Grutzmacher said.<\/p>\n
That she was 84 was, in itself, immaterial. \u201cAs long as you\u2019re healthy enough to undergo surgery, age is not a concern,\u201d Mullins said. One recent Northwestern implant patient had been 99.<\/p>\n
Some patients need to ponder\u00a0this decision, given that after the operation, clearer hearing still requires months of practice and adaptation, and the degree of improvement is hard to predict. \u201cYou can\u2019t try it out in advance,\u201d Mullins said.<\/p>\n
But Grutzmacher didn\u2019t hesitate. \u201cI couldn\u2019t go on the way I was,\u201d she said in\u00a0a postimplant phone interview\u00a0\u2014 one\u00a0that\u00a0involved frustrating repetition, but would have been impossible a few weeks earlier. \u201cI was completely isolated.\u201d<\/p>\n
Hearing loss among older adults remains vastly undertreated.\u00a0Federal epidemiologists<\/a>\u00a0have estimated that it affects about 1 in 5 people ages 65 to 74 and more than half of those over 75.<\/p>\n \u201cThe inner ear mechanisms weren\u2019t built for longevity,\u201d said Cameron Wick, an ear, nose, and throat specialist at University Hospitals in Cleveland.<\/p>\n Although hearing loss can contribute to\u00a0depression<\/a>,\u00a0social disconnection<\/a>,\u00a0and\u00a0cognitive decline<\/a>, fewer than a third of people over 70 who could benefit from hearing aids have worn them.<\/p>\n For those who do, \u201cif your hearing aids no longer give you clarity, you should ask for a cochlear implant assessment,\u201d Wick said.<\/p>\n Twenty-five years ago, \u201cit was a novelty to implant people over 80,\u201d said Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. \u201cNow, it\u2019s pretty routine practice.\u201d<\/p>\n 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.<\/p>\n 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.\u00a0Without insurance \u2014 cochlear implantation can cost $100,000 or more for the device, surgery, counseling, and follow-up \u2014 many older people don\u2019t have the option.<\/p>\n \u201cIt was incredibly frustrating, because patients on Medicare were being excluded,\u201d Della Santina said. (Similarly, traditional Medicare doesn\u2019t cover hearing aids, and Medicare Advantage plans with hearing benefits still leave\u00a0patients paying most of the tab<\/a>.)<\/p>\n Then, in 2022, Medicare expanded cochlear implant coverage to include\u00a0older adults\u00a0who could identify up to 60% of words\u00a0on a speech recognition test, increasing the pool of eligible patients.<\/p>\n Still, while the\u00a0American Cochlear Implant Alliance<\/a>\u00a0estimates that implants are increasing by about 10% annually,\u00a0public awareness and referrals from audiologists remain low<\/a>.\u00a0Less\u00a0than 10% of eligible adults with \u201cmoderate to profound\u201d hearing loss receive them, the alliance says.<\/p>\n 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.<\/p>\n The\u00a0surgeon implants an internal receiver beneath the patient\u2019s 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.)<\/p>\n Two or three weeks later, after the swelling recedes and the patient\u2019s stitches have been removed, an audiologist activates the device.<\/p>\n \u201cWhen we first turn it on, you won\u2019t like what you hear,\u201d 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.<\/p>\n \u201cA cochlear implant is not something you just turn on and it works,\u201d Mullins said. \u201cIt takes time and some training to get used to the new sound quality.\u201d She assigns homework, like reading aloud for 20 minutes a day and watching television while reading the captions.<\/p>\n Within one to three months, \u201cboom, the brain starts getting it, and speech clarity takes off,\u201d Wick said. By six months, older adults will have reached most of their enhanced clarity, though some improvement continues for a year or longer.<\/p>\n How much improvement? That\u2019s measured by two hearing tests: The CNC (consonant-nucleus-consonant) test, in which patients are asked to repeat individual words, and the\u00a0AzBio\u00a0Sentence Test, in which\u00a0the words to be repeated\u00a0are part of full sentences.<\/p>\n At Northwestern, Mullins tells older prospective patients that one year after activation, a 60% to 70% AzBio score \u2014 correctly repeating\u00a060 to 70 words out of 100\u00a0\u2014 is typical.<\/p>\n A\u00a0Johns Hopkins study<\/a>\u00a0of about 1,100 adults, published in 2023, found that after implantation, patients 65 and\u00a0older\u00a0could correctly identify about 50 additional words (out of 100) on the AzBio test, an increase comparable to the younger cohort\u2019s results.<\/p>\n Participants over 80 showed roughly as much improvement as those in their late 60s and 70s.<\/p>\n \u201cThey transition from having a hard time following a conversation to being able to participate,\u201d said Della Santina, an author of the study. \u201cDecade by decade, cochlear implant results have gotten better and better.\u201d<\/p>\n Moreover, an analysis of 70 older patients\u2019 experiences at 13 implantation centers, for which Wick was the lead author, found not only \u201cclinically important\u201d hearing improvements but also\u00a0higher quality-of-life ratings<\/a>.<\/p>\n 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.\u00a0Studies that focus on people in their 80s and 90s<\/a>\u00a0have shown that those with mild cognitive impairment also benefit from implants.<\/p>\n Nevertheless, \u201cwe\u2019re cautious not to overpromise,\u201d 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.<\/p>\n A minority of patients feel dizzy or nauseated after surgery, though most recover quickly.\u00a0Some struggle with the technology, including phone apps\u00a0that adjust the sound.\u00a0Implants are less effective in noisy settings like crowded restaurants, and since they are designed to clarify speech, music may not sound great.<\/p>\n For those\u00a0at the upper end of Medicare eligibility\u00a0who already understand roughly half of the speech they hear, implantation may not seem worth the effort. \u201cJust because someone is eligible doesn\u2019t mean it\u2019s in their best interests,\u201d Wick said.<\/p>\n 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.<\/p>\n She reported that after a few rough days,\u00a0her ability to talk by phone had improved, and instead of turning the television volume up to 80, \u201cI can hear it at 20,\u201d she said.<\/p>\n So she was making plans. \u201cThis week, I\u2019m going out to lunch with a friend,\u201d she said. \u201cI\u2019m going to play cards with a small group of women. I have a luncheon at church on Saturday.\u201d<\/p>\n The New Old Age is produced through a partnership with\u00a0The New York Times<\/a>.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n