Long-term outcomes of cochlear implants in patients over 65: Hearing thresholds remain stable, but speech perception declines with age

Abstract

Objective

This study aimed to evaluate long-term cochlear implant (CI) outcomes in elderly patients aged ≥65 years, with a particular focus on the impact of implantation age and chronological age at testing on auditory performance.

Methods

We conducted a retrospective study of 53 postlingually deafened adults aged ≥65 years at the time of outcome evaluation who underwent unilateral CI at our institute between 1987 and 2019. Patients were divided into two groups according to age at implantation: the Younger-elderly group (<75 years; n = 36) and the Older-elderly group (≥75 years; n = 17). Postoperative aided thresholds and monosyllabic speech discrimination scores in quiet were collected annually up to 10 years postoperatively.

Results

CI-aided thresholds remained stable over 10 years after implantation and did not differ between groups (p = 0.40). In contrast, speech discrimination scores were significantly poorer in the Older-elderly group compared with the Younger-elderly group (p = 0.020). Regression analyses confirmed that chronological age at testing, but not age at implantation, was a significant predictor of speech outcomes (p < 0.0001). Notably, patients aged ≥80 years exhibited mean CI-aided speech discrimination below 50 %.

Conclusions

CI effectively restored hearing thresholds in elderly patients, independent of implantation age. However, speech perception declined progressively with advancing test age, particularly in those ≥80 years, suggesting that central auditory and cognitive aging are the primary constraints on long-term outcomes. Candidacy criteria should therefore be applied cautiously in this age group, with thorough preoperative counseling to establish realistic expectations.