When a hearing aid is not enough

Katie Grutzmacher has suffered from hearing loss for a decade, but the problem has worsened over the past year. Even with her hearing aids on, “there was little to no sound,” she said.

“I was avoiding going out in groups. I stopped playing cards, I stopped going to Bible study, and I stopped even going to church.”

Her audiologist wasn’t able to provide a solution for Grotzmacher, a retired nurse in Elgin, Illinois. But she found her way into the cochlear implant program at Northwestern University.

There, Christine Mullins, an audiologist who evaluates patients’ hearing and advises them on their options, explained that surgically implanting this electronic device usually greatly improves the patient’s ability to understand speech.

“I never thought about it,” Grotzmacher said.

That she was 84 was intangible in itself. “As long as you are healthy enough to undergo surgery, age is not a concern,” Mullins said. One recent Northwestern transplant patient was 99 years old.

Some patients need to consider this decision, because after the operation, clearer hearing still requires months of practice and adaptation, and the degree of improvement is difficult to predict. “You can’t try it beforehand,” Mullins said.

But Grutzmacher did not hesitate. “I couldn’t go on like this,” she said in a phone interview after the transplant, an interview that involved frustrating repetition but would have been impossible a few weeks ago. “I was completely isolated.”

Hearing loss among the elderly remains largely untreated. Federal epidemiologists It has been estimated to affect 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 built for longevity,” said Cameron Wick, an ear, nose and throat specialist at University Hospitals in Cleveland.

Although hearing loss can contribute to… depression, Social separationand Cognitive declineless than a third of people over 70 who could benefit from hearing aids have worn them.

For those who do, “If your hearing aids are no longer giving you clarity, you should seek a cochlear implant evaluation,” Wick said.

Twenty-five years ago, “cochlear implants for people over 80 were new,” said Charles Della Santina, director of the Cochlear Implant Center at Johns Hopkins University. “Now, it’s a very routine practice.”

In fact, a 2023 study published in the Journal of Otolaryngology reported that cochlear implants are increasing at a higher rate in patients over 80 than in any other age group.

Until recently, Medicare covered the procedure only for those with severe hearing loss who could repeat fewer than 40% of words correctly on a word recognition test. Without insurance — a cochlear implant can cost $100,000 or more for the device, surgery, counseling and follow-up — and many seniors don’t have that option.

“It was very frustrating because patients were left out of Medicare,” Della Santina said. (Similarly, traditional Medicare does not cover hearing aids, and Medicare Advantage plans with hearing benefits still leave patients out.) Pay most of the tab.)

Then, in 2022, Medicare expanded cochlear implant coverage to include older adults who can recognize up to 60% of words on a speech recognition test, expanding the pool of eligible patients.

However, instead American Cochlear Implant Alliance It is estimated that organ transplants are increasing by approximately 10% annually, public awareness and referrals from audiologists Stay low. The coalition says less than 10% of eligible adults with “moderate to profound” hearing loss get it.

Cochlear implants require commitment. After the patient receives tests and counseling, surgery, an outpatient procedure, usually takes two to three hours. Many adults have surgery in one ear and continue to use a hearing aid in the other; Some later go on to have a second transplant.

The surgeon implants an internal receiver under the patient’s scalp and inserts electrodes that stimulate the auditory nerve in the inner ear. Patients also wear an external processor behind the ear. (Clinical trials of a completely internal device are underway.)

Two or three weeks later, after the swelling subsides and the patient’s stitches are removed, the audiologist activates the device.

“When we play it for the first time, you’re not going to like what you hear,” Wick warned. The sounds at first seem robotic and mechanical. It takes several weeks for the brain to adapt and patients are able to decode words and sentences reliably.

“A cochlear implant is not something you just turn on, and it works,” Mullins said. “It takes time and some practice to get used to the new sound quality.” You assign homework, such as reading aloud for 20 minutes a day and watching TV while reading captions.

“Within one to three months, the brain starts to pick up on it, and speech intelligibility begins,” Wick said. By six months, seniors will have achieved most of the enhanced clarity, although some improvement may persist for a year or more.

How much improvement? This is measured by two hearing tests: the CNC (Consonant, Nucleus, Consonant) test, in which patients are asked to repeat single words, and the AzBio Sentence test, in which the words to be repeated are part of complete sentences.

At Northwestern University, Mullins tells older prospective patients that a year after activation, an AzBio score of 60% to 70% — that is, repeating 60 to 70 words correctly out of 100 — is typical.

A Johns Hopkins study Of about 1,100 adults, published in 2023, it found that after the transplant, patients 65 or older could correctly identify about 50 more words (out of 100) on the AzBio test, an increase similar to the results of the younger group.

Participants over the age of 80 showed almost as much improvement as those who were in their late 60s and 70s.

“They go from having difficulty following a conversation to being able to participate,” said study author Della Santina. “Decade after decade, cochlear implant outcomes have gotten better and better.”

Moreover, an analysis of the experiences of 70 elderly patients at 13 transplant centers, of which Weick was the lead author, found not only “clinically significant” hearing improvements; Higher ratings for quality of life.

Standard cognitive test scores also rose: After six months of cochlear implant use, 54% of participants had a passing score, compared to 36% before surgery. People-focused studies In their eighties and nineties It has shown that people with mild cognitive impairment also benefit from transplants.

However, Wake said, “We are careful not to overpromise.” Typically, the longer older patients have significant hearing loss, the harder they have to work to regain their hearing and the less improvement they may notice.

A minority of patients feel dizzy or nauseous after surgery, although most recover quickly. Some have difficulty dealing with technology, including phone applications that adjust the volume. The implants are less effective in noisy places like crowded restaurants, and since they’re designed to clarify speech, music may not sound as great.

For those at the upper end of Medicare eligibility who already understand about half of the speech they hear, an organ transplant may not seem worth the effort. “Just because someone is eligible doesn’t mean it’s in their best interest,” Wick said.

But for Grotzmacher, the choice seemed clear. Her initial testing found that even with hearing aids, she understood only 4% of the words on AzBio. Two weeks after Mullins’ cochlear implant operation, Grutzmacher could understand 46% of sounds using a hearing aid in her other ear.

She reported that after a few difficult days, her ability to speak on the phone improved, and instead of turning the TV volume up to 80, she said, “I can hear it at 20.”

So she was making plans. “This week, I’m going out to lunch with a friend,” she said. “I’m going to play cards with a small group of women. I’m going to have lunch at church on Saturday.”

New Old Age is produced in partnership with New York Times.