Auditory performance analysis and evaluation of quality of life after cochlear implantation in patients aged 60 (sixty) and older

Purpose: The aim of this study is to evaluate the auditory performance and quality of life in patients aged 60 years and older who underwent unilateral cochlear implantation. Materials and method: Our study is a retrospective study and includes 34 patients aged 60 years and older who underwent unilateral cochlear implantation between 2002 and 2020 in Çukurova University Faculty of Medicine, ENT Department. Demographic characteristics of the patients (age, gender, educational status, comorbidity, duration of hearing loss, causes of hearing loss) were analyzed . Preoperative CT and MR images of the patients was examined to determine the difficulties that may be encountered during surgery. The patients were divided into three subgroups as 1-3 years, 4-6 years, 7 years and above according to the duration of preoperative hearing loss, and into two subgroups according to the duration of implant use during the day, as less than and above 11 hours. In addition, patients aged 60-70 years and those over 70 years of age were divided into two groups. Auditory gains and quality of life were evaluated in all groups. Pure tone audiometry test was used to test auditory gain after cochlear implantation. In addition, "Quality of Life Scale-Short Form Inventory" was used to evaluate satisfaction in patients who underwent cochlear implantation. Results: A total of 34 patients aged 60 years and older (mean 66.06), 21 (61.77%) female and 15 (38.23%) male were included in this study. Twenty-six patients (76.5%) were aged between 60-70 years, while 8 patients (23.5%) were aged 70 and over. Six of the patients (17.6%) were using their implants less than 11 hours a day, and 28 (82.4%) were using their implants for more than 11 hours. The duration of preoperative hearing loss was 1-3 years in 15 patients (44.1%), 4-6 years in 9 patients (26.5%), and 7 years or more in 10 patients (29.4%). Additional disease was observed in 19 (55.9%) patients, while 15 (44.1%) patients did not have any additional disease. While 7 of the patients (20.6%) were not educated, 25 (73.5%) were primary school/secondary school graduates and 2 (5.9%) were university graduates. The mean score of the patients who used their implant for more than 11 hours during the day was higher in all subscales of the questionnaire than the patients who used less than 11 hours, and it was statistically significant (p<0.05). The auditory gain values of patients with hearing loss for duration between 1-3 years were statistically significantly higher than those with hearing loss duration of 4-6 years and >7 years (p<0.001). Except the "general health status" subscale, the mean score in all subscales of the questionnaire increased inversely as the duration of pre-implant hearing loss decreased. In addition, the increase in the "psychological and social relations" subscales was statistically significant (p=0.042, p=0.035). The mean score in the "environment" subscale was found to be higher in female patients than in male patients, and a statistically significant difference was found (p=0.041). When the level of education increased the mean score of the "psychological" subscale, was increased and a statistically significant difference was found (p=0.027). When compared according to age, no statistically significant difference was found between the patient aged over 70 years and those who were under 70 years, in the mean scores of the subscales of the "WHOQOL-BREF" questionnaire and in the auditory gains (p>0,05). Conclusion: In our study, it was shown that all patients aged 60 years and older with postlingual bilateral severe sensorineural hearing loss achieved significant auditory gain after cochlear implantation. The duration of hearing loss before cochlear implantation was inversely proportional to the gain in hearing thresholds. At the same time, the quality of life of the patients increased significantly as the duration of daily use of CI increased. The auditory gain and quality of life scores that obtained in patients over 70 years of age were similar to those under 70 years of age. No major complication requiring surgery was observed. Our study showed that age is not a limiting factor for good and functional outcomes in CI. In patients aged 60 years and older, CI is a safe surgery with low complication rates and satisfactory results.