1. 12/6/20151 Cochlear implants in the older patient Mark Pyle MD Professor of surgery and Academic Vice Chair Division of Otolaryngology

2. 12/6/20152 Introduction How do we define “ older” Iife expectancy 78.7 years Frailty, NOT AGE, is a consideration

3. 12/6/20153 Demographics 41 million ( 2011) and increasing Increased incidence of hearing loss Association with dementia

4. 12/6/20154

5. 5 UW Experience 44 % of adult patients over 65 Only one patient has been explanted for medical complication

6. 12/6/20156 Special considerations Loss of other special senses Depression and dementia Communication with caregivers including family and physicians

7. 12/6/20157 Who is a candidate ? Severe to profound bilateral sensorineural hearing loss Limited benefit from hearing aid History of auditory communication “ nerve deafness “ is OK No medical contraindication

8. 12/6/20158 Am I healthy enough to have CI surgery ? Collaboration with primary MD Surgery itself is very well tolerated Most medical problems are easily managed Pain is usually minimal

9. 12/6/20159 Evaluation History, examination, audiogram Audiologic CI evaluation including sentence testing Imaging studies- MRI Balance tests

10. 12/6/201510 Financial questions Medicare guidelines Secondary Insurance January 2014 ??

11. 12/6/201511 Surgical Recovery Hospital stay Wound care Audiology visits

12. 12/6/201512 Complications “ minor “ are most common In one 445 patient study by Chen, et al, safety was comparable to younger patient population. Imbalance greater than 1 month in 10% of patients over 75 and 5 % of patients 60-74. 3.8% required device removal. 15 of these 17 patients were successfully reimplanted

13. 12/6/201513 Summary Cochlear Implants can be done safely in patients over 65 and 75. They significantly improve quality of life and communication in this population.