Cochlear Implantation in Adults 65 Years and Older With Single-sided Deafness and Asymmetric Hearing Loss.

Background: Cochlear implantation has proven success as a treatment for single sided deafness (SSD) and asymmetric hearing loss (AHL) in children and adults. However, in adults 65 years and older, cochlear implantation for the treatment of SSD and AHL has been difficulty to study given the restrictions in insurance coverage for cochlear implants (CI) due to current Medicare guidelines. Objective: This study aimed to evaluate outcomes in patients 65 years old and older who underwent cochlear implantation for SSD and AHL to provide data supporting a change in CI candidacy indications for Medicare beneficiaries. Methods: A cohort of CI recipients over the age of 65 years with either SSD (4-frequency pure tone average [4fPTA] ≥90 dB in the implanted ear and ≤30 dB in the better hearing ear) or AHL (interaural difference in 4fPTA ≥15 dB HL, better hearing ear 4fPTA >30 dB HL and ≤70 dB HL) was identified from a single tertiary-level CI center. Results: Forty CI recipients ≥65 years (9 SSD; 31 AHL) were identified. There were significant improvements (percentage point change, ∆%) demonstrated with CI use on consonant-nucleus-consonant (CNC) scores from baseline to 3 timepoints in both SSD (3 m, +38 ∆%; 6 m, +40 Δ%; 12 m, +47 Δ%) and AHL subjects (3 m, 40 Δ%; 6 m, +41 Δ%; 12 m, +42 Δ%). Significant improvements were also seen on AzBio sentences in quiet in both SSD (3 m, +67 Δ%; 6 m, +45 Δ%; 12 m, +68 Δ%) and AHL subjects (3 m, +44 Δ%; 6 m, +57 Δ%; 12 m, +54 Δ%). The status of the contralateral ear accounted for little variance in CNC improvement at 6 or 12 months. Moderate positive associations between device usage and CNC word and AzBio sentence testing were observed at 6 months. Conclusions: Outcomes in adults ≥65 years old with SSD and AHL who undergo CI support the use of implantation in Medicare beneficiaries and provide further evidence for ear-specific candidacy criteria.