title: Predictive models for cochlear implantation in elderly candidates.
abstract: OBJECTIVE
  An aging American population carries a high prevalence of profound sensorineural hearing loss. We examined the performance of multichannel cochlear implant recipients in a large database of adult subjects.
  
  
  METHODS
  Nonconcurrent prospective study of a national cohort with multivariate regression analysis of preoperative and postoperative performance variables in multichannel cochlear implant recipients. We applied models of prediction established in previous studies to the observed results.
  
  
  METHODS
  Referral centers with active cochlear implant programs.
  
  
  METHODS
  Adolescents and adults with profound hearing loss (N = 749; age range, 14-91 years).
  
  
  METHODS
  Postoperative monosyllabic word recognition.
  
  
  RESULTS
  The population 65 years and older demonstrated a clinically insignificant 4.6%-smaller postoperative word score compared with the population younger than 65 years. When duration of deafness exceeded 25 years, elderly recipients demonstrated higher word scores than their younger counterparts. A more significant factor affecting outcomes is the ratio of duration of deafness to age at implantation.
  
  
  CONCLUSIONS
  Age at implantation carried relatively little predictive value for postoperative performance in subjects 65 years and older. Although a small decrement in mean speech recognition scores was evident, the clinical significance of this difference is questionable when all of the results observed in elderly patients are considered. A shorter percentage of life spent in severe-to-profound sensorineural hearing loss suggests a foundation of acoustic/auditory processing in the elderly cohort that may mitigate potential physiological effects associated with advanced age. This study confirms and extends previous observations that duration of profound deafness and residual speech recognition carry higher predictive value than the age at which an individual receives an implant.
authors.affiliation: Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Leung
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Yeagle
authors.forename: Jill
authors.initials: J
authors.lastname: Chinnici
authors.forename: Stephen
authors.initials: S
authors.lastname: Bowditch
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019929:Cochlear Implantation; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome