From: CMS MedCACPresentations

Attachments: Case control analysis of geriatric implant.pdf

To whom it may concern:

I am writing to express my support for continuing and expanding the use of cochlear implants in adult patients with hearing loss. I have extensive personal experience in the use of cochlear implants to rehabilitate sensorineural hearing loss in children and adults. My research has specifically focused on performance outcomes in adult patients with particular attention to the elderly. Our program implanted 92 patients in calendar year 2010, consisting of 52 adults of which 21 were over the age of 60.

Our recent work (reprint is attached) looked at cochlear implant performance in the elderly. The salient results are:

1) All our subjects over the age of 65 showed improvement in speech perception after cochlear implantation.

2) Performance was directly related to pre-implant performance. Meaning, those scoring between 41-60% on pre-operative sentence testing did significantly better than those scoring between 21-40% which in turn did better than those scoring between 0-20%.

3) Elderly patients show slightly worse performance than younger adults, particularly in noise.

The conclusions from these results are:

1) Cochlear implants are highly effective in providing useful hearing in elderly patients

2) Early intervention with cochlear implants (i.e., better speech scores (sentences up to 60%)) leads to significantly better outcomes

3) Bilateral implantation, and its ability to improve performance in noise, may be most useful in older patients

In short, the evidence is strongly in favor of continuing support for cochlear implantation in older adults, should expand the criteria to include those with sentence scores up to 60%, and should include bilateral implantation.