Beyond Sentence Recognition in Quiet for Older Adults: Implications for Cochlear Implant Candidacy

OBJECTIVE:To study postoperative hearing outcomes in older adult cochlear implant recipients who did not meet Medicare candidacy criteria by sentence testing in quiet. STUDY DESIGN:Case Control Series. SETTING:University Based Tertiary Referral Cochlear Implant Center. PATIENTS:Fifty-four patients age 60 or greater with bilateral moderate to profound sensorineural hearing loss who underwent cochlear implantation. Patients were divided into three groups by preoperative testing scores1) sentence recognition in quiet and monosyllabic word recognition scores ≤40%, 2) sentence recognition in quiet scores >40% and sentence recognition in noise scores ≤40%, and 3) sentence recognition in quiet scores >40% and monosyllabic word recognition scores ≤40% in the ear to be implanted. INTERVENTION(S):Cochlear implantation. MAIN OUTCOME MEASURE(S):Pre- versus postoperative sentence and word recognition scores. RESULTS:All three groups received a statistically significant benefit from their cochlear implant as measured by both postoperative sentence and word recognition. When comparing postoperative sentence recognition scores between groups, there were no statistically significant differences (Group 1mean 83.1%, SD ± 17.4%; Group 2mean 90.1%, SD ± 8.0%; Group 3mean 90.6%, SD ± 6.9%). When comparing postoperative monosyllabic word recognition scores, there were no statistically significant differences between groups (Group 1mean 60.3%, SD ± 19.6%; Group 2mean 66.8%, SD ± 20.0%; Group 3mean 70.0%, SD ± 18.8%). CONCLUSION:Results of this study demonstrate that older patients who do not meet current Medicare candidacy criteria derive significant long-term benefit from cochlear implantation when either sentence in noise or monosyllabic word recognition in quiet ≤40% is used to determine candidacy. Further research and greater numbers are needed to better characterize the role of monosyllabic word recognition in cochlear implant candidacy.