Jim Cooke blames his hearing loss on the constant roar of C-119 aircraft engines he experienced in the Air Force. He didn’t wear protective gear because, like most 20-year-olds, “you think you’re indestructible,” he said. By the time he was 45, he needed hearing aids for both ears.
Still, he had a long career as a telephone company executive while he and his wife, Jean, raised two children in Broadview Heights, Ohio. Only after retirement, he told me in an interview, did he start having trouble communicating.
Jean and Jim Cooke
Mr. Cooke had to relinquish a couple of part-time jobs he enjoyed because “I felt insecure about dealing with people on the phone,” he said. He withdrew from a church organization he led because he couldn’t grasp what members were saying at meetings.
“He didn’t want to be in social situations,” Mrs. Cooke said. “It gave him a feeling of inadequacy, and anger at times.”
Two years ago, when their grandchildren began saying that Granddad needed to replace his hearing aid batteries — although the batteries were fine — the Cookes went to the Cleveland Clinic, where an audiologist there, Dr. Sarah Sydlowski, told Jim that at 76, he might consider a cochlear implant.
Perhaps the heart-tugging YouTube videos of deaf toddlers suddenly hearing sounds have led us to think of cochlear implants as primarily for children. Or perhaps, said Dr. Frank R. Lin, a Johns Hopkins University epidemiologist, we consider late-life hearing loss normal (which it is), “an unfortunate but inconsequential aspect of aging,” and don’t explore treatment beyond hearing aids.
In any case, the idea of older adults having a complex electronic device surgically implanted has been slow to catch on, even though by far the greatest number of people with severe hearing loss are seniors.
Often, when patients start to withdraw from conversation and activities, “families chalk it up to aging or the beginning of cognitive decline, when in fact their hearing loss has progressed to the point where they can’t engage,” Dr. Sydlowski said.
Beyond the social and emotional toll — isolation, withdrawal, depression — “the kind of hearing loss we’ll all develop increases our risk for cognitive decline, dementia and even physical decline,” Dr. Lin said. A brain constantly working to try to interpret degraded sound, he explained, has less ability to handle other kinds of thinking and memory-building.
Dr. Lin estimated that 150,000 Americans over age 70 could benefit from an implant.
But you can understand why the idea gives older people pause. Some find the technology daunting. Unlike hearing aids, which amplify sound, an implant directly stimulates the auditory nerve, bypassing the damaged part of the ear. Users usually wear the external parts of the device, including a small processor and microphone, behind the ear. To allow time for healing, surgeons wait about a month past surgery before activating the device.
When they do, the implant doesn’t miraculously restore normal hearing. The sounds it transmits aren’t what an ear hears, but an approximation. Patients should expect to spend months, perhaps a year, practicing at home and working with therapists to learn to interpret those signals.
“This is not something you get and turn on and go,” said Dr. Erika Woodson, a Cleveland Clinic otolaryngologist. “It takes time to learn to use it and to learn to listen again.”
People, she said, with considerable cognitive deficits may be unable to handle those tasks.
Moreover, though cochlear implantation is an outpatient procedure, any surgery involving general anesthesia poses greater risk at older ages. The most common problem, dizziness after the procedure, usually only lasts a few days. But at Johns Hopkins, which annually performs more than 60 cochlear implantations on patients over age 60, about 6 percent of patients complain of dizziness after a month and have to work with physical therapists to strengthen their balance.
Medicare’s strict eligibility policy has probably prevented some candidates from having implants, too. The most common speech recognition test involves a patient with hearing aids sitting in a sound booth, trying to repeat sentences an audiologist reads aloud. The Food and Drug Administration has approved cochlear implants for patients who correctly repeat fewer than 60 percent of the sentences. But Medicare will only reimburse for patients who get fewer than 40 percent right.
That’s worrisome, because studies at Johns Hopkins and elsewhere have demonstrated that younger seniors and those with higher speech scores do better with implants. After prolonged hearing loss, “the pathways in the brain that handle auditory processing may begin to atrophy,” Dr. Lin said. So while “the attitude among a lot of people is, ‘Let’s wait until it gets really bad,’” results are better if you don’t.
(Medicare will undertake a national study of cochlear implants in older people, so that policy could change, eventually. Meanwhile, the absurdity of Medicare’s willingly paying $70,000 to $80,000 for implant surgery and all the associated costs at the Cleveland Clinic, but not $4,000 to $5,000 for a digital hearing aid, continues.)
Still, even for those in their 80s and 90s, the results can be dramatic. Patients’ ability to understand speech increases significantly, several studies have found, and quality of life improves. At Johns Hopkins, for instance, a review of speech outcomes a year after surgery in 83 patients over age 60 found an average 60 percent improvement in speech scores. “It’s common for them to say, ‘I should have done this 10 years ago,’” Dr. Lin said.
Jim Cooke, who had no pain or dizziness after his outpatient surgery, is a satisfied customer. “Six months after the operation, I felt more confident in communicating,” he said. The following year, a cousin who hadn’t seen him since his implant came to visit and declared, “This is the old Jim I knew before.”
Mr. Cooke still practices listening — using an online program — 45 minutes each day and gets weekly aural rehab at the University of Akron. And he uses assistive devices for his phone and TV.
But we spoke by phone for 45 minutes, and though he asked Mrs. Cooke for help a few times, we had a perfectly satisfactory conversation.
“Could we have talked like this before your implant?” I asked.
Mr. Cooke answered quickly. “No.”