Postoperative Outcomes With Bimodal Hearing and Bilateral Cochlear Implantation in the Elderly

OBJECTIVE: To compare speech recognition and quality of life outcomes in elderly patients with bimodal hearing and bilateral cochlear implants (CIs). STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Adults older than 65 years with preoperative AzBio sentences in quiet scores <60% bilaterally who underwent cochlear implantation between 2012 and 2021. MAIN OUTCOME MEASURES: Consonant-nucleus-consonant (CNC), AzBio sentences in quiet, and Speech, Spatial and Qualities of Hearing Scale (SSQ) scores. RESULTS: Two hundred fifty-eight patients met the inclusion criteria, of whom 227 (88.0%) were bimodal hearing, and 31 (12.0%) underwent bilateral cochlear implantation. Bimodal patients were older than bilateral at the time of initial implant [76 (71 to 82) vs 74 (70 to 77), P = 0.03] and had a lower contralateral pure tone average [77 (65 to 90) vs 87 (73 to 100), P = 0.04]. All other preimplant testing was similar. Twelve months after initial implant, those who ultimately pursued a second implant had greater device usage (P = 0.03 ) but similar preoperative audiometric evaluations. At 12 months post-second implant, bilateral CI users had higher bilateral AzBio scores in quiet [87 (77 to 94) vs 77 (58 to 88), P = 0.05] but were otherwise similar to bimodal users. Multivariable regression demonstrated age at first implant as the only predictor of audiometric outcomes. CONCLUSIONS: Elderly bilateral CI patients have improved sentence recognition outcomes one year postoperatively compared with elderly bimodal patients. Bilateral CI patients performed similarly after first versus second implant.