Kitty Grutzmacher had contended with poor hearing for a decade, but the problem had worsened over the past year. Even with her hearing aids, “There was little or no sound,” she sys.
“I was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.”
Her audiologist was unable to offer Grutzmacher, a retired nurse in Elgin, a solution. But she found her way to the cochlear implant program at Northwestern University.
Krystine Mullins, an audiologist there who assesses hearing and counsels people about their options, says surgically implanting this electronic device usually substantially improved a person’s ability to understand speech.
That Grutzmacher was 84 was immaterial.
“As long as you’re healthy enough to undergo surgery, age is not a concern,” Mullins says.
Another recent Northwestern implant patient was 99.
Some people need to consider that, after the operation, clearer hearing still requires months of practice and adaptation, and the degree of improvement is hard to predict.
But Grutzmacher didn’t hesitate.
“I couldn’t go on the way I was,” she says by phone after the implant procedure — an interview that involved repetition that frustrated her but that would have been impossible a few weeks earlier. “I was completely isolated.”
Hearing loss among older adults remains vastly undertreated. Federal government epidemiologists have estimated that it affects 1 in 5 people 65 to 74 and more than half of those over 75.
“The inner-ear mechanisms weren’t built for longevity,” says Dr. Cameron Wick, an ear, nose and throat specialist at University Hospitals in Cleveland.
Though hearing loss can contribute to depression, social disconnection and cognitive decline, fewer than one-third of people over 70 who could benefit from hearing aids have worn them.
For those who do, Wick says, “If your hearing aids no longer give you clarity, you should ask for a cochlear implant assessment.”
Twenty-five years ago, “It was a novelty to implant people over 80,” says Dr. Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. “Now, it’s pretty routine practice.”
Cochlear implantation can cost $100,000 or more. Until recently, Medicare covered the procedure only for people with extremely limited hearing who could correctly repeat less than 40% of the words on a word-recognition test.
“It was incredibly frustrating because patients on Medicare were being excluded,” Della Santina says.
Similarly, traditional Medicare doesn’t cover hearing aids, and Medicare Advantage plans with hearing benefits still leave patients paying most of the tab.
Then, in 2022, Medicare expanded cochlear implant coverage to include older adults who could identify up to 60% of words on a speech-recognition test.
Still, awareness and referrals from audiologists remain low. Fewer than 10% of eligible adults with “moderate to profound” hearing loss receive them, the American Cochlear Implant Alliance estimates.
Cochlear implantation requires commitment. The surgeon implants an internal receiver beneath the scalp and inserts electrodes, which stimulate the auditory nerve, into the inner ear. Patients also wear an external processor behind the ear. Clinical trials of an entirely internal device are underway.
Many adults undergo surgery on one ear and continue using a hearing aid in the other. Some later get a second implant.
Two or three weeks later, after the swelling recedes, and the patient’s stitches have been removed, an audiologist activates the device.
“When we first turn it on, you won’t like what you hear,” Wick says.
Voices initially sound robotic, mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.
“It takes time and some training to get used to the new sound quality,” says Mullins, who assigns homework, like reading aloud for 20 minutes a day and watching television while reading the captions.
Within one to three months, though, “Boom, the brain starts getting it, and speech clarity takes off,” Wick says.
By six months, older adults will have reached most of their enhanced clarity, though some improvement continues for a year or longer.
“We’re cautious not to overpromise,” Wick says.
Usually, the longer that older patients have had significant hearing loss, the harder they have to work to regain their hearing, and the less improvement they might see.
Some people struggle with the technology, including phone apps that adjust the sound. Implants are less effective in noisy settings like crowded restaurants. And, since they are designed to clarify speech, music might not sound great.
For Grutzmacher, though, the choice seemed clear. Her initial testing found that, even with hearing aids, she understood only 4% of words on the AzBio Sentence Test. Two weeks after Mullins turned on the cochlear implant, Grutzmacher could understand 46% using a hearing aid in her other ear.
After a few rough days, her ability to talk by phone had improved. And, instead of turning the television volume up to 80, “I can hear it at 20,” she says.
So she was making plans.
“This week, I’m going out to lunch with a friend,” she says. “I’m going to play cards with a small group of women. I have a luncheon at church on Saturday.”
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