Cochlear Implantation in Elderly Patients: Survival Duration, Hearing Outcomes, Complication Rates, and Cost Utility

INTRODUCTION

The prevalence of hearing loss and its consequences is increasing as the elderly population grows. As the guidelines for cochlear implantation (CI) expand, the number of elderly CI recipients is also increasing. We report complication rates, survival duration, and audiological outcomes for CI recipients aged 80 years and over and discuss the cost utility of CI in this age group.

METHODS

A retrospective cohort study was undertaken of all CI recipients (126 cases), aged 80 years and over at the time of their surgery, implanted at our institution (Cambridge University Hospitals) during a period from January 1, 2001, to March 31, 2019. Data on survival at 1, 3, and 5 years post-implantation, post-operative complications and functional hearing outcomes including audiometric and speech discrimination outcomes (Bamford-Kowal-Bench sentence test) have been reported.

RESULTS

The mean age at implantation was 84 years. The mean audiometric score improved from 108 dB HL to 28 dB HL post-implantation. The mean Bamford-Kowal-Bench score improved from 14% to 66% and 73% at 2 and 12 months post-implantation, respectively. The complication rate was 15.3%. The survival probability at 1 year post-implantation was 0.95 for females and 0.93 for males, at 3 years was 0.89 for females and 0.81 for males, and at 5 years was 0.74 for females and 0.54 for males.

CONCLUSION

CI is safe and well-tolerated in this age group and elderly patients gain similar audiometric and functional benefit as found for younger age groups.

Cochlear Implantation in NF2 Patients Without Intracochlear Schwannoma Removal

OBJECTIVE

To determine if cochlear implantation without removal of inner ear schwannomas (IES) is an effective treatment option for Neurofibromatosis 2 (NF2) patients. To determine how the presence of an intracochlear schwannoma might impact cochlear implant (CI) outcomes and programming parameters.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary center for cochlear and auditory brainstem implantation.

PATIENTS

Of 10 NF2 patients with IES, 8 are reported with no previous tumor removal on the implanted ear.

INTERVENTIONS

Cochlear implant without tumor removal.

MAIN OUTCOME MEASURES

Performance outcomes with CI at least 1-year post intervention. Programming parameters, including impedances, for patients with IES.

RESULTS

All patients had full insertion of the electrode arrays with round window approaches. Performance outcomes ranged from 0 to 100% for Bamford-Kowal-Bench sentences. Impedance measurements for active electrodes for patients with IES were comparable to those measured in patients without vestibular schwannoma (VS). Only patients who had radiation treatment before receiving their implant had elevated threshold requirements for CI programming compared with CI recipients without VS.

CONCLUSION

Cochlear implantation without tumor removal is an effective option for treating NF2 patients with IES. The presence of an intracochlear tumor did not have an impact on CI performance or programming requirements compared with patients without VS; however, previous treatment with radiation may be related to elevated current requirements in the CI settings.

P375The impact of hypothyroidism on hospitalization frequency and cost-effectiveness among patients with atrial fibrillation

Background

 thyroid disorders are a well-known fact of high risk developing of atrial fibrillation (AF). While it is established that hyperthyroidism increases AF incidence, data of the effect of hypothyroidism on AF and heart failure is contradictory. 

Purpose

 to examine effect of untreated hypothyroidism on frequency of paroxysmal AF, state of the permanent AF and chronic heart failure (CHF) which is the main cause of high rate repeated hospitalizations.

Methods

 This retrospective study was conducted among patients (pts) with AF, who were admitted to the hospital from June 2018 till June 2019. They were divided into 2 groups: 1-st group – pts with AF and hypothyroidism and 2-nd group – euthyroid pts (by using hormonal replacement therapy) with AF. All pts were surveyed about their age, gender, medical history, therapy, number and reasons for hospitalization for the past 12 months. Reference range of TSH was 0,4-4,0 mU/L.

Results

 A total of 75 pts, 57,3% (n = 43) women, 41,3% (n = 31) men, mean age 70,5 years (SD 6,7) were enrolled in the research. 1-st group consist of 66,7% (n = 24) women, 33,3% (n = 12) men,  mean age 70,3 years (SD 6,8), paroxysmal AF 38,9% (n = 14), permanent AF 61,1% (n = 22), first diagnosed hypothyroidism during hospitalization 61,1% (n = 22),  mean TSH 9,3 mU/L (SD 3,7), 33,3 % (n = 12) were re-admitted 2 and more times,  mean hospitalization duration 7,1 day (SD 1,1).

2-nd group consist of 51,3% (n = 20) women, 48,7% (n = 19) men,  mean age 70,6 years (SD 10,6), paroxysmal AF 35,9% (n = 14), permanent AF 64,1% (n = 25), mean TSH 2,1 mU/L (SD 1,12), 17,9 % (n = 7) were hospitalized 2 times,  mean hospitalization duration 5,9 day (SD 0,9). Reasons for hospitalization in the 1-st group were pharmacological cardioversion (n = 8) and decompensated CHF (n = 4), in the 2-nd group were pharmacological cardioversion (n = 2) and decompensated CHF (n = 5).

Average cost of whole hospitalization in the 1-st group was 252$ (SD 8,1), in the 2-st group – 221 $ (SD 5,2). As an example, average cost for patient with CHF and AF per month in Ukraine is 45 $.

Conclusion

 Tight control of thyroid function ensures optimal dose of hormonal replacement therapy and decrease number of repeated hospitalizations and average hospitalization duration in patients with AF and hypothyroidism. As a result, we receive improving of cost-effectiveness of hospitalization AF pts.

[THE LEVEL OF PROTECTION FROM OXIDATIVE STRESS AND THREE-YEAR DYNAMICS OF STRUCTURAL AND FUNCTIONAL CHANGES OF THE MYOCARDIUM IN CHRONIC ISCHEMIC HEART DISEASE IN MEN]

Aim - to assess the nature and three-year dynamics of structural and functional changes in the cardiovascular system in relation to the levels of enzymatic and non-enzymatic antioxidants in chronic coronary heart disease in men. The study included 246 men aged 48 to 65 years (mean age 58 years (53,0; 63,0)) with stable form of ischemic heart disease - angina FC II-III CHF I-III FC (NYHA), observed during 2012-2015. To assess the level of oxidative stress in all patients by ELISA was determined by lipid peroxide, total antioxidant status (CCA) and levels of non-enzymatic antioxidant bilirubin (BR). Patients were divided into 2 groups according to the level of serum BR: the main group - 146 patients with the level of BR< 8.0 µmol/l; the control group-100 patients with the level of BR ≥8.0 µmol/l. Assessment of the structural and functional state of the myocardium included ECG, XM ECG, EchoCG, VEM test. A decrease in the level of protection against oxidative stress (OS) in men with stable CHD in the form of a significant increase in the level of lipid peroxides and a decrease in the OAS index was found. In the study group OxyStat, total cholesterol and LDL cholesterol were significantly higher (p<0.01)., and ImAnOx - significantly lower than in the control group (p<0.01). A high degree of direct relationship between the level of blood BR and the indicator of AOC is established. Three-year dynamic observation showed a close relationship between the processes of cardiovascular system remodeling and OS components. The high level of OS in men with stable ischemic heart disease is accompanied by adverse changes in the geometry of the left ventricle (eccentric non-dilatated hypertrophy, an increase in the number of segments with hypokinesis), which leads to the progression of chronic heart failure with the risk of ischemic and arrhythmic reactions to physical activity.