For over ten years, Kitty Grutzmacher struggled with her hearing, a problem that had recently grown much worse. Even with her trusty hearing aids, she could barely make out any sounds.
She found herself withdrawing from social life, no longer attending card games, Bible study, or even church services.
Her local audiologist, despite efforts, couldn’t find a solution for Ms. Grutzmacher, a retired nurse from Elgin, Illinois. Determined, she sought out the specialized cochlear implant program at Northwestern University.
At Northwestern, audiologist Krystine Mullins, who guides patients through their hearing choices, informed her that a cochlear implant – an electronic device surgically placed in the ear – could significantly enhance her ability to comprehend speech.
“It had never even crossed my mind,” Ms. Grutzmacher recalled.
Her age, 84, was not a barrier. Dr. Mullins emphasized that as long as a patient is healthy enough for surgery, age is not a limiting factor. In fact, one of their recent patients was 99 years old.
For some, such a decision requires careful consideration. Achieving clearer hearing after the operation involves months of practice and adjustment, and the extent of improvement isn’t something that can be guaranteed or tested beforehand.
But for Ms. Grutzmacher, there was no hesitation. “I simply couldn’t continue living as I was,” she stated during a post-implant phone conversation. Though the call still involved some frustrating repetitions, it was a conversation that would have been entirely impossible just weeks prior. “I was utterly isolated.”
Remarkably, hearing loss in older adults is still largely untreated. According to national health experts, this condition impacts roughly one in five individuals between 65 and 74 years old, and more than half of those over 75.
Dr. Cameron Wick, an ENT specialist at University Hospitals in Cleveland, explained, “Our inner ear mechanisms simply weren’t designed to last for a lifetime.”
Despite its links to depression, social isolation, and even cognitive decline, less than a third of individuals over 70 who could benefit from hearing aids actually use them.
For those already using hearing aids, Dr. Wick advises, “If your hearing aids are no longer providing sufficient clarity, it’s time to inquire about a cochlear implant assessment.”
Just a quarter-century ago, implanting individuals over 80 was considered a rare procedure, according to Dr. Charles C. Della Santina, director of the Johns Hopkins Cochlear Implant Center. “Today,” he noted, “it’s a fairly routine practice.”
A 2023 study in the journal Otology & Neurotology confirmed this trend, revealing that cochlear implant procedures were growing faster among patients over 80 than in any other demographic.
Previously, Medicare only covered these implants for individuals with severe hearing loss, specifically those who could repeat less than 40% of words on a recognition test. With the total cost often exceeding $100,000 for the device, surgery, and aftercare, many older adults simply couldn’t afford it without insurance.
Dr. Della Santina expressed immense frustration, highlighting that many Medicare patients were being unfairly excluded. He also pointed out that traditional Medicare typically doesn’t cover hearing aids, and even Medicare Advantage plans often leave patients responsible for a substantial portion of the cost.
However, a significant change occurred in 2022 when Medicare broadened its coverage for cochlear implants. Now, older adults who can identify up to 60% of words on a speech recognition test are eligible, dramatically expanding access to the procedure.
Despite these positive changes, the American Cochlear Implant Alliance reports an annual increase of about 10% in implants, yet public awareness and referrals from audiologists remain surprisingly low. The organization notes that fewer than 10% of eligible adults with moderate to profound hearing loss actually receive these devices.
Undergoing a cochlear implant procedure is a significant commitment. Following comprehensive testing and counseling, the outpatient surgery itself usually lasts two to three hours. Many adults opt for an implant in one ear while continuing to use a hearing aid in the other, with some eventually choosing a second implant.
During the surgery, a small internal receiver is placed under the patient’s scalp, and electrodes are carefully inserted into the inner ear to stimulate the auditory nerve. Patients then wear an external sound processor behind their ear. It’s worth noting that fully internal devices are currently being developed in clinical trials.
After a recovery period of two to three weeks, once swelling has decreased and stitches are removed, an audiologist activates the newly implanted device.
Dr. Wick warns patients that the initial activation can be jarring. Voices often sound robotic or mechanical at first. It takes several weeks for the brain to adapt and learn to accurately process speech and sentences from the new input.
“A cochlear implant isn’t a simple ‘on-off’ solution,” Dr. Mullins explained. “It requires dedicated time and training to acclimate to the new sound experience.” She often gives patients homework, such as reading aloud for 20 minutes daily and watching TV with captions to aid adaptation.
Within one to three months, there’s a breakthrough: “The brain suddenly grasps it, and speech clarity rapidly improves,” Dr. Wick observed. Most older adults achieve significant clarity enhancement within six months, with further improvements often continuing for a year or more.
The extent of improvement is quantified through two primary hearing tests: the CNC (consonant-nucleus-consonant) test, which assesses a patient’s ability to repeat single words, and the AzBio Sentence Test, which evaluates comprehension of words within complete sentences.
At Northwestern, Dr. Mullins informs prospective older patients that achieving an AzBio score of 60 to 70 percent – meaning correctly repeating 60 to 70 out of 100 words – is a common outcome one year post-activation.
A recent comprehensive study from Johns Hopkins, involving approximately 1,100 adults, revealed that patients aged 65 and older gained the ability to correctly identify about 50 more words (out of 100) on the AzBio test after receiving an implant. This improvement was on par with results seen in younger patient groups.
Remarkably, participants over 80 experienced similar levels of improvement compared to those in their late 60s and 70s.
“Patients move from struggling to follow conversations to actively participating,” noted Dr. Della Santina, who co-authored the study. “The efficacy of cochlear implants has consistently improved with each passing decade.”
Furthermore, Dr. Wick led an analysis of 70 older patients across 13 implant centers, which demonstrated not only significant hearing improvements but also a notable increase in reported quality-of-life.
Even scores on standard cognitive tests improved; six months after receiving an implant, 54% of participants achieved a passing score, a marked increase from 36% before surgery. Research specifically on octogenarians and nonagenarians indicates that even those with mild cognitive impairment can benefit from these implants.
Despite these successes, Dr. Wick advises caution: “We’re careful not to make exaggerated promises.” Generally, the longer a patient has experienced significant hearing loss, the more effort is required for rehabilitation, and the potential for improvement might be slightly lower.
A small percentage of patients experience temporary dizziness or nausea post-surgery, though most recover rapidly. Adjusting to the technology, particularly navigating phone apps for sound adjustments, can be challenging for some. Additionally, implants are less effective in loud environments like bustling restaurants, and because they are optimized for speech clarity, music reproduction may not be ideal.
For individuals at the higher end of Medicare eligibility who can already understand about half of spoken words, a cochlear implant might not always feel like a worthwhile endeavor. “Eligibility doesn’t automatically mean it’s the best option for every patient,” Dr. Wick clarified.
For Ms. Grutzmacher, however, the decision was straightforward. Her initial tests showed she understood only 4% of words on the AzBio, even with hearing aids. A mere two weeks after Dr. Mullins activated her cochlear implant, her comprehension jumped to 46% while also using a hearing aid in her other ear.
She shared that after a challenging initial few days, her phone conversations were notably clearer, and she no longer needed to blast her television to volume 80; now, “I can hear it perfectly at 20,” she beamed.
With her newfound hearing, she was eagerly making plans. “This week, I’m having lunch with a friend,” she announced. “I’m going to play cards with a small group of women, and I have a luncheon at church on Saturday.”
This column, The New Old Age, is a collaboration with KFF Health News.