Implant after more than ten years of unilateral deafness: most still benefit

Design

Retrospective multicentre cohort, five academic centres

Population

68 adults with more than 10 years of unilateral severe to profound deafness (median 17 years)

Primary outcome

Change in word recognition score and daily device use

Effect

Mean gain 28.4 points (SD 31.6); 54.5% gained 20 points or more; use 7.1 to 8.4 hours a day

A retrospective cohort from five US academic centres (The Laryngoscope, published 10 September) included 68 adults implanted after more than ten years of severe to profound deafness in one ear; the median duration was 17 years.

After implantation, word recognition improved by a mean of 28.4 percentage points in those tested before and after. More than half (54.5%) gained at least 20 points and about a third gained 50 points or more. Mean daily device use was 8.4 hours in the first year and 7.1 hours afterwards. On multivariable analysis, duration of deafness did not predict the result.

Long duration of deafness is commonly treated as a reason not to implant, on the assumption that the auditory pathway has lost the capacity to adapt. These results suggest many such patients still gain useful hearing and wear the device daily. Candidacy should be individual rather than ruled out by a duration cut-off, with realistic counselling about the range of outcomes.

• Do not exclude adults from cochlear implant assessment solely because unilateral deafness has lasted more than ten years.
• Counsel candidates that outcomes vary widely and some gain little.
• Assess motivation and rehabilitation support, which affect device use.
• Record pre-operative word recognition so benefit can be measured.
• Refer adults with severe to profound unilateral deafness who want better hearing for specialist implant assessment.

Why it matters

It challenges a duration-of-deafness cut-off that may be excluding patients who would benefit.

Don't overread it

This is a retrospective series of 68 selected patients without a control group, and post-operative data were missing for some.

The statistics, in plain English

A mean gain of 28.4 points with a standard deviation of 31.6 means results varied widely: some patients improved a great deal and others hardly at all. Excluding patients without follow-up data may make the average look better than it is.

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