Impact of Patient Frailty on Speech Recognition and Quality of Life Outcomes in Adult Cochlear Implant Users

Abstract

ObjectiveThe process of cochlear implantation (CI) and subsequent post-cochlear implant care is extensive and can be difficult to navigate for patients considered medically frail. This study investigates potential impact of patient frailty on speech recognition and quality of life outcomes after CI.Study DesignRetrospective review of a prospectively maintained database.SettingTertiary cochlear implant center.PatientsThree hundred seventy adults undergoing CI for traditional bilateral hearing loss indication.InterventionsNone.Main Outcome MeasuresComparison of pre-CI to 12-month post-CI change in consonant–nucleus–consonant phoneme/words, AzBio sentences in quiet/+10SNR, and Cochlear Implant Quality of Life (CIQOL)-35 Profile domain and global scores based on degree of patient frailty as assessed using the five-factor modified frailty index and Charlson Comorbidity Index.ResultsThe average age at implantation was 65.4 years (±SD, 15.7; 19–94 years). Overall, there were minimal to absent and nonsignificant differences in speech recognition outcomes (consonant–nucleus–consonant phoneme/words, and AzBio sentences +10SNR) based on pre-CI patient frailty. The exception was less improvement in AzBio quiet sentence score in patients noted to be severely frail based on Charlson Comorbidity Index (57.1% vs. 35.2%,d =0.7 [0.3, 1]). Similar findings were observed for CIQOL-35 Profile domain and global scores where no associations were found other than decreased improvement in the social domain in patients noted to be severely frail (21.7 vs. −0.3,d= 1 [0.4, 1.7]).ConclusionsAlthough some differences in outcomes were noted based on cochlear implant user frailty, these were small and isolated to only a few outcome measures. Therefore, assuming the patient is medically safe for surgery, preoperative frailty should not dissuade clinicians from recommending CI.