Background:
Cochlear implantation in the elderly (above the age of 70 years) as a treatment for profound sensorineural deafness is to some extent regarded with skepticism. First, the perception of sound transmitted by electrical stimulation is regarded as being generally too unfamiliar for elderly recipients to adapt to. Second, retrocochlear neural transduction and processing are supposed to underlie age-related degeneration and therefore a cochlear implant (CI) may give only poor outcomes in seniors.

Material and Methods:
Two cohorts of elderly people with hearing disabilities aged 60 years and above were studied. Retrospectively gained results in 129 hearing aid (HA) users (average age 72 years) and 115 CI recipients (average age 69 years, collected in our department) were investigated. Freiburger monosyllable scores were measured at 65 dB speech level in the best aided condition (FMS 65dB) and compared to the best monosyllable score (speech level set below uncomfortable loudness to achieve highest score) measured in the unaided condition with headphones.

Results:
Verification of hearing aid fitting showed satisfying results in only 25% of all tests, whereas an average improvement of Freiburger monosyllable scores between 50% and 70% (range 5% to 100%) was found in the CI group, nearly independent of age, when compared to hearing aid results before surgery. Aided performance in the HA group was inferior compared to the CI group (FMS 65 dB: HA 52.7%, CI 62.8%). Additionally, age at surgery (range 60 to 84 years) showed no significant correlation to benefit after rehabilitation.

Conclusions:
The results demonstrate a severe lack of fitting success in the group of seniors with hearing aids in this study. The seniors in the study fitted with a cochlear implant showed very good results, without any evidence of age-related problems. When deciding on cochlear implant surgery in seniors, the faster pace of progression of hearing loss with age should be considered.