Cognitive Abilities and Quality of Life After Cochlear Implantation in the Elderly.

OBJECTIVE: To evaluate quality of life (QoL) and cognitive function in elderly patients with cochlear implants relative to auditory improvement, using geriatric validated scales. STUDY DESIGN: Prospective observational study. SETTING: A tertiary referral center for cochlear implantation (CI) and a geriatric center in Nancy, France. PATIENTS: Sixteen consecutive patients were included, from 65 to 80 years old, with postlingual severe-to-profound deafness. MAIN OUTCOME MEASURES: Evaluations were conducted before and at 6 and 12 months after cochlear implant surgery. A monosyllabic word recognition test was used to measure speech perception. QoL was evaluated by the World Health Organization Quality of Life Assessment for elderly people; cognitive function was evaluated by the Mini-Mental State Examination; depression was evaluated by the Hamilton Scale; autonomy was evaluated by the Instrumental Activities of Daily Living. RESULTS: Speech intelligibility evolved from 10% before surgery to 63% and 69% at 6 and 12 months after cochlear implant activation, respectively. QoL showed significant improvement in sensory abilities. The Mini-Mental State Examination evaluations remained stable and executive functions tended to improve. Autonomy improved significantly. CONCLUSION: Cochlear implantation improves autonomy and the QoL in the elderly. Cognitive functions are not influenced by surgery, but executive functions appear to benefit from implantation. Age should not be a limiting factor, and cochlear implantation can be proposed as an efficient treatment for severe-to-profound hearing loss in the elderly.

Fine-tuned evaluation of olfactory function in patients operated for nasal polyposis.

Given the forced-choice procedure of the identification test, patients with profound anosmia are more likely to have higher identification scores by chance than patients with hyposmia or normosmia. This may be a confusing factor when assessing the sense of smell, which alters the appreciation of real olfaction improvement. The aim of this study was to fine-tune the results of the identification Sniffin' Sticks test before and 6 weeks after surgery using the real identification score. A total of 133 patients underwent the Identification (I) and Threshold (T) tests the day before and 6 weeks after nasalization surgery. The scores of the identification test, called I G (global identification), were ranked from 0 to 16. Patients had to specify if their forced-choice answers were given either surely or randomly, called I H (hazard identification). The real score of identification I R was obtained as follow: I R = I G - I H. Patients with an immeasurable threshold according to the T test were more prone to give randomly correct answers. On the basis of I G scores, 43.6% of patients remained hypo-anosmic after surgery compared to 72.9% before surgery. Using I R scores, only 3.8% of patients remained anosmic (I R = 0) at 6 weeks after surgery. Hence, patients with real anosmia (I R = 0) were less prone to improve their olfaction than patients with I R > 0. The analysis of random factor when using identification test allows differentiating a real anosmia from a hyposmia. An I G ≤ 4 could be considered as a profound/real anosmia or a severe hyposmia. This procedure cannot, however, replace the forced-choice method in odor identification testing.