Benefits of cochlear implantation in elderly patients.

Cochlear implantation in elderly patients is a questionable subject. The purpose of this study was to evaluate the procedure and its outcome, the postoperative course, and the audiologic and social benefits of cochlear implantation in this population. Twenty-seven patients older than 60 years were compared with a control group of 15 adult patients. This retrospective study analyzed data concerning the outcome of the procedure, postoperative course, postoperative orthophonic test results, and answers of a questionnaire assessing the changes in communication, perception, and social outcomes. The procedure was uneventful in both groups. Minor complications were not more frequent in elderly patients. Orthophonic test results were comparable in both groups. At 12 months, 83% of the elderly patients had an open-set speech discrimination score above 60%. The benefits of cochlear implantation in terms of the quality of life are not statistically different with younger patients. Cost-utility analysis might support these findings.

[Cochlear implants in the elderly]. / Implant cochléaire chez le sujet âgé.

The authors present a retrospective and multicenter study of 18 elderly patients aged above 60 years-old who underwent a cochlear implantation by comparing them with a population of adult patients. The purpose of this study is to evaluate the utility and benefits of cochlear implantation in the elderly by analyzing the clinical data and the results of a questionnaire assessing the use of the implant and the consequences of implantation on the quality of life. The results of this study indicate that the improvement of quality of life in the elderly is similar compared to a control group of adult patients.

The ultrastructure of the reaction of arterial walls to cholesterol crystals in atheroembolism.

Scanning electron microscopy of atheromatous material revealed flat rhombic cholesterol crystals piled one upon the other. The fate of cholesterol crystals in the atheromatous material was followed after injection intra-arterially into the left renal arteries and left common carotid arteries of rabbits. The lipid and membranous component of the atheromatous material disappeared from the lumen of the vessels in 2-3 days after injection. Macrophages engulfed small cholesterol crystals and exposed surfaces attracted a layer of platelets. Larger cholesterol crystals evoked a giant cell response while within the lumen. Some cholesterol crystals penetrated the vessel walls or were included in the vessel wall reaction and induced a covering of endothelial cells sequestrating them from the lumen. The cholesterol crystals contained in some of the macrophages showed fracture lines and in some instances there were associated myelin figures. Large cholesterol crystals eventually elicited a fibroblastic response from the vessel wall (at about 1-4 weeks after injection) which could give rise to partial or almost complete occlusion of the vessel lumen.

Electron microscopy of the sequence of events in the atheroembolic occlusion of cerebral arteries in an animal model.

Atheromatous material was removed from human atheromas, suspended in sterile saline in the ratio of 1 g to 5 ml and ground to allow passage through a needle; 0-5 ml of this suspension was injected into the left common carotid artery of 16 rabbits. Six animals died after the injection. The remaining animals were killed after various time intervals and the occluded arteries studied by electron microscopy. The general pattern of the embolic event in the cerebral arteries was that there were 3 groups of changes. Firstly, an immediate period of atherothrombotic occlusion occurred, which was followed by some resolution of the obstruction so as to leave the cholesterol crystals of the embolus stuck in the vessel walls as the only remaining element of the embolus in some cases. Finally, there was a late period in which the cholesterol crystals were isolated from the lumen of the vessel and surrounded by macrophages, fibroblastic cells and collagen. Endothelial lined channels developed in the original obstruction.