For older adults, particularly those with dementia, hearing loss can increase isolation and damage their overall quality of life. Cochlear implants are an effective treatment for hearing loss, but the anesthesia used during the procedure may cause risks for this populations.
Listen in as Selena Heman-Ackah, MD, explains how she performs the implantation procedure with only local anesthesia with sedation to improve the overall outcome and decrease the risks of the procedure for patients with dementia.
Cochlear Implantation and Dementia
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Learn more about Dr. Heman-Ackah
Selena Heman-Ackah, MD, PhD, MBA
Dr. Heman-Ackah completed her medical degree at the University of Cincinnati-College of Medicine, followed by a surgical internship and Otolaryngology-Head and Neck Surgery residency at the University of Minnesota, and a fellowship in neurotology at New York University. Dr. Heman-Ackah holds an MBA from the University of Cincinnati and a PhD in otolaryngology from the University of Minnesota. She previously served as the Director of Otology, Neurotology and Audiology at Beth Israel Deaconess Medical Center, and as instructor and assistant professor of otolaryngology at Harvard Medical School.Learn more about Dr. Heman-Ackah
Transcription:
Cochlear Implantation and Dementia
Melanie Cole (Host): Hearing loss has been found to independently increase the progression and severity of dementia. So, cochlear implants would decrease that progression. However, there is a concern that general anesthesia may contribute to that progression. My guest today is Dr. Selena Heman-Ackah. She is otolaryngologist with MedStar Washington Hospital Center. Welcome to the show, doctor. Tell us a little bit about hearing loss as it relates to dementia and the progression of that.
Dr. Selena Heman-Ackah (Guest): There have been a number of studies just in the past decade that have linked progression of hearing loss with the progression of cognitive decline with aging. A number of these studies have shown a correlation between an increased incidence of dementia of all forms as well as an increase in the progression of dementia in patients as related to the severity of hearing loss. So, the goal is to prevent hearing loss or mitigate the hearing loss in some form, either with hearing aids or with cochlear implantation, depending upon the severity of the hearing loss, to help decrease the progression of dementia or even prevent the onset.
Melanie: Is there any link to that frustration of somebody with hearing loss and their ability to get themselves out in the community?
Dr. Heman-Ackah: Definitely. Because, exactly what you stated, individuals who are communicating with other individuals with hearing loss they tend to get frustrated. It leads to social withdrawal, particularly in the geriatric population or the aging population with hearing loss. And there have been a number of studies that have linked social withdrawal, depression, anxiety and decline in function as well with progressive hearing loss. So, the goal really is to keep individuals having the ability to communicate, and that keeps them in the game. It keeps them active. It keeps them cognitively functional as well.
Melanie: So, along with that social feeling, now cochlear implants could help with that. What has typically been done in the past with those?
Dr. Heman-Ackah: In general, implants are an outpatient procedure that can be performed on anyone from the ages of one to the oldest person that has had an implant on record is over a hundred. And the device is implanted within the cochlea, which is the hearing organ, and then there’s an external device that’s worn outside that picks up the sound from the environment and codes it into a signal that your inner ear and brain can understand. So, those two devices coupled help to improve an individual’s hearing both in terms of the clarity of their hearing as well as the volume of their hearing.
Melanie: So, if that’s what’s typically been done then why are we seeing that there’s a concern that general anesthetic can also contribute to that progression of dementia?
Dr. Heman-Ackah: Typically, with the cochlear implantation, it’s done under general anesthesia and in general anesthesia, there is a risk factor of exposing an individual with dementia to general anesthesia. It’s been reported to increase the progression of dementia. So, the procedure that I’ve been doing, which is somewhat different from the traditional cochlear implant procedure, is performing the implant not under general anesthesia but under local anesthesia with sedation. That decreases the risk of progression of dementia for these individuals while improving their hearing. So, it helps to decrease the progression again. In other words, you’re helping their hearing with a cochlear implant and mitigating that risk of general anesthesia of the traditional approach for cochlear implantation.
Melanie: So, then how does that work, are they in twilight with a local anesthesia, how does that work, and is there a fear?
Dr. Heman-Ackah: The patients that I’ve had that have undergone this procedure have done remarkably. They are in a sedated state, so they tend to be resting during the procedure, but they don’t have a breathing tube. They’re breathing spontaneously and we just use local anesthesia and do the procedure. It’s similar to some of the other procedures that are done for hearing loss, a different type of hearing loss called the stapes procedure, which is traditionally under local sedation. It’s using that same anesthetic model but for a different procedure in the same area.
Melanie: And, are there any other advantages? Time in the recovery room or length of a hospital stay?
Dr. Heman-Ackah: Definitely. For an individual who has dementia, and they may also have other associated comorbidities such as heart disease or lung disease, it decreases the risk of anesthesia for other procedure as well. They do have a decreased time in recovery; whereas, usually if you have a general anesthetic, you have an extended course in recovery. But, with the local and sedation the recovery time in the hospital is decreased almost in half, and the recovery outpatient is decreased as well.
Melanie: And, what’s it like for the patient after the surgery, after this procedure under a local anesthetic, how soon can they go back home? Is there dizziness? What’s it like for them?
Dr. Heman-Ackah: They go home the same day. About a third of patients to half the patients will experience some dizziness for about a day or two. That typically resolves on its own and it’s very short-lived. Two weeks to four weeks after the procedure, the device is activated and that’s when the individual hears. So, it’s important to note that on the day that surgery is done, the hearing is not restored. It takes about two weeks for the device to be activated, but at that time then there is some improvement in hearing. Then, there’s a period of counseling and sessions with an audiologist to optimize the hearing and help the patient to learn how to hear with their new device.
Melanie: That’s got to be a weird feeling for them?
Dr. Heman-Ackah: It is an interesting feeling for them, definitely. But most patients are so excited about having implants and restoring their hearing. It’s more of an exciting experience for people than a weird one.
Melanie: Could you use that same procedure for a young adult with hearing loss?
Dr. Heman-Ackah: You can use the same procedure for anyone with hearing loss. The cochlear implantation itself, in general, is for younger individuals without other comorbidities. It’s performed under general anesthetic, but it could be performed under local with sedation as well. Anyone essentially with severe to profound sensory neural hearing loss could undergo cochlear implantation. And, in fact, in the pediatric population, it’s quite common as well.
Melanie: Doctor, in the last few minutes, please wrap it up for us about the progression of dementia and how cochlear implantation may decrease that progression and how that concern of general anesthesia can be allayed by doing the procedure under local with sedation.
Dr. Heman-Ackah: With age and with time, it’s very common for individuals to experience sensory neural hearing loss or progression of hearing loss. In some individuals that hearing loss progresses faster than others and puts them in a situation where their hearing is severe to profound. They have difficulty communicating with their family, interacting in the grocery store, and participating with their care, with their providers, and they can’t hear or understand descriptions of medications or proposed procedures. Cochlear implantation is a procedure that can be performed and a device that can be used to help mitigate those issues for individuals with severe to profound hearing loss. Additionally, with age and with time, dementia is relatively common within the geriatric population. Studies have shown that hearing loss can accelerate the progression of dementia and increase the incidence of dementia. So, with implantation, the goal is to restore hearing but also decrease the progression of dementia or onset of dementia in this population.
Melanie: Thank you so much for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information you can go to medstarwashington.org. That’s medstarwashington.org. This is Melanie Cole. Thanks so much for listening.
Cochlear Implantation and Dementia
Melanie Cole (Host): Hearing loss has been found to independently increase the progression and severity of dementia. So, cochlear implants would decrease that progression. However, there is a concern that general anesthesia may contribute to that progression. My guest today is Dr. Selena Heman-Ackah. She is otolaryngologist with MedStar Washington Hospital Center. Welcome to the show, doctor. Tell us a little bit about hearing loss as it relates to dementia and the progression of that.
Dr. Selena Heman-Ackah (Guest): There have been a number of studies just in the past decade that have linked progression of hearing loss with the progression of cognitive decline with aging. A number of these studies have shown a correlation between an increased incidence of dementia of all forms as well as an increase in the progression of dementia in patients as related to the severity of hearing loss. So, the goal is to prevent hearing loss or mitigate the hearing loss in some form, either with hearing aids or with cochlear implantation, depending upon the severity of the hearing loss, to help decrease the progression of dementia or even prevent the onset.
Melanie: Is there any link to that frustration of somebody with hearing loss and their ability to get themselves out in the community?
Dr. Heman-Ackah: Definitely. Because, exactly what you stated, individuals who are communicating with other individuals with hearing loss they tend to get frustrated. It leads to social withdrawal, particularly in the geriatric population or the aging population with hearing loss. And there have been a number of studies that have linked social withdrawal, depression, anxiety and decline in function as well with progressive hearing loss. So, the goal really is to keep individuals having the ability to communicate, and that keeps them in the game. It keeps them active. It keeps them cognitively functional as well.
Melanie: So, along with that social feeling, now cochlear implants could help with that. What has typically been done in the past with those?
Dr. Heman-Ackah: In general, implants are an outpatient procedure that can be performed on anyone from the ages of one to the oldest person that has had an implant on record is over a hundred. And the device is implanted within the cochlea, which is the hearing organ, and then there’s an external device that’s worn outside that picks up the sound from the environment and codes it into a signal that your inner ear and brain can understand. So, those two devices coupled help to improve an individual’s hearing both in terms of the clarity of their hearing as well as the volume of their hearing.
Melanie: So, if that’s what’s typically been done then why are we seeing that there’s a concern that general anesthetic can also contribute to that progression of dementia?
Dr. Heman-Ackah: Typically, with the cochlear implantation, it’s done under general anesthesia and in general anesthesia, there is a risk factor of exposing an individual with dementia to general anesthesia. It’s been reported to increase the progression of dementia. So, the procedure that I’ve been doing, which is somewhat different from the traditional cochlear implant procedure, is performing the implant not under general anesthesia but under local anesthesia with sedation. That decreases the risk of progression of dementia for these individuals while improving their hearing. So, it helps to decrease the progression again. In other words, you’re helping their hearing with a cochlear implant and mitigating that risk of general anesthesia of the traditional approach for cochlear implantation.
Melanie: So, then how does that work, are they in twilight with a local anesthesia, how does that work, and is there a fear?
Dr. Heman-Ackah: The patients that I’ve had that have undergone this procedure have done remarkably. They are in a sedated state, so they tend to be resting during the procedure, but they don’t have a breathing tube. They’re breathing spontaneously and we just use local anesthesia and do the procedure. It’s similar to some of the other procedures that are done for hearing loss, a different type of hearing loss called the stapes procedure, which is traditionally under local sedation. It’s using that same anesthetic model but for a different procedure in the same area.
Melanie: And, are there any other advantages? Time in the recovery room or length of a hospital stay?
Dr. Heman-Ackah: Definitely. For an individual who has dementia, and they may also have other associated comorbidities such as heart disease or lung disease, it decreases the risk of anesthesia for other procedure as well. They do have a decreased time in recovery; whereas, usually if you have a general anesthetic, you have an extended course in recovery. But, with the local and sedation the recovery time in the hospital is decreased almost in half, and the recovery outpatient is decreased as well.
Melanie: And, what’s it like for the patient after the surgery, after this procedure under a local anesthetic, how soon can they go back home? Is there dizziness? What’s it like for them?
Dr. Heman-Ackah: They go home the same day. About a third of patients to half the patients will experience some dizziness for about a day or two. That typically resolves on its own and it’s very short-lived. Two weeks to four weeks after the procedure, the device is activated and that’s when the individual hears. So, it’s important to note that on the day that surgery is done, the hearing is not restored. It takes about two weeks for the device to be activated, but at that time then there is some improvement in hearing. Then, there’s a period of counseling and sessions with an audiologist to optimize the hearing and help the patient to learn how to hear with their new device.
Melanie: That’s got to be a weird feeling for them?
Dr. Heman-Ackah: It is an interesting feeling for them, definitely. But most patients are so excited about having implants and restoring their hearing. It’s more of an exciting experience for people than a weird one.
Melanie: Could you use that same procedure for a young adult with hearing loss?
Dr. Heman-Ackah: You can use the same procedure for anyone with hearing loss. The cochlear implantation itself, in general, is for younger individuals without other comorbidities. It’s performed under general anesthetic, but it could be performed under local with sedation as well. Anyone essentially with severe to profound sensory neural hearing loss could undergo cochlear implantation. And, in fact, in the pediatric population, it’s quite common as well.
Melanie: Doctor, in the last few minutes, please wrap it up for us about the progression of dementia and how cochlear implantation may decrease that progression and how that concern of general anesthesia can be allayed by doing the procedure under local with sedation.
Dr. Heman-Ackah: With age and with time, it’s very common for individuals to experience sensory neural hearing loss or progression of hearing loss. In some individuals that hearing loss progresses faster than others and puts them in a situation where their hearing is severe to profound. They have difficulty communicating with their family, interacting in the grocery store, and participating with their care, with their providers, and they can’t hear or understand descriptions of medications or proposed procedures. Cochlear implantation is a procedure that can be performed and a device that can be used to help mitigate those issues for individuals with severe to profound hearing loss. Additionally, with age and with time, dementia is relatively common within the geriatric population. Studies have shown that hearing loss can accelerate the progression of dementia and increase the incidence of dementia. So, with implantation, the goal is to restore hearing but also decrease the progression of dementia or onset of dementia in this population.
Melanie: Thank you so much for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information you can go to medstarwashington.org. That’s medstarwashington.org. This is Melanie Cole. Thanks so much for listening.