When a Hearing Aid Isn’t Enough

Kitty Grutzmacher had struggled with poor hearing for a decade, but her condition worsened significantly over the past year. Despite wearing hearing aids, she found that “there was little or no sound,” she recalled.

“I started avoiding group outings. I stopped playing cards, attending Bible study, and even going to church,” she shared.

Her audiologist was unable to provide a solution, but Grutzmacher, a retired nurse from Elgin, Illinois, discovered the cochlear implant program at Northwestern University.

At Northwestern, audiologist Krystine Mullins explained that surgically implanting this electronic device often leads to substantial improvements in a patient’s ability to understand speech.

“I had never even thought about it,” Grutzmacher admitted.

Age was not a barrier; Mullins reassured her, stating, “As long as you’re healthy enough for surgery, age is not a concern.” In fact, one of their recent patients was 99 years old.

Some patients take time to consider this decision, as clearer hearing requires months of practice and adaptation post-surgery, with improvement levels being unpredictable. “You can’t try it out in advance,” Mullins noted.

However, Grutzmacher didn’t hesitate. “I couldn’t continue living like this,” she said during a post-implant phone interview, which involved some frustrating repetition but would have been impossible just weeks earlier. “I was completely isolated.”

Hearing loss among older adults remains significantly undertreated. According to federal epidemiologists, it affects about 1 in 5 people aged 65 to 74, and more than half of those over 75.

“The inner ear mechanisms weren’t built for longevity,” explained Cameron Wick, an ear, nose, and throat specialist at University Hospitals in Cleveland.

Hearing loss can lead to depression, social disconnection, and cognitive decline, yet fewer than a third of those over 70 who could benefit from hearing aids actually use them.

For those who do, Wick advises, “If your hearing aids no longer provide clarity, you should ask for a cochlear implant assessment.”

Twenty-five years ago, it was considered a novelty to implant individuals over 80, according to Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. “Now, it’s pretty routine practice.”

A 2023 study published in the journal Otology & Neurotology revealed that cochlear implantation is increasing at a higher rate among patients over 80 than any other age group.

Until recently, Medicare only covered the procedure for those with extremely limited hearing, specifically those who could correctly repeat less than 40% of words on a recognition test. Without insurance, cochlear implantation can cost $100,000 or more, making it inaccessible for many older adults.

“It was incredibly frustrating because patients on Medicare were being excluded,” Della Santina lamented. Traditional Medicare also does not cover hearing aids, and even Medicare Advantage plans often leave patients paying most of the costs.

In 2022, Medicare expanded coverage to include older adults who could identify up to 60% of words on a speech recognition test, broadening the pool of eligible patients.

Despite the American Cochlear Implant Alliance estimating that implants are increasing by about 10% annually, public awareness and referrals from audiologists remain low. Less than 10% of eligible adults with “moderate to profound” hearing loss receive them, according to the alliance.

Cochlear implantation requires commitment. After testing and counseling, the outpatient surgery typically lasts two to three hours. Many adults opt for surgery on one ear while continuing to use a hearing aid in the other, with some later choosing to get a second implant.

The procedure involves implanting an internal receiver beneath the scalp and inserting electrodes into the inner ear to stimulate the auditory nerve. Patients also wear an external processor behind the ear. Clinical trials for an entirely internal device are currently underway.

Two to three weeks post-surgery, after swelling subsides and stitches are removed, an audiologist activates the device.

“When we first turn it on, you won’t like what you hear,” Wick cautioned. Initially, voices may sound robotic or mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.

“A cochlear implant is not something you just turn on and it works,” Mullins emphasized. “It takes time and some training to get used to the new sound quality.” She often assigns homework, such as reading aloud for 20 minutes daily and watching television with captions.

Within one to three months, “boom, the brain starts getting it, and speech clarity takes off,” Wick noted. By six months, older adults typically reach most of their enhanced clarity, although some improvement continues for a year or longer.

How much improvement can be expected? This is measured by two hearing tests: the CNC (consonant-nucleus-consonant) test, where patients repeat individual words, and the AzBio Sentence Test, which involves repeating words within full sentences.

At Northwestern, Mullins informs older prospective patients that a year after activation, a 60% to 70% AzBio score—correctly repeating 60 to 70 words out of 100—is typical.

A Johns Hopkins study involving around 1,100 adults published in 2023 found that patients aged 65 and older could correctly identify about 50 additional words (out of 100) on the AzBio test post-implantation, a result comparable to younger cohorts.

Participants over 80 showed similar improvement levels as those in their late 60s and 70s.

“They transition from having difficulty following conversations to being able to participate,” Della Santina explained, noting that decade by decade, cochlear implant results have improved.

Moreover, an analysis of 70 older patients’ experiences across 13 implantation centers, led by Wick, found not only “clinically important” hearing improvements but also higher quality-of-life ratings.

Scores on standard cognitive tests also improved: after six months of using a cochlear implant, 54% of participants achieved a passing score, compared to 36% pre-surgery. Studies focusing on individuals in their 80s and 90s have shown that even those with mild cognitive impairment benefit from implants.

However, Wick cautioned against overpromising results. Generally, the longer older patients have experienced significant hearing loss, the more effort they must exert to regain their hearing, and the less improvement they may see.

Some patients may experience dizziness or nausea post-surgery, though most recover quickly. Others may struggle with the technology, including phone apps that adjust sound settings. Implants are less effective in noisy environments, such as crowded restaurants, and while they clarify speech, music may not sound as good.

For those at the upper end of Medicare eligibility who already understand about half of the speech they hear, implantation may not seem worthwhile. “Just because someone is eligible doesn’t mean it’s in their best interests,” Wick advised.

For Grutzmacher, however, the choice was clear. Initial testing revealed that even with hearing aids, she understood only 4% of words on the AzBio. Just two weeks after Mullins activated her cochlear implant, she could understand 46% using a hearing aid in her other ear.

She reported that after a few challenging days, her phone conversation skills improved, and instead of cranking the television volume up to 80, “I can hear it at 20,” she said.

Excitedly, she shared her plans: “This week, I’m going out to lunch with a friend. I’m going to play cards with a small group of women. I have a luncheon at church on Saturday.”

The New Old Age is produced through a partnership with The New York Times.

Kitty Grutzmacher had struggled with poor hearing for a decade, but her condition worsened significantly over the past year. Despite wearing hearing aids, she found that “there was little or no sound,” she recalled.

“I started avoiding group outings. I stopped playing cards, attending Bible study, and even going to church,” she shared.

Her audiologist was unable to provide a solution, but Grutzmacher, a retired nurse from Elgin, Illinois, discovered the cochlear implant program at Northwestern University.

At Northwestern, audiologist Krystine Mullins explained that surgically implanting this electronic device often leads to substantial improvements in a patient’s ability to understand speech.

“I had never even thought about it,” Grutzmacher admitted.

Age was not a barrier; Mullins reassured her, stating, “As long as you’re healthy enough for surgery, age is not a concern.” In fact, one of their recent patients was 99 years old.

Some patients take time to consider this decision, as clearer hearing requires months of practice and adaptation post-surgery, with improvement levels being unpredictable. “You can’t try it out in advance,” Mullins noted.

However, Grutzmacher didn’t hesitate. “I couldn’t continue living like this,” she said during a post-implant phone interview, which involved some frustrating repetition but would have been impossible just weeks earlier. “I was completely isolated.”

Hearing loss among older adults remains significantly undertreated. According to federal epidemiologists, it affects about 1 in 5 people aged 65 to 74, and more than half of those over 75.

“The inner ear mechanisms weren’t built for longevity,” explained Cameron Wick, an ear, nose, and throat specialist at University Hospitals in Cleveland.

Hearing loss can lead to depression, social disconnection, and cognitive decline, yet fewer than a third of those over 70 who could benefit from hearing aids actually use them.

For those who do, Wick advises, “If your hearing aids no longer provide clarity, you should ask for a cochlear implant assessment.”

Twenty-five years ago, it was considered a novelty to implant individuals over 80, according to Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. “Now, it’s pretty routine practice.”

A 2023 study published in the journal Otology & Neurotology revealed that cochlear implantation is increasing at a higher rate among patients over 80 than any other age group.

Until recently, Medicare only covered the procedure for those with extremely limited hearing, specifically those who could correctly repeat less than 40% of words on a recognition test. Without insurance, cochlear implantation can cost $100,000 or more, making it inaccessible for many older adults.

“It was incredibly frustrating because patients on Medicare were being excluded,” Della Santina lamented. Traditional Medicare also does not cover hearing aids, and even Medicare Advantage plans often leave patients paying most of the costs.

In 2022, Medicare expanded coverage to include older adults who could identify up to 60% of words on a speech recognition test, broadening the pool of eligible patients.

Despite the American Cochlear Implant Alliance estimating that implants are increasing by about 10% annually, public awareness and referrals from audiologists remain low. Less than 10% of eligible adults with “moderate to profound” hearing loss receive them, according to the alliance.

Cochlear implantation requires commitment. After testing and counseling, the outpatient surgery typically lasts two to three hours. Many adults opt for surgery on one ear while continuing to use a hearing aid in the other, with some later choosing to get a second implant.

The procedure involves implanting an internal receiver beneath the scalp and inserting electrodes into the inner ear to stimulate the auditory nerve. Patients also wear an external processor behind the ear. Clinical trials for an entirely internal device are currently underway.

Two to three weeks post-surgery, after swelling subsides and stitches are removed, an audiologist activates the device.

“When we first turn it on, you won’t like what you hear,” Wick cautioned. Initially, voices may sound robotic or mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.

“A cochlear implant is not something you just turn on and it works,” Mullins emphasized. “It takes time and some training to get used to the new sound quality.” She often assigns homework, such as reading aloud for 20 minutes daily and watching television with captions.

Within one to three months, “boom, the brain starts getting it, and speech clarity takes off,” Wick noted. By six months, older adults typically reach most of their enhanced clarity, although some improvement continues for a year or longer.

How much improvement can be expected? This is measured by two hearing tests: the CNC (consonant-nucleus-consonant) test, where patients repeat individual words, and the AzBio Sentence Test, which involves repeating words within full sentences.

At Northwestern, Mullins informs older prospective patients that a year after activation, a 60% to 70% AzBio score—correctly repeating 60 to 70 words out of 100—is typical.

A Johns Hopkins study involving around 1,100 adults published in 2023 found that patients aged 65 and older could correctly identify about 50 additional words (out of 100) on the AzBio test post-implantation, a result comparable to younger cohorts.

Participants over 80 showed similar improvement levels as those in their late 60s and 70s.

“They transition from having difficulty following conversations to being able to participate,” Della Santina explained, noting that decade by decade, cochlear implant results have improved.

Moreover, an analysis of 70 older patients’ experiences across 13 implantation centers, led by Wick, found not only “clinically important” hearing improvements but also higher quality-of-life ratings.

Scores on standard cognitive tests also improved: after six months of using a cochlear implant, 54% of participants achieved a passing score, compared to 36% pre-surgery. Studies focusing on individuals in their 80s and 90s have shown that even those with mild cognitive impairment benefit from implants.

However, Wick cautioned against overpromising results. Generally, the longer older patients have experienced significant hearing loss, the more effort they must exert to regain their hearing, and the less improvement they may see.

Some patients may experience dizziness or nausea post-surgery, though most recover quickly. Others may struggle with the technology, including phone apps that adjust sound settings. Implants are less effective in noisy environments, such as crowded restaurants, and while they clarify speech, music may not sound as good.

For those at the upper end of Medicare eligibility who already understand about half of the speech they hear, implantation may not seem worthwhile. “Just because someone is eligible doesn’t mean it’s in their best interests,” Wick advised.

For Grutzmacher, however, the choice was clear. Initial testing revealed that even with hearing aids, she understood only 4% of words on the AzBio. Just two weeks after Mullins activated her cochlear implant, she could understand 46% using a hearing aid in her other ear.

She reported that after a few challenging days, her phone conversation skills improved, and instead of cranking the television volume up to 80, “I can hear it at 20,” she said.

Excitedly, she shared her plans: “This week, I’m going out to lunch with a friend. I’m going to play cards with a small group of women. I have a luncheon at church on Saturday.”

The New Old Age is produced through a partnership with The New York Times.