Question
QUESTION: Hi,
    My mother have a conductive hearing loss for more than 10 years. 2 years before she have stapedotomy surgery. After that surgery she cant hear nothing. Now we are planning to do the cochlear implant. Her age is 52, is there any problem for aged person.

Regards
Sachindranath

ANSWER: Hello,

I've been reading through your question, in order to help me understand better. It looks like your poor mother has gone through a lot. I understand that she has been losing her hearing over a long period of time (you say more than 10 years), and now she cannot hear anything (following stapedotomy surgery). This must be very frustrating and distressing for her, and for the people around her.

I note that you say that a Cochlear Implant is planned as her next surgery. I understand that your mother is 52. Nowadays, I wouldn't really consider 52 to be particularly elderly. Many people are living well beyond their 60s and into their 70s and 80s. So, I would probably suggest that 52 is somewhere around "middle aged"!

Your mother has lived for much of her life with hearing degeneration; but to lose her hearing completely must have been the last straw. Studies carried out in places like America are showing that healthy elderly patients - even ones with severe and profound hearing loss - can undergo surgical procedures to receive Cochlear Implants with very little risk.

Obviously, many people (no matter how old they are) have worries about surgery. This is because any surgery has some degree of risk attached. The main problems are generally with the ANAESTHETIC, and also the possibility that the surgery may go wrong, or that the patient may suffer COMPLICATIONS. This is why, before a person has ANY form of surgery, they really DO need to discuss it carefully with their Doctor(S) and Surgeon. To give consent to having surgery, a person has to be aware of the pros and cons (i.e. the benefits and disadvantages of having surgery), as well as any risks and side-effects. It is always sensible to consider EVERYTHING before you make a final decision to have surgery. You need to know if the benefits are greater than any possible risks or problems. You need to know if the surgery is suitable. You need to know how long people take to recover on average from the surgery.

Other things to know are things about the actual Surgeon. How successful are they? What techniques do they use (do they use new ones, that may be better, or that may not have been fully tested? How long do they usually take to do the surgery? How long has the Surgeon been working? Are they a Specialist in what they do?

During ANY medical appointment (and particularly ones where a patient is discussing possible surgery) it is always good to ask questions. You need to be able to discuss any worries, and to make sure that you get the right information.

With regard to Cochlear Implant surgery in older people, as I said above, one of the main worries is ANAESTHETIC. People who have this type of surgery are usually given a GENERAL ANAESTHETIC, which "puts them fully to sleep" before the surgery takes place. They are aware of nothing, and should feel nothing at all during the surgery. Some people can be concerned that older patients do not tolerate General Anaesthetic. However, this is not necessarily the case. AGE does not tend to predict whether a person will have problems following Anaesthetic. Many old people are perfectly fine. It is more likely that patients of ANY age, who have either pre-existing medical conditions that make their health poor, or patients who have allergic reactions to Anaesthetic, will struggle.

You need to think about whether your mother fits into any of THESE categories - her AGE, alone, is not an issue. If your mother has had surgery before, and has coped with General Anaesthetic, then it would seem unlikely that she will have problems this time. I speak from PERSONAL EXPERIENCE here, because I HAVE A VERY BAD REACTION AFTER ANAESTHETIC. I am younger than your mother (aged 43 years), but have ALWAYS been affected by Anaesthetic. It tends to make me VERY sick, pale, sweaty, fatigued, dizzy... VERY ILL. I find it VERY hard to fully wake up again after the Anaesthetic, and my body does NOT seem to function fully (low blood pressure, headaches, hard to keep my eyes open, cannot eat, or go to the toilet, or walk). I have ALWAYS been like this, because I remember having surgery even when I was a child (aged about 8 years old) and being VERY, VERY sick and dizzy after Anaesthetic. IF YOUR MOTHER SUFFERS FROM ANYTHING LIKE THIS, IT IS BEST TO DISCUSS EVERYTHING VERY CAREFULLY WITH HER SURGEON AND DOCTOR. It does NOT necessarily mean she can't have surgery (I can still have surgery, I just KNOW I will be very ill afterwards) - it simply means that everyone has to be fully aware of her reaction to Anaesthetic.

The other thing to consider is whether your mother is fully fit and healthy, or whether she has any other health problems, besides hearing problems, that might make her a little frail. If she is fairly fit and healthy for her age, then it is likely, again, that she will not be badly affected by Anaesthetic. If your mother has problems with her heart, or blood pressure, for example, she may be somewhat more at risk as a result of Anaesthesia. One of the worst problems is being VERY OVERWEIGHT or OBESE. This is because a greater amount of Anaesthetic is needed (Surgeons work out how much Anaesthetic is required, based on a patient's BMI {Body Mass Index} or height-to-weight ratio). Again, this is SOMETHING TO DISCUSS WITH HER DOCTOR AND SURGEON.

When a person is to have surgery that includes GENERAL ANAESTHETIC it is best to discuss matters fully in advance. Any issues that your mother has which may put her more at risk should be explained, and then the Surgeon is aware. Patients who are suspected of being ALLERGIC to Anaesthetic can be sent for tests to see if this is truly the case. Patients who are often sick following Anaesthetic can ask to have an ANTI-EMETIC (a drug that stops them being sick) added into their medication. Surgeons can also consider different types of Anaesthetic, to find the most suitable.

Any other RISKS and COMPLICATIONS of the surgery should also be fully explored during discussions with the Doctor and Surgeon. You need to find out what the risks/complications are, and what the likelihood of them happening is. Statistically, most complications are rare (which shows that MOST people have successful surgery) - but you still need to be aware. That way, you can decide if your mother is happy to accept the risk, in order to have a surgery that may well improve her hearing considerably.

I have included a few links to other articles that you can access on the Internet. These will tell you a bit more (in greater detail) about Cochlear Implant Surgery, and about Anaesthetic (and any risks). DO take time to read them, as they will provide you with even more information, that may help. The articles are -

1. Cochlear Implant Surgery & Older People - www.sciencedaily.com/releases/2009/02/090227145144.htm

2. Anaesthetic & Complications - www.patient.co.uk/doctor/important-complications-of-anaesthesia

3. Cochlear Implant Surgery & Risks - www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprostetics/cochlearimplants/ucm062843.htm

I really do hope that the information I have provided is of some assistance. I wish you and your mother well, and hope that everything turns out for the best.

Regards,
Elaine Ellis.

---------- FOLLOW-UP ----------

QUESTION: Hi Sir,
        Thanks for your Reply. I more thing i want to discuss with you is, my mother have diabetic problems. Is cochelar implant fit for a diabetic patient .

Regards
Sachindranath

Answer
Hello again,

In answer to your second question, I understand that people with Diabetes can have Cochlear Implants. Diabetes is considered an additional health risk (like heart disease, obesity - which I had mentioned before). However, the fact that a patient has Diabetes does NOT automatically mean they cannot have a Cochlear Implant.

Instead, it is advised that where a patient has a known health condition that may lead to increased risk, they should get checked over by their G.P. / Primary Physician. This check-up should be a thorough examination which includes general blood tests (e.g. to make sure the patient is not Anaemic, and to make sure that blood sugar levels are stable), a chest X-Ray (to make sure that nothing "bad" is going on that may cause complications during, or after surgery), tests of blood pressure and pulse rate (to make sure the heart is pumping effectively)... This examination is best discussed with the G.P. as they will be able to take account of all your concerns, and should know what to include in their tests.

In addition, it is advised that you discuss something like Diabetes with the Surgeon, and Anaesthetist, as well (perhaps at a pre-operative consultation). Clearly, the Hospital where your mother may be likely to have her surgery will need to know about her Diabetes. They will need to be aware of things like:
1. How well-controlled it is.
2. Whether it is managed via diet, or by taking medication.
3. What medication your mother takes (if any), and when - plus the dosage.
4. Whether your mother has any complications as a result of her Diabetes (Diabetes can sometimes affect eyesight; or can affect nerves, particularly those which cause sensation in the feet).
5. Whether your mother's Diabetes has lead to any past problems during, or after, surgery (if it did, it may be sensible to give the Hospital an idea of what these were).

Medicine, like anything else, works well on information. Provided that the people involved in your mother's care and treatment have all the necessary information available to them, then it is likely that your mother may be able to go ahead and have the Implant.

I hope that everything works out well.
Best wishes,
Elaine Ellis.