How do Patient Comorbidities Influence Adult Cochlear Implant Outcomes?

Abstract

To evaluate the relationship between weighted comorbidity indices and post-cochlear implant (CI) speech recognition and patient-reported outcome measures (PROMs). Retrospective cohort. Tertiary Neurotology Center. Adults with bilateral hearing loss who received CIs from 2017 to 2022 were included. Comorbidities were extracted via chart review of anesthesia notes, medication lists, and clinical encounters. Three comorbidity scores were calculated: the Charlson Index (10-year mortality), Elixhauser Index (30-day hospital readmission), and a basic sum index assigning equal weight to 31 conditions. Spearman correlations evaluated bivariate associations. Multivariable linear regression was used to evaluate independent contributions of each index to CI outcomes, adjusting for clinical covariates. Early (1- or 3-month post-CI) and long-term (6- or 12-month post-CI) outcomes included Consonant-Nucleus-Consonant word recognition (CNC) and AzBio sentence recognition in quiet (AzBioQ), and PROMs. 346 patients were included. The Charlson Index was negatively associated with both early and long-term speech recognition outcomes (CNC and AzBioQ; r_s = -0.16 to -0.31, all FDR-adjusted P < .05). The Elixhauser Index negatively correlated with early AzBioQ scores (r_s= -0.22), while the basic sum index negatively correlated with early CNC and long-term AzBioQ. No indices were associated with PROMs. In multivariable models, only the Elixhauser Index independently predicted early (β = -1.03, P = .005) and long-term (β = -0.65, P = .050) AzBioQ. Our findings highlight the influence of cumulative comorbid disease burden on speech recognition performance and suggests a differential impact of individual comorbidities on CI outcomes.