The Impact of Smoking on Audiologic Outcomes in Cochlear Implant Patients

Introduction: Smoking is a known risk factor for poor health outcomes, but its impact on cochlear implant (CI) surgery and post-implantation auditory performance remains underexplored. This study examines the influence of smoking status on pre- and post-operative audiologic outcomes.

Methods: A single-institution retrospective analysis was conducted on patients who underwent CI since 2017. Data was collected on demographics, smoking status (current, former, never), preoperative and postoperative audiologic outcomes, and postoperative surgical complications. Statistical analysis utilized t-tests and chi-squared tests.

Results: A total of 242 patients were included in the study. Current smokers underwent CI surgery significantly younger than former or never smokers (54.23 vs. 68.72 and 60.39 years, respectively; p < 0.001). Preoperatively, current smokers had worse PTA (98.63 vs. 88.3 dB, p = 0.1), WRS (8% vs. 20%, p = 0.001), CNC Words (1.6% vs. 11.8%, p < 0.001), CNC Phonemes (8.2% vs. 21.7%, p = 0.03), and AzBio scores (11.67% vs. 19.1%, p = 0.4).

Postoperatively, all wound infections (1.5%) occurred in ever smokers. Current smokers had worse postoperative audiologic outcomes, with lower AzBio scores (38.34% vs. 61.8% [former] and 71.4% [never], p = 0.02), CNC Words (36.5% vs. 47.2% [former] and 50.4% [never], p = 0.4), and CNC Phonemes (44% vs. 64.9% [former] and 66.1% [never], p = 0.2). Improvements were significantly lower following CI in smokers compared to nonsmokers, including in CNC Words (+3.3% vs. +36.0%, p < 0.001), CNC Phonemes (+10.3% vs. +44.1%, p = 0.01), and AzBio (+3.0% vs. +48.1%, p < 0.001).

Conclusions: Current smoking is associated with significantly worse pre- and post-operative audiologic outcomes in cochlear implant patients. Despite undergoing CI surgery at a younger age, smokers often present with poorer hearing at evaluation and delayed intervention in their hearing loss journey. These findings highlight the importance of smoking cessation in optimizing outcomes for these patients.