Information for Professionals

This page provides information for professionals regarding referral criteria for cochlear implant assessment and the option of bimodal hearing following implantation.

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Referral criteria

Figures show that between 2006 and 2011 94% of eligible children had received a cochlear implant by the age of 17. This contrasts sharply with only 5% of adults eligible for a cochlear implant actually receiving one (Raine 2013).

Patients may be referred to NERCIP if they have a profound loss at 2 & 4 kHz (i.e. >= 90 dBHL or dead regions / suspected dead regions at these frequencies), or ≥80 dB HL at 2 and 4 kHz if post meningitis. Patients diagnosed with Auditory Neuropathy Spectrum Disorder (ANSD) and not gaining adequate benefit from full time use of bilateral hearing aids may be referred with thresholds better than those described above. All patients should have been wearing appropriately fitted hearing aids for at least six weeks unless hearing loss is a result of meningitis or there is a clinical reason why this is not possible.

It is recognised that generally the sooner a child is implanted the better the outcomes. Therefore, we would encourage referrals to be made as soon as a child has a profound loss confirmed.

Newly diagnosed profoundly deaf children from the newborn hearing screening programme should be referred once:

  • The infant has an assumed profound sensorineural loss at 2 and 4 kHz, or if basing this on objective testing alone, no response to a 4kHz and 1kHz stimulus (regardless of the click response)
  • They have worn hearing aids consistently for at least six weeks
  • They have no middle ear fluid demonstrated by tympanometry

If a child is referred before eight months of age the family will receive a home visit from a cochlear implant key worker but will usually not be seen for formal testing until around eight months of age. An exception to this would be in cases of meningitis, where the child would be seen as soon as possible and would be treated as an urgent case due to the potential for ossification of the cochlear.

For both adult and paediatric patients if the referring professional feels a referral is warranted but the patient does not meet the referral criteria then they should seek the advice of NERCIP

References:

Raine, C. 2013. ‘Cochlear Implants in the United Kingdom: Awareness and utilization.’ Cochlear implants international> An Interdisciplinary Journal. Vol 14, Issue sup1.

Bimodal hearing

For patients who have one cochlear implant there may be a compatible hearing aid that can be used in the other ear. The audiologist will discuss this with the patient if appropriate. The hearing aids that are currently available from the cochlear implant companies (although these may not be provided by NERCIP) are:

  • Advanced Bionics:- Naida Link or CROS for bimodal streaming, volume and programme functions and microphone directionality
  • Cochlear: – GN Resound UP or CSW91 for bimodal streaming