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Cochlear implants:who to refer and what to expect
when you doTracey Twomey
Consultant Clinical ScientistNottingham Auditory Implant
Programme
Chair BCIG
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Who can refer?
• Outlined in NHS England’s Service Specifications for Cochlear
Implants D9a
•
https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d09/
– GP– NHS or private audiology service– ENT service–
Paediatrician
https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d09/
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CI candidature• Governed by NICE TA166 (January 2009)
• Unilateral cochlear implantation recommended for:– Severe to
profound deafness– Hearing only sounds > 90 dB HL at frequencies
of 2 and 4 kHz without acoustic hearing aids
• Inadequate benefit from acoustic hearing aids:– Adults: a
score of
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Referral criteria≠ implant criteria
• Not always the same
• Functional hearing is key eg ANSD– Evidence of what the child
can hear– What meaning they can ascribe to sound
• Contact your CI centre for advice
• Hints and tips for making a CI referral
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British Cochlear Implant Group
• http://www.bcig.org.uk/
• How can we make our website more useful?
http://www.bcig.org.uk/
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There is no upper or lower age limit for referral
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Other considerations
• Asymmetry– Close to borderline
• Look for overall functional profound deafness– Single sided
deafness (SSD )
• Not routinely funded• Current multi-centre trial
• Severely sloping losses– Combined CI/HA (EAS)– Limitations to
hearing preservation– Risk of progression of underlying HL– Adults
rarely qualify due to NICE BKB criterion
• Those with no auditory experience / language may be
declined
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What to do before referral• Prompt referral recommended• Refer
urgent cases immediately
– Meningitis– Sudden onset
• If possible– test >90dBHL, include 2&4kHz– BKB at
60dBSPL (adults)– Optimised hearing aid trial
• Manage CHL• Begin managing other health needs• Contact CI
centre for any advice
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Patient ‘misconceptions’
WrongageNot for
congeni-tally deaf
Funding problems
Additional needs
Surgery is risky
Brain surgery Sounds
like a Dalek
It will change
who I am
I will learn to
talk
Too drastic
Long wait
Not for me
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Professional‘misconceptions’
WrongageNot for
congen-itally deaf
Funding problems
Additional needs
Surgery is risky
Someone else will
referHearing aids are better
Previously declined
High/lowexpect-ations
Too drastic
Long wait
Not for you
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Generic CI assessment pathwayInitial
assessment(audiology)
Initial rehab
F/U rehab
F/U Audiology
F/U Audiology
MDA
Surgery
Initial SLT
F/U SLT
ImagingMRI/CT (Psychology)
Local assessments
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Working in partnership
• If in doubt, discuss potential referrals with CI centre•
Collaborative assessment• Provide your expertise
– (HAs, tinnitus, dementia…)• Patient-centred, seamless service•
RTT clocks – under pressure!• Joint support (bimodal patients after
CI)• Give us feedback!
Cochlear implants:�who to refer and what to expect when you
doWho can refer?CI candidatureReferral criteria≠ implant criteria
Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide
Number 9British Cochlear Implant GroupThere is no upper or lower
�age limit for referralOther considerationsWhat to do before
referralSlide Number 14Slide Number 15Generic CI assessment
pathwayWorking in partnership
