The BCIG (British Cochlear Implant Group) is a professional body with members including clinicians working in cochlear implant centres across the UK, experts and scientist working in the field, manufactures of cochlear implant equipment, and other professionals and members of the public with an interest in cochlear implantation.
You will be sent an appointment to see a Consultant ENT Surgeon, who will have cochlear implant experience. He/she will carry out an examination of the ears and assess your overall medical fitness.
A CT scan will usually be required, since it is important to find out whether it will be possible to insert an electrode into your cochlea. The test is painless. However, you should not have it done if you think you might be pregnant or have recently had another CT scan.
Some patients will be asked to undergo an additional type of scan, an MRI (Magnetic Resonance Image) to obtain additional information. Since this test involves the use of powerful magnets, you should not have this test done if you have any metal fragments in your body.
You will, of course, have a number of hearing tests, and you may undergo a hearing aid trial. It is important to find out whether a hearing aid can offer more benefit than a cochlear implant. In some cases, the hearing aid trial can take many weeks or even months. Many people find that modern hearing aids are a great improvement over the aids that they tried years ago, and relieved to discover that cochlear implant surgery is not necessary.
Auditory Brainstem Response
This special hearing test involves recording the electrical activity of your hearing pathway. It is useful for assessing people with profound hearing loss.
Your responses are measured by placing small recording pads onto the head whilst loud clicks are played to you via headphones. You are required to lie still during this procedure, and you may even go to sleep if you wish! The procedure is painless.
Hearing Aid Benefit and Lipreading Assessment
You may be asked to take part in an evaluation of your lipreading skills. You may be asked to watch a speaker on a TV screen who will say various sentences, and to repeat back what you have heard. You will be tested using lipreading alone and then lipreading and sound together. This will tell us how much you rely on lipreading to understand speech and how much your hearing aid(s) support your lipreading. We will also test your ability to understand speech without lipreading to evaluate your hearing aid benefit. These tests give us baseline measurements for later comparisons with your implant.
In order to see if there are any changes in your voice quality after receiving an implant you may be asked to see a speech and language therapist. He/she will make a recording of your speech. This normally involves you reading or speaking a short passage which may be recorded.
You may be asked to complete a number of different questionnaires. These are often administered by computer and your responses are recorded by an easy-to-use touch screen system. The questionnaires are an opportunity for you to tell us how you feel about your deafness, how you think it affects the quality of your life, and what you are expecting from a cochlear implant.
All replies are treated completely confidentially.
It is important to consider your psychological status before implantation. Some cochlear implant teams will refer you to a Clinical Psychologist or Psychiatrist.
At this appointment you will be able to discuss your reasons for wanting an implant. Cochlear Implant Teams need to be sure that you fully understand about all that is involved in having a cochlear implant as well as establishing that your expectations are realistic. The purpose of these discussions is to help you to make up your mind whether or not you want an implant and whether you would really benefit from one
You and your child will be seen by a consultant and other members of the team in a children’s cochlear implant centre. The centre will usually have asked you to complete a preliminary questionnaire with some basic information about your child. The centre may have asked your permission to approach your child’s doctors, audiologists, teachers and other professionals involved with your child for information.
Your child’s hearing will be assessed in detail. It is very important to make sure that every child has had the best possible hearing aids and earmoulds, and has used them consistently before proceeding with decisions about cochlear implantation. The child’s teachers and local therapists may also be asked to comment on the child’s auditory progress.
These initial visits may last for most of the day as there can be a lot of work to do.
Some children may be found to be unsuitable for an implant as assessment progresses. Cochlear implant centres will ensure that everyone understands clearly why the decision against cochlear implantation was made, and will offer the opportunity for alternative ideas to be explored.
This involves detailed assessment at home and at school, and a named key-worker will help co-ordinate this and provide a contact for you. As well as visits by the cochlear implant team members to home and school, there will be assessments of language, communication, education and expectations by the advisory teachers, speech and language therapists and psychologists.
Certain specific tests will be important for most children.
A CT scan which is a specialised X-ray of the inner ear is carried out to establish whether it is possible to insert a cochlear implant electrode into the cochlea. It is often followed by an MRI Scan (Magnetic Resonance Image). The MRI will look carefully at the soft tissues, and the nerve of hearing.
Auditory Brainstem Response (ABR) tests may also be required. This is a hearing test using temporary electrodes placed on the head to pick up the responses to sound.
The CT scan, the MRI and the ABR are all painless, but do require the child to be completely still. It is for this reason that a short general anaesthetic, given by a specialist children’s anesthetist is sometimes necessary. Most children under the age of six years will require an anaesthetic.
Some children may require additional tests which will be discussed with you.
This second stage can take quite some time to complete, especially if the child is asked to try a different type of hearing aid which can lengthen the process. You will be in close contact with your keyworker who can inform you of how the various parts of the assessment are being organised.
Finally, there will be a meeting of the children’s cochlear implant team at the end of the assessment period. Whether or not the team consider a cochlear implant to be the best option for your child will be discussed, and if an implant is offered, then you have plenty of time to consider your decision.
A clinical psychologist may assess your child’s development.