In this section
The adult auditory implant centre manages patients of all ages once they have left school, college or university. The centre manages prospective adult candidates as well as current users of cochlear implants. Below is a summary of the team involved in patient care and the visits adult patients may be expected to attend as part of the cochlear implant assessment process.
Who we are
- Mr Simon Freeman, Consultant Otolaryngologist
- Prof Simon Lloyd, Consultant Otolaryngologist
- Prof Iain Bruce, Consultant Otolaryngologist
- Emma Stapleton, Consultant Otolaryngologist and Skull base Surgeon
- Unai Martinez De Estibariz , Audiologist and Co-ordinator of Adult Implant Team
- Dr Martin O’Driscoll, Clinical Scientist in Audiology, Head of Audiology
- Deanne Jayewardene-Aston, Clinical Scientist in Audiology
- Sarah Hornby, Audiologist
- Elizabeth Whittle, Audioloist
- Christine Melling Speech and Language Therapist
- Angela Fuller, Assistant Technical Officer
- Deniece Walker, Outpatient Coordinator
- Anne Stockbridge, Secretary of Cochlear Implant Programme
- Lianne Riley, Audiologist (Rehabilitation)
- Juleka Begum, Outpatient Co-ordinator
Pre-Operative
The main goal of the pre-operative assessment process is to determine if a cochlear implant is the best option for an individual. In general, if it is felt that a cochlear implant could provide more benefit to a patient than their current hearing aid (s) or residual hearing then they will be considered for an implant. Another goal of the assessment process is to provide the patient with realistic expectations about what an implant will do for them. This will allow them to make an informed decision about whether to proceed with an implant. Finally, the pre-operative process will determine a patient’s medical suitability for implant surgery and provide the patient with any relevant surgical information.
Initial Assessment
When an adult patient is referred to the centre, they are scheduled for an initial assessment. A full history will be taken, hearing aids will be checked and several different types of hearing tests will be performed. Tests will include pure tone hearing tests, tests of speech understanding, and an evaluation of hearing aid function where appropriate. Once the assessment has been completed, a recommendation will be made about whether or not a cochlear implant may be a good option. There will be lots of opportunity for the patient to ask any questions about the cochlear implant and the process of receiving one.
Further assessment
After the initial visit, more testing may be required. In some cases, a different type of hearing aid may be recommended and tried for a period of time. In other cases, an individual may not have been fit with a hearing aid and a hearing aid trial will be completed. Other tests that may be performed include objective tests of the auditory system (ie, auditory brainstem responses (ABR), otoacoustic emissions (OAE), acoustic reflexes, etc.) Cortical Auditory Evoked Potentials (CAEPs) as objective test.
Information Session
All adult cochlear implant candidates will attend an information session as part of the pre-operative process. This session used to be done as a group meeting, but due to COVID-19 pandemic we are currently offering this appointment only virtually or as an individual face to face appointment. These sessions allow candidates to receive information about cochlear implants. The topics covered include how the cochlear implant works; what to expect to hear with an implant; the surgery and risks and the opportunity to meet an implant user.
Scans
A critical component of the candidacy process are the Magnetic Resonance Imaging (MRI) and computer tomography (CT) scans. Once it is determined that a patient is or may be a candidate for a cochlear implant, the scans will be undertaken to ensure that the anatomy is suitable for an implant. The scans may be completed in Manchester or at a local hospital.
Other Consultations
Whenever needed, other assessments may be carried out by the team prior to a decision being made. These assessments may include vestibular testing (ie, testing of the balance function), psychological assessment, or other medical consultations as needed.
Multidisciplinary Team (MDT) Meeting
All patients who are referred for a cochlear implant and who undergo assessment are discussed at a multi disciplinary team meeting. The MDT consists of surgeons, audiologists and therapists with information from other healthcare professionals including radiologists and others. The team will discuss the findings of the asseessment and then decide whether or not to recommend implantation.
ENT Consultation
Once a patient has completed the pre-operative assessment and their case has been through the MDT meeting, they will be booked to meet one of the ENT consultants. At this visit, the scan results will be discussed and a final decision about implantation will be made. A discussion will also take place about the surgery and risks associated with the procedure. If a cochlear implant is recommended the patient will be listed for surgery at this visit.
Pre-surgical check
This appointment is at the hospital for a medical health check that will ensure the patient is safe to undergo a general anaesthetic and surgical procedure. If surgery under a general anaesthetic is not recommended, surgery under local can be considered in some cases. The anaesthetists and the cochlear implant surgeons will discuss this option with any prospective candidates.
Surgery
The surgery lasts about 2 hours. Patients are generally admitted to hospital in the morning, have their surgery in the afternoon and are discharged home in the evening. Some patients may need to stay in hospital a bit longer depending on their own health status. Most patients are advised to stay off work for approximately 1-2 weeks. During the pre-operative process, more information about surgery and the risks involved will be given to patients.
Post-Operative
Initial activation (switch on)
This visit will take place 3-4 weeks after surgery. At this visit, the external speech processor is fit and activated for the first time. This visit generally takes anywhere from 2-3 hours and it can be quite an emotional day for the patient and their family. While they will hear through the implant for the first time, the sound is likely to be very strange at first. It will take several weeks and months to get used to the new sound.
Subsequent Programming
Programming or Mapping of the implant will take place at 1 week, 1 month, 3 months and 9 months post-activation. Programming is when the audiologist works with the patient to determine the appropriate settings for the speech processor. A “Map” is created which tells the speech processor how to code the sound. Maps can change quite a bit over the first few weeks of implant use, so patients are seen frequently during this time. Maps are then monitored on a regular basis to ensure that the patient is receiving the highest quality sound that is possible for them.
Rehabilitation Sessions
During the first few months of implant use a great deal of learning must take place. When initially switched-on, the implant may sound very strange and an individual may have quite a bit of difficulty understanding speech or identifying environmental sounds. Habilitation sessions with a hearing therapist are offered for the first month of implant use and as needed after that to give the patient a chance to learn about their device and learn to use it effectively. Activities may include listening to recorded speech, using assistive listening devices or using the telephone. Patients are encouraged to bring their significant other or a communication partner to these sessions as practice for home will be given. The patient and the hearing therapist may decide to continue the sessions longer than the first month if desired.