In this section
Our Team
- Mr Simon Freeman, Consultant Otolaryngologist
- Prof Simon Lloyd, Consultant Otolaryngologist
- Prof Iain Bruce, Consultant Otolaryngologist
- Jaya Nichani, Consultant Otolaryngologist
- Lise Henderson, Certified Auditory-Verbal Therapist®, Speech and Language Therapist, Co-ordinator Paediatric Cochlear Implant Programme
- Helen Ley, Speech and Language Therapist, LSLS Certified Auditory Verbal Therapists®
- Emma Gray, Speech and Language Therapist,LSLS Certified Auditory Verbal Therapists®
- Jayne Jones, Speech and Language Therapist, LSLS Certified Auditory Verbal Therapists®
- Rebecca Bentley, Teacher of the Deaf, LSLS Certified Auditory Verbal Therapists®
- Morag Lockley, Clinical Scientist in Audiology
- Kerri Millward, Clinical Scientist in Audiology
- Deanne Jayewardene-Aston, Clinical Scientist in Audiology
- Elizabeth Whittle Clinical Scientist in Audiology
- Mark Sladen Clinical Scientist in Audiology
- Craig Went, Audiologist
- Tamasin Brown, Audiologist
- Angela Brown, Assistant Technical Officer
- Andy Cooper, Assistant Technical Officer
- Deniece Walker, Outpatient Coordinator
- Anne Stockbridge, Secretary of Cochlear Implant Programme
- Georgina Anderson, Speech Therapy Assistant
Referral Criteria
Please see NICE Guidance for current referral criteria.
Some children may have a progressive or acquired hearing loss while others may have been born with hearing loss.
Sudden, acquired hearing loss
Children with a sudden hearing loss should be referred to the programme immediately. Children who have lost their hearing due to meningitis are placed in a fast-track option which enables surgical priority if necessary. This is due to the risk of ossification (bony growth in the cochlea) after meningitis , which can make insertion of a cochlear implant array difficult. Sudden hearing loss due to head trauma should also be referred promptly.
Congenital Severe to Profound Hearing Loss
Children who were born with a severe to profound sensorineural hearing loss and who receive no benefit from hearing aids are accepted for referral until the age of four. When children have a hearing loss at birth, we know that the earlier a child receives an implant the better their outcome will be.
Children over the age of four with congenital hearing loss should only be referred if they have used hearing aids for development of spoken language. Children will be considered on an individual basis, and if it is felt that a cochlear implant may provide them with more benefit than their current hearing aids an implant may be considered an appropriate option for them..
There is no minimum age limit for referral. The programme welcomes referrals of children who are suspected of having a significant hearing impairment even if they are very young and the extent of their hearing loss or progress with hearing aids is still unknown. This allows us to begin the process at the same time as local services and be able to determine candidacy as early as possible.
Progressive Hearing Loss
Children who have had some benefit from hearing aids in the past but whose hearing has deteriorated to a point where hearing aids are no longer useful will be accepted by the paediatric programme up to the age of 10. (Over 10 years of age, referrals should be made to the adolescent team).
Hearing Aid Trial
We recommend that very child completes a hearing aid trial where there is measurable residual hearing. The goal of the trial should be full time hearing aid use with an aid that is suitable for the type and degree of hearing loss. The child does not need to finish this hearing aid trial prior to referral to the team and we can offer the family help to encourage full time hearing aid use if needed.
The Assessment Process
The main goal of the 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 for learning language and communication then they will be considered for an implant. Another goal of the assessment process is to provide the patient and family 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 a child 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 depending on the child’s age and development. Tests will include pure tone hearing tests, an evaluation of hearing aid function, and tests of response to speech or speech understanding where appropriate. It may take more than one appointment to complete the audiological assessment depending on the child’s age, ability and needs.
We recommend that very child completes a hearing aid trial where there is measurable residual hearing. The goal of the trial should be full time hearing aid use with an aid that is suitable for the type and degree of hearing loss. The child does not need to finish this hearing aid trial prior to referral to the team and we can offer the family help to encourage full time hearing aid use if needed.
Further assessment
After the initial visit, more testing may be required. Other tests that may be performed include objective tests of the auditory system (ie, auditory brainstem responses (ABR), otoacoustic emissions (OAE), acoustic reflexes, etc.
Information Session
All families will be required to attend an information session to ensure they fully understand the benefits and limitations of the cochlear implant and are aware of the assessment process and surgical procedure.
These sessions allow families 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 look at the internal device and speech processor.
The sessions are often in small groups but can be one to one if required. They may be carried out over a video call or can be face to face in the department. Interpreters can be arranged as required.
Developmental Progress
A child’s developmental progress and in particular speech, language and communication is an important factor to be considered. It is necessary to have a full and accurate picture of a child’s speech and language development with traditional hearing aids. We can then make a prediction about their ability to develop language with a cochlear implant. For the youngest patients, this may not be a separate, formal assessment, but an informal evaluation. For older children, this may consist of standardised tests in a more formal setting.
If a child is not making expected progress with their hearing aids, they may be scheduled for diagnostic habilitation sessions. The purpose of these sessions is to evaluate a child’s ability to learn through listening and to find out if there are factors which may affect their ability to succeed with a cochlear implant.
Family
A family’s readiness and acceptance of the process of cochlear implantation is essential. During every step of the assessment process, the family will be fully involved in the decision-making process. Every effort will be made to ensure that the pre-operative process is family-centred.
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. If your child has already had a scan carried out we will request access to that information and it may not be necessary to do further scans as part of the assessment.
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 assessment 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 is an appointment at the hospital for a medical health check that will ensure the child is safe to undergo a general anaesthetic and surgical procedure.
Surgery
The surgery lasts about 2 hours. Patients are generally admitted to hospital in the morning, have their surgery and are discharged home in the evening. Some patients may need to stay in hospital a bit longer depending on their own health status and distance from the hospital.
Post-Operative
Information will be given to you when you leave the hospital regarding wound care. You will not routinely be reviewed by the ENT consultant after surgery but you will be asked to send a photograph of the wound to the department.
Initial activation of the speech processor usually occurs 7-10 days after the operation. Older children who have established consistent hearing aid use will have both their processors activated on the same day. Separate appointments for younger children will be made to activate their processors.
Habilitation appointments
A cochlear implant can give access to all the sounds of speech. We then work together with families to enable the child to learn to listen and to use their listening skills, to their full potential, and to develop communication and spoken language as appropriate. Every child and family is offered a series of habilitation appointments. We are able to offer a range of habilitation options, depending on the child’s and families individual needs. Five of our habilitation team are Certified Auditory Verbal Therapists. This is an approach which maximises development of spoken language through auditory learning.
Programming appointments
Children will receive regular appointments to ensure their speech processors are optimally set to allow them access to environmental sounds and given them access to spoken language.