Is a cochlear implant right for me?
There is a lot to think about when choosing if a cochlear implant is right for you. The assessment process helps you make an informed choice. Coming for an assessment does not mean you are going to have an implant. Attending an assessment is the best way you can get as much information as possible about your hearing solution options. Many people find it useful to further understand their hearing problems and solution options.
Things that may affect your suitability for cochlear implants, or the benefit you get from an implant are:
- how long you have had your hearing loss
- how your hearing loss has progressed over time
- the cause of your hearing loss
- your previous hearing aid use and duration of use
- your motivation to adapt and acclimatise to an implant
- your medical suitability for surgery
- your availability to attend multiple hospital appointments
The cochlear implant assessment process
There are multiple stages of the assessment process to ensure we can gather as much information about you and your hearing as possible. Remember, you are not committing to having an implant at this point and can stop the assessment at any time. If the assessments show a cochlear implant is unlikely to benefit your hearing, then you will not be offered an implant.
Referrals
People aged 15 years and older can be referred to for a cochlear implant assessment by an Audiologists, GPs, or Ear, Nose and Throat (ENT) Doctor. There is no age limit to be assessed for a cochlear implant.
The referral should include information on your hearing and hearing aid history (such as previous hearing test results, duration of hearing aid use and hearing aid types).
All implant centres in the UK are bound by national guidelines for selection criteria as published by the National Institute for Health and Clinical Excellence (NICE) in 2019.
Initial implant clinic
All referrals that meet the NICE criteria are invited to a Hearing Implant clinic, located in ENT outpatients, in the main hospital building. During this clinic you will meet some of the ENT Consultants, Implant Audiologists/Clinical Scientists and Hearing Therapists/Rehabilitation Audiologists.
Before you come
- you will get a questionnaire in the post about your hearing history. Please send the questionnaire back before you attend.
- you must bring your hearing aids with you. Please make sure they are working properly and that the attached ear mould(s) fit well.
- please bring a list of your medication.
If you are not suitable, the doctor will explain why, and consider any other options that may be available to you.
The hearing implant clinic
- first, an audiologist will test your hearing using a standard pure-tone test and some speech tests.
- next, you will see an ENT doctor. They will take a full history of your hearing difficulties and any ear problems you may have had.
- if the initial results and appointment suggest you could be suitable for a cochlear implant, we will arrange for you to have a full assessment.
- if you are not suitable, the doctor will explain why, and consider any other options that may be available to you.
Audiology assessment
The full assessment takes place in Queen Elizabeth Hospital Audiology Centre, in Nuffield House. The appointment is to identify if a cochlear implant is the right for your individual circumstances.
Please bring your latest hearing aids and well-fitting ear mould(s) to this appointment.
Appointment length: up to 1hour 30 minutes
A Cochlear Implant Audiologist will talk to you about your hearing history, use of hearing aids, understand your communication needs and the impact of your hearing loss. The Audiologist will do more tests, some you will have done before.
Tests include:
- standard hearing test
- test of word recognition
- test of speech recognition
- tympanometry (test on the middle ear)
- tests of hearing aid function
- test of lip reading
More appointments might be needed to collect all the information. These could include a hearing aid trial, hearing aid optimisation, balance testing and tests that measure the hearing system objectively. Your clinician will tell you if they need to arrange any of these additional tests.
At the end of this appointment, the audiologist will explain the test results and tell you if you are either within, or outside of NICE guidelines for cochlear implants. If an implant is not an option for you at this time, you will be discharged and do not need to attend any more appointments. Do not hesitate to get a new referral for another cochlear implant assessment should your hearing change in the future.
Rehabilitation (Rehab) assessment
Appointment length: up to 90 minutes.
A member of the Rehab Team will give you information to help you decide if a cochlear implant is right for you.
Topics include:
- explanations of different devices and your choices (including different technologies and colours)
- explanation of the surgery, the process and risks
- discussion on ear choice (Left or Right)
- discussion on what to expect from a cochlear implant
- discussion on your motivation to have a cochlear implant
- discussion on what support you have
- discussion and answers to any questions you may have
Scans
If the assessment shows you may be suitable for an implant, the doctor will order MRI and/or CT scans of your ears. There is an appointment for you to attend the imaging department at Queen Elizabeth Hospital Birmingham. The doctor uses the scans to check the ears and nerves are suitable for an implant.
Multi-disciplinary team meeting and decision clinic
You will get another appointment in the Hearing Implant Clinic, located in ENT outpatients, in the main hospital building.
Before this appointment, the Implant Team (ENT consultants, Cochlear Implant Specialist Nurse, the Rehab Team and Implant Audiologists) discuss your test results, scans and case history. The information will be considered to make a final decision on whether a cochlear implant is the right for you, and which ear is most suitable.
This ‘decision appointment’ is with an ENT doctor. If you are offered an implant, the surgery is explained again, you discuss which side is best to implant, and you will be asked to sign to consent for surgery. You could be offered a surgery date, or it would be sent in the post.
Cochlear implant surgery
The surgery details can vary depending on you circumstance and medical history.
The majority of cases include:
- pre-op assessment (within one week of surgery)
- surgery takes one hour
- done under General anaesthetic (can be under local anaesthetic if needed)
- day case surgery (can often go home the same day)
- minimum of one week off work
The switch-on
The ‘switch-on (day one)’ is two to six weeks after the implant surgery. The ‘switch on (day two)’ is one to two days after this. Appointments are at QEHAC, Nuffield House. Please bring someone with you.
Each appointment is with an implant audiologist, followed by a rehab audiologist straight afterwards. If possible, continue to use your hearing aid on the other ear, at the same time as the cochlear implant
Any sounds given by the implant are electrical in origin, this means the implant sounds electronic and unnatural. In the Switch-on week, it can be hard to understand and distinguish new sounds. Over time, you slowly learn to make sense of the signals, and the sounds become more pleasant, natural and meaningful.
In the programming appointments:
- set up of the external sound processor (which activates the internal implant)
- the sound processor is programmed by an Implant Audiologist on a computer
- you will hear quiet beeps. Occasionally this is felt as a sensation rather than a sound.
- the programming is needed to find the best settings for each implant user.
- the microphones on the processor are activated and you will try listening to live sound through your implant
- your brain adapts to the sound and the processor needs re-programming multiple times in the 10 days.
In the Rehab appointment:
- help you to understand and recognise the new sounds
- give you listening exercises to do at home
- explain how to get the most from listening with your new implant and sound processor.
- explain your new cochlear implant equipment
Programming visits
After the switch-on appointments, you have regular programming checks and follow-up appointments to review your progress. Each visit, you will usually be seen by an audiologist and a rehabilitation specialist in back-to-back appointments. You may have the sound processor re-programmed, repeated speech testing and device checks. You will discuss your progress and expectations. A member of the Rehab team will test your functional hearing and give you suitable rehab exercises and offer ongoing support.
Appointments are typically as follows:
- one week review
- three month review
- 12 month review
- on-going remote care checks (using remote care applications (apps) and email)
Additional appointments can be scheduled as needed. We do not offer a walk-in service, but if you need an urgent appointment, please contact us to arrange a short notice appointment.
Aftercare
Patients can contact us to request spares, repairs and troubleshooting advice.
In 2020 we established an on demand service. Most patients that have been using their implants for a long time do not need scheduled annual face to face reviews. This group of patients are welcome to contact us to book a review appointment as needed.
The remote care pathway allows some patients to access checks and tests of their implant from home, called ‘Remote Check’. See our Remote Check page for more details or contact us to find out if you are suitable to enrol onto Remote Check.
For those with complex needs or who do not have access to this technology, we offer face to face appointments either scheduled, or as needed.
We do not offer a walk-in service. If you need an urgent appointment, please contact us to arrange a short notice appointment.
Last reviewed: 03 August 2023