Cochlear implant programme

The Cochlear Implant Programme (CIP) at Great Ormond Street Hospital (GOSH) accepts referrals for children with congenital or acquired losses which are within the severe/profound categories. We accept referrals from birth to 15 years of age.

• The audiological criteria is based on the child’s aided hearing levels when using appropriately fitted high powered hearing aids. Referrals will be welcomed for children where their hearing thresholds are 80dB or more at 2 or more frequencies between 500Hz - 4kHz in both ears.

• Duration of deafness is an important factor:

Congenital: worldwide results show that in general the best outcomes are obtained from children implanted under five years of age. Occasionally older children may be suitable.
Acquired: The best outcomes are obtained from children who are implanted at three years or less following onset of deafness. Immediate referral of post-meningitic children is essential. The very best results are obtained where children are implanted as soon as possible following meningitis.
Progressive: Children of all ages with progressive losses also require prompt referral. A number of assessments are required in order to determine the suitability of each prospective child for cochlear implant surgery.

• All children will normally be expected to have worn appropriately fitted high powered hearing aids for a period of time before a final decision can be made on the benefit provided by their hearing aids vis a vis the potential benefit of a cochlear implant.

The assessments will differ slightly depending on the child's age, the cause of their hearing loss, how much useable hearing they have and how they currently communicate. These tests are carried out at GOSH and will be evaluated in conjunction with any tests conducted by a child’s local services.

The combined results of all of these tests allow the cochlear implant team to advise families on the appropriate management and expected benefits they may receive from the device.

There is a pathway that a child follows once referred to the cochlear implant team and below provides a brief outline of this patient care pathway.

When a child is first referred for an assessment to determine suitability for cochlear implantation, it is important to determine exactly how much can be heard using the best available hearing aids. Even if a child dislikes their hearing aids and appears to be gaining little benefit from them it is essential the cochlear implant team is able to assess what they are capable of doing with consistent hearing aid use.

It is rare for hearing aids to provide absolutely no benefit.

Implantation will only be considered if benefit from consistent use of hearing aids is extremely limited, and a cochlear implant is anticipated to provide better access to speech and environmental sounds. At this stage a detailed assessment of speech and language abilities together with educational requirements is carried out.

The family are also counselled and informed at this stage about the implant, deafness, the assessment procedure and the aims of the intensive rehabilitation programme required after surgery.

Medical investigations are also carried out in order to identify the cause of hearing loss with CT scanning and MRI scanning of the cochlea and hearing nerve. This also helps to determine if the insertion of the cochlear implant electrodes will be anatomically possible.

To obtain all of this information there will be multiple appointments at GOSH, and may include a home, nursery or school visits. The cochlear implant team will attempt to minimise hospital visits wherever possible.

Once the cochlear implant team has evaluated all the test results, discussions will be held with the child’s family to review whether cochlear implantation is recommended. Families are then encouraged to decide if they would like to proceed with implantation.

If a family decides cochlear implantation is a procedure they would like their child to have they will meet with one of the ear, nose and throat surgeons associated with the programme to discuss the surgical procedure.

Cochlear implantation is carried out as a single stage (one operation) procedure and children are admitted to the Peter Pan Ward in the Southwood Building for about three days.

A number of services are provided to children and their families to assist in optimising their hearing and helping them adapt to and incorporate their cochlear implant into their daily lifestyle. Rehabilitation post-implant is comprehensive and incorporates device programming, speech and language therapy, educational and psychological intervention where required.

Home and school visits may be included in a child’s post implant programme. Furthermore a child’s performance with their cochlear implant will be monitored and assessed regularly at GOSH.

Ongoing programming of the cochlear implant and audiological management is provided to ensure optimal benefit is achieved and maintained from the cochlear implant device.
Maintenance services also include provision of replacement parts, batteries and arranging repairs for broken equipment. Children are provided with regular assessments on a once or twice yearly basis.