1. Cochlear implants: who to refer and what to expect when you do
Tracey Twomey
Consultant Clinical Scientist
Nottingham Auditory Implant Programme
Chair BCIG

2. Who can refer?
Outlined in NHS England’s Service Specifications for Cochlear Implants D9a GP
NHS or private audiology service
ENT service
Paediatrician

3. CI candidature Governed by NICE TA166 (January 2009)
Unilateral cochlear implantation recommended for:
Severe to profound deafness
Hearing only sounds > 90 dB HL at frequencies of 2 and 4 kHz without acoustic hearing aids
Inadequate benefit from acoustic hearing aids:
Adults: a score of <50% on BKB sentence testing at a sound intensity of 70 dB SPL
Children: speech, language and listening skills not appropriate for age, developmental stage and cognitive ability
Bilateral cochlear implantation recommended for:
Children for whom it is clinically appropriate
Adults with multisensory impairment (primarily deaf-blind)
Outside of these criteria, exceptional request for funding can be made

4. Referral criteria≠ implant criteria
Not always the same
Functional hearing is key eg ANSD
Evidence of what the child can hear
What meaning they can ascribe to sound
Contact your CI centre for advice
Hints and tips for making a CI referral

10. British Cochlear Implant Group
How can we make our website more useful?

11. There is no upper or lower age limit for referral
Assessment: around 40
Implanted: around 280

12. Other considerations Asymmetry Severely sloping losses
Close to borderline
Look for overall functional profound deafness
Single sided deafness (SSD )
Not routinely funded
Current multi-centre trial
Severely sloping losses
Combined CI/HA (EAS)
Limitations to hearing preservation
Risk of progression of underlying HL
Adults rarely qualify due to NICE BKB criterion
Those with no auditory experience / language may be declined

13. What to do before referral
Prompt referral recommended
Refer urgent cases immediately
Meningitis
Sudden onset
If possible
test >90dBHL, include 2&4kHz
BKB at 60dBSPL (adults)
Optimised hearing aid trial
Manage CHL
Begin managing other health needs
Contact CI centre for any advice

14. Patient ‘misconceptions’ Not for congeni-tally deaf
Wrong age
Not for congeni-tally deaf
Funding problems
Additional needs
Surgery is risky
Brain surgery
Sounds like a Dalek
It will change who I am
I will learn to talk
Too drastic
Long wait
Not for me

15. Professional ‘misconceptions’ Wrong age Not for congen-itally deaf
Funding problems
Additional needs
Surgery is risky
Someone else will refer
Hearing aids are better
Previously declined
High/low
expect-ations
Too drastic
Long wait
Not for you

16. Generic CI assessment pathway
Initial assessment
(audiology)
Initial rehab
F/U rehab
F/U Audiology
MDA
Surgery
Initial SLT
F/U SLT
Imaging
MRI/CT
(Psychology)
Local assessments

17. Working in partnership
If in doubt, discuss potential referrals with CI centre
Collaborative assessment
Provide your expertise
(HAs, tinnitus, dementia…)
Patient-centred, seamless service
RTT clocks – under pressure!
Joint support (bimodal patients after CI)
Give us feedback!