Assessment

All patients referred for a hearing implant will have a comprehensive assessment. The aim of the assessment process is to determine the best hearing option for each individual. The processes will vary based on the type of hearing loss and type of implant that you are being assessed for. The process can also be slightly different depending on whether the patient is a child, teenager or adult. We ensure that the candidate and their family / carers are involved at each step. The assessment consists of various components, with different members of the team. The length of the assessment will vary from person to person.

The assessment may include:

  • Otoscopy: Visually checking the health of the ear canal and ear drum using an otoscope (light source and magnification)
  • Hearing tests: Measuring the quietest sounds you/your child are able to hear. The hearing test will be similar to tests you/your child will have done in the past.
  • Tympanometry: Assessing the condition of the middle ear and ear drum. Some people know this as a pressure test.
  • Objective hearing assessment: Assessing the responses of the cochlea and the hearing nerve. Unlike a normal hearing test, you do not need to respond to the sound. Sticky pads placed behind the ears and on the head measure the response of the hearing pathway to sound. The test requires patients to lie quietly so in some young children the tests may be done under sedation or anaesthesia.
  • Speech detection and discrimination testing: Evaluating the detection and discrimination of different speech sounds, words and sentences.
  • A CT Scan (Computerised Tomography) using X-rays to look at the bony parts of the ear including the inner ear, may be required.
  • An MRI scan (Magnetic Resonance Imaging) to look at the nerve of hearing and the structure of the inner ear, may be required.
  • Speech, language and listening skills assessments: various assessments will be conducted to determine the level of language development, to assess communication problems and determine if any additional equipment may improve hearing and communication.
  • Vestibular assessment: To assess any problems with balance or dizziness concerns.
  • Hearing aid changes: during the assessment we may need to change/upgrade the hearing aids being worn. If so, we may monitor the progress with the adjusted/new aids before finalising a decision about hearing implants.
  • Medical consultations: Tests that may be performed include a standard electrocardiogram (ECG) to tract the heart rhythm, this may be done under sedation or anaesthesia in young children.

During the assessment there is also the opportunity to discuss the different treatment options, ask questions and when possible contact a current implant user to learn about their experience.

Results Appointment

Once the assessment has been completed the results are reviewed by the team at our Multi-Disciplinary Team Meetings, to consider if a hearing implant is suitable. Most patients have an appointment to see a surgeon who will explain the results of the assessment, the team decision and discuss the operation and its risks. The patient can then decide whether they would like to go ahead with an implant. Some patients may not have an appointment with the surgeon, for example if they are not suitable for an implant, or have decided they do not wish to proceed with an implant.

Surgery

Surgery for an implant is considered routine and the side effects are limited. Patients and parents/carers will be fully advised of the risks of surgery prior to giving consent and every opportunity will be given for patients and their families to ask questions.

Most patients attend a pre-admission clinic, when you will meet a nurse practitioner. At this clinic, we will ask for details of your medical history and carry out any necessary clinical examinations and investigations to ensure you are fit for surgery.

Most people are able to go home on the same day, although some do need to stay in hospital overnight. Most operations are performed under general anaesthetic however in some cases it may be done under local anaesthetic (e.g. some adult bone anchored hearing aids). Some swelling or discomfort around the implant is not uncommon. This can normally be controlled by standard pain relief medication.

Programming for implantable devices

A few weeks after surgery, the sound processor is programmed for the first time. Initially there are regular programming appointments to adjust the sound. During the first year after implantation, there may be frequent appointments to monitor and ensure optimal progress and performance. After the first year, recipients are usually seen annually to check the implant/s and ensure they are hearing optimally, as well as to address any difficulties they may be experiencing. You can also make additional appointments if they are needed.

Rehabilitation

Once implanted, recipients may be offered auditory rehabilitation, to help them get the most from their implant/s. Rehabilitation ensures that you are detecting, identifying and discriminating sounds using your hearing implant. Rehabilitation will be tailored to each individual. This may include guidance on listening devices that may help at school, work or home, such as loop and FM systems. Auditory training may give advice on managing equipment and specific situations, such as help using the telephone and listening to music. Advice will also be given to family members on communication tactics when speaking to hearing impaired people. For children, the rehabilitationist will also liaise with their Teacher of the Deaf, nursery, school or college.

On-going care and maintenance

On-going support such as repairs and replacement parts may be provided via the manufacturer known as managed services, or by the Emmeline centre.

Transferring care to / from other programmes

If you move to our catchment area, a referral can be made for your care to transfer to our service. It is important that a referral is made so that we can request all of the information about your implant, its settings, and funding to ensure you get the best possible care.

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