Emmeline Centre for hearing implants

Ear, Nose and Throat

The Emmeline Centre is a specialist Hearing Implant Centre in East Anglia; serving patients in Cambridgeshire, Norfolk, Suffolk, Essex, Hertfordshire, Northamptonshire and Bedfordshire. Our multi-disciplinary team has highly experienced professionals from audiology, ENT, speech and language therapy, specialist education, and medical physics; together with any additional professionals appropriate to the individual.

Attend Anywhere video consultation

Did you know your outpatient appointment for this service may now be done by video consultation using Attend Anywhere. This enables you to be able to attend your appointment from home, saving you time and money.

Find out more about outpatient video appointments

Non-urgent advice: I need to cancel an appointment

If you are unable to attend an appointment for any reason, please contact us as soon as possible. Failure to attend appointments may delay your treatment, and could result in discharge.

We do not operate a drop-in service. If you wish to come in, please contact us first. We are not able to see you without an appointment.

Referrals

Referrals are accepted from ENT surgeons, GPs, audiologists, paediatricians and some other professionals. Referral criteria specific to each implant type (based on NICE guidelines) are available.

Referrals can be addressed to:

Head of Service
The Emmeline Centre
Box 163
Addenbrooke’s Hospital
Cambridge, CB2 2QQ
Tel: 01223 217589

Age of referral

Any age can be referred, and we welcome referrals before 12 months of age for assessments for cochlear implants.

Useful additional information to include:

  • Present and past audiograms
  • For paediatric testing, all ABR results (ideally to include tone pip testing at 1, 2 and 4 KHz)
  • Hearing aid information and any difficulties at present
  • Referrals made e.g. to Access to Work or Sensory Services

Before referral it is preferable if:

  • Any middle ear condition is resolved or in treatment.
  • Hearing aids have been optimally fitted according to national guidelines
  • Any areas of developmental or medical concern have been highlighted
  • Please contact us if you have any queries. We are happy to discuss.
  • Referral for cochlear implant, or auditory brainstem implant

Referral Criteria may include (based on NICE guidelines):

  • Profound hearing loss at 2 and 4kHz bilaterally (≥90dB)
  • Poor speech discrimination (<50% on sentences testing (BKB) at 70dBA)
  • Limited benefit from hearing aids
  • Paediatrics: failure to develop age appropriate speech and language and lack of benefit from hearing aids
  • Presence of cochlear Dead Regions
  • Presence of Auditory Neuropathy/dys-synchrony (AN/AD)

Referral guidelines for Bone Conduction Devices

  • Conductive or mixed hearing loss in one ear or both
  • Inability to wear conventional hearing aids (e.g. due to ear infections, ear malformations, etc)
  • Outer or middle ear problems
  • Single Sided Deafness or asymmetric hearing loss

Referral guidelines for Middle Ear Implants

Referral Criteria for those with SNHL in one ear or both:

  • Normal Tympanograms
  • Inability wear conventional hearing aids due to outer ear problems (e.g. exostoses, allergic to earmoulds, etc)
  • Preserved speech discrimination (>50% on AB Words) at a comfortable level (aided or unaided)
  • Stable hearing loss
  • Absence of active or chronic middle ear infection
  • Suitable middle ear anatomy assessed by CT scan

Referral Criteria for those with a Mixed or Conductive hearing loss in one ear or both:

  • Stable BC thresholds
  • Inability to wear conventional hearing aids (e.g. due to outer ear infections, ear malformations, etc)
  • Absence of active or chronic middle ear infection
  • Suitable middle ear anatomy assessed by CT scan

Assessment

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.

Devices we offer

The type of implant needed depends on the type and level of hearing loss.  If the problem is a poor sound conduction in the outer or middle ear, you may be considered for a Bone Conduction Implant or a Middle Ear Implant (MEI). If the problem is in the cochlea, you may benefit from a cochlear implant (CI).  Alternatively, for poor hearing nerve function, you may be considered for an auditory brainstem implant (ABI). It is important to discuss with your audiologist what your own level of hearing is and which type of hearing aid or hearing implant might benefit you.

Hearing implants are an option when conventional hearing aids are not able to give sufficient benefit. Below are the four types of implants we offer:

Cochlear Implants

A cochlear implant is a small electronic device that can help a patient with severe hearing problems to gain access to everyday sounds and the sound of speech.

The implant consists of a internal and external part. The internal part consists of an electronic package, a magnet and an electrode array. The external component is called a speech processor, this is worn behind the ear and connects to the implant via a magnet on the head.

The processor picks up the sound and converts this into digital information which is transmitted to the internal implant. The implant array is positioned within the cochlea. Along the length of the implant are tiny electrical contacts called electrodes.  Each electrode can give small electrical pulses to a specific part of the cochlea.  This triggers the auditory nerve and gives a sensation of sound. This then allows the person to have perception of sound and better understanding of speech.

Who is suitable for a cochlear implant?

This service is provided for both children and adults with a significant hearing loss and receive limited benefit from hearing aids. A cochlear implant may be suitable for those with either a congenital or an acquired hearing loss. Candidacy will depend on several factors such as the anatomy of the ear and general medical health.

Candidates with a profound hearing loss in the high frequencies, but aidable low frequency hearing may be suitable for Electro-Acoustic Stimulation (EAS). EAS combines the electric stimulation from a cochlear implant with an acoustic component from a conventional hearing aid.

For more information on the above please refer to our referral section.

Possible outcomes using a cochlear implant?

All implant users have different experiences of sound through their cochlear implants. An implant is able to give you access to sound, which your brain has to be trained to recognise. Adapting to the sound can take time and effort. It takes training and practice for sounds to be interpreted.

The factors below influence how well you/your child will do with the cochlear implant:

  • Age at implantation
  • Onset and duration of deafness
  • Educational setting and mode of communication
  • Additional disabilities
  • Commitment by the user
  • Local support (family and professionals)
  • A cochlear implant may help with:
  • Hearing sounds in the environment
  • Hearing speech
  • Improving the ease of listening
  • Improved hearing in background noise
  • Increased access to sounds in music
  • For children implanted at an early age, an implant may aid development of oral speech and listening skills
  • Monitoring the pitch and volume of your own voice
  • Using the telephone

Bone Conduction Implants

What is a Bone Conduction Implant?

A Bone Conduction Implant delivers sound via direct bone conduction to the inner ear, effectively bypassing the outer and middle ear. The term Bone Anchored Hearing Aid (BAHA) was used historically to describe bone conduction implants, however the term BAHA refers to a specific type and brand of bone conduction implant. A Bone Conduction Implant relies on a working cochlea to send sound to the brain. There are several bone conduction implants which may be suitable; each works in a different way. They all have a surgically inserted fixing point anchored to the skill and an external processor. The external processor converts the sound energy into mechanical movement of the implanted anchor. The fixture vibrates in the skull and so that the natural bone conduction (transmission) of sound to the cochlea can bypass the non-functioning outer or middle ear.

Who is suitable for a Bone Conduction Implant?

Candidates may include those:

  • With hearing problems in the outer or middle ears.
  • Those who are unable to wear conventional hearing aids due to ear infections or skin problems.
  • Those who are unable to wear conventional hearing aids due to ear abnormalities such as bony growths in the ear canal, a very narrow ear canal, or difficulty wearing ear moulds due to previous ear        surgery.
  • Single sided deafness.

Possible outcomes using a Bone Conduction Implant?

A bone conduction implant may help with:

  • Reducing the risk of ear infections or skin problems
  • Hearing without occluding ear moulds
  • Hearing sounds in the environment
  • Hearing speech
  • Monitoring the volume of your own voice
  • Lip reading
  • Using the telephone 
  • Enhanced music appreciation

More information on the above is available in the referral section. 

Middle Ear Implants

A middle ear implant is implanted in the middle ear and mechanically stimulates the inner ear. It is designed for candidates who are unable to use hearing aids for medical reasons. The middle ear implant system consists of two main parts: an internal and an external part.

The internal part is implanted during the surgical procedure. It consists of:

A receiver package, including a magnet
An internal component which is attached in the middle ear either to one of the bones in the middle ear, or attached near to the round window of the cochlea.

The external part is called the processor. It picks up sound from the environment, and transmits the signal across the skin to the implanted receiver. It uses a magnet to hold in position. The internal component adds extra movement to the natural hearing pathway. The sound is transmitted into the cochlea along this pathway.

Who is suitable for a Middle Ear Implant?

Candidates may include those:

  • With hearing problems in the outer, middle or inner ears
  • Those who are unable to wear conventional hearing aids due to certain types of ear infections, skin problems or ear mould allergies
  • Those who are unable to wear conventional hearing aids due to ear abnormalities such as bony growths in the ear canal or a very narrow ear canal

Possible outcomes using a middle ear implant?

  • Reducing the risk of ear infections or skin problems
  • More natural sound quality
  • Lack of feedback              
  • Absence of occlusion                    
  • Less distortion

Auditory Brainstem Implants

What is an Auditory Brainstem Implant

Auditory Brainstem Implants are designed for those with a profound hearing loss who are not able to use a cochlear implant. The auditory brainstem implant uses technology similar to that of the cochlear implant but instead of electrical stimulation within the cochlea, it stimulates the cochlear nucleus in the brainstem.

An auditory brainstem implant consists of two parts, an internal and external part.

The internal part is known as the electrode array or implant. It is inserted surgically, usually under general anesthetic.It consists of a receiver package with a magnet, placed under the skin above the ear; and an electrode array, placed in the brainstem.

The external part is known as the sound processor. It is worn behind the ear and consists of a sound processor with a microphone to pick up sounds and cable and circular coil held on the head by a magnet, which enable sounds to be transferred to the electrode array.

Who is suitable for an auditory brainstem implant?

An auditory brainstem implant may be suggested when the hearing nerve is absent or damaged. An auditory brainstem implant can give some access to sound as it bypasses the nerve of hearing and takes the sound signal directly to the brainstem.

This may apply to:

  • Some cases of acoustic tumors.
  • Some people diagnosed with NF2.
  • Those born without a hearing nerve.

Possible outcomes using an auditory brainstem implant:

All implant users have different experiences of sound through their implants. The degree of benefit cannot be guaranteed. It is a difficult task to position the auditory brainstem implant (ABI) on the brainstem exactly to deliver sound.  It is possible that there is no hearing sensation at all from the auditory brainstem implant. In other cases the response is within a narrow range so that sounds are not well differentiated. People listening with an auditory brainstem implant are very likely to need to lip-read as well. It takes time to adjust to the sound perceived through an auditory brainstem implant. 

An auditory brainstem implant may help with:

  • Hearing sounds in the environment
  • Monitoring the pitch and volume of your own voice
  • Lip reading: using sound alongside lip patterns to understand speech

More information on the above is available in our referral section.

Spares, repairs and maintenance

Spare equipment

You will be given a kit with any spare consumable equipment you may need; appropriate to the type of implant. If you need replacements please contact your managed services provider or the Equipment Support Team (as appropriate).

If parents and schools wish to keep extra spares in addition to the above, information on obtaining these direct from the manufacturer can be provided on request.

Batteries

Many processors are equipped with custom made rechargeable batteries. If your processor requires disposable batteries these will be provided by the Emmeline Equipment Support Team.

Help my implant isn’t working!

Just as for conventional hearing aids, sound processors can develop faults from time to time. If a sound processor develops a fault:

Firstly, we ask the patient/parent to identify the fault using the troubleshooting guidelines given at initial programming. Your device information booklet will help you to resolve any equipment problems. Remember you can always look at the implant company website too. If you are unsure, then please ask for advice.

If the problem persists or the patient needs advice, they can contact the Emmeline Centre Equipment Support Team or Managed Service provider (as appropriate).

If a sound processor has to be sent out by us, it is usually sent to the patient's home address. If delivery to a different address is preferred please state this clearly. Please have address details handy when calling us.

A sound processor is an expensive item of equipment, therefore, it is important that broken or faulty speech processors are returned without delay.

Holiday Loans

If you are planning on going abroad, and would like a spare speech processor to take with you many of the implant manufacturers provide a holiday loaner service that you can use, for a charge. To request a holiday loan, please contact the implant company directly.

Once the company has received this information they will then ask the Emmeline Centre to forward your/your child's processor settings to them.

Please be aware that all companies need sufficient time to process your request:

Lost or damaged processors

The NHS provides speech processors on a permanent loan basis; they are not the personal property of the patient. NHS equipment should always be returned when it is no longer needed. In order to avoid unnecessary costs, the Emmeline Centre now has a strict policy regarding broken or lost sound processors.

If you think you have lost your processor; Search everywhere, ask everyone, retrace your steps and think of all the possibilities of where it can be!

As soon as you are aware of the loss, and your searches have been unsuccessful, please contact the Emmeline centre. When you contact the Emmeline centre you will be asked about the circumstances of the loss. You will usually be contacted by a senior clinician, the same day if possible. A replacement processor will be issued at the Centre, or (exceptionally) by post [as agreed with the senior clinical staff]. An appointment may be arranged to discuss processor wear and handling. If you later find the processor, please inform the Centre immediately. You may be asked to pay an administrative fee before the replacement processor is provided.