Hearing implant assessment

Assessment overview

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. See below a summary of the assessment process.

Assessment process

Initial assessment

Appointment with Audiologist and/or Hearing Rehabilitationist to determine whether you meet the criteria for an implant, and if it would be of benefit to you.

Medical assessment

Appointment with the Specialist Nurse to determine medical suitability for an implant (up to 30 mins + any other appointments required such as blood tests).

CT / MRI head scan

Appointment can be at Addenbrooke’s Hospital, or another hospital in the surrounding area.

Team meeting

Individual cases are discussed within the Multidisciplinary Team to determine whether or not to offer an implant.

Clinic appointment with consultant

Your opportunity to meet the Consultant to be informed whether or not we are able to offer you an implant, and to discuss the risks of surgery.

Device information appointment

For cochlear implants only: an appointment with the rehabilitationist to explore expectations of hearing with a CI in more in depth, and to order your CI equipment.

After this assessment process, surgery can take place.

Assessment appointments

The assessment may include some or all of the following:

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.
CT Scan (Computerised Tomography) using X-rays to look at the bony parts of the ear including the inner ear, may be required.
MRI scan (Magnetic Resonance Imaging) to look at the hearing nerve 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 concerns with balance or dizziness.
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 making a final decision about hearing implants.
Medical consultations: a full medical history will be taken during this nurse led clinic. Tests which may be performed include blood pressure, pulse, temperature, height and weight, MRSA swab test, blood tests, and 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.

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. Some swelling or discomfort around the implant is not uncommon. This can normally be controlled by standard pain relief medication.

Post-operative check

All patients will be seen in clinic for a post-operative check with the specialist nurse approximately 2 weeks following the surgery. During this appointment the nurse will check the wound, remove the dressing and any stitches, and check any post-operative X- rays of the cochlea or facial bones where necessary. For patients with a bone anchored hearing aid, they will also demonstrate hygiene techniques, check there is no infection at the site, and tighten the abutment if necessary. During this appointment the nurse may recap any post-operative wound care and safety advice.

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, you can request an appointment at any time if you are experiencing any difficulties or notice any changes to your sound.

Rehabilitation

Once implanted, all cochlear implant recipients are 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 establishing consistent processor use, further 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.

More information can be found on our Rehabilitation page.

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. See the Implant Equipment Support page for more information.

Transferring care to and from other centres

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.

Further sources of information

Organisations offering further support and information: