Organising a CT scan of the ears for your patient locally is very helpful and our team will be able to review this on the National PACS Archive. Depending on your local radiology department, the scan could be called a CT temporal bone, CT mastoid or CT IAM. If unsure, it is best to check with your radiologist or CT radiographers to confirm which exam code to use.

Ideally, CT imaging for cochlear implant workup should be:

· high resolution

· sub-mm slice thickness

· volumetric (so it can be reconstructed in multiple planes)

· reconstructed at the time of scanning with a "bone window" algorithm (most CT departments will have this as standard protocol)

· non contrast is fine

A standard CT head may also be sufficient for use, but it must have the bone window reconstruction to maximise the visibility of the auditory structures.

Additional MRI scanning can be useful in a small number of adults e.g. in cases of meningitis, autoimmune hearing loss or sudden onset sensorineural hearing loss. The surgically important imaging findings are in relation to fibrosis of the cochlear scala.

This is best seen on a dedicated IAM study which is:

· high resolution

· heavily T2 weighted

· volumetric

Please send a copy of the patient's ABR assessment if available

Please send us your diagnostic ABR.  This can avoid the need for later ABR under general anaesthetic.

High-resolution MRI is essential to assess inner ear anatomy, cochlear nerve integrity, and surrounding central structures before cochlear implantation in children.

· The ideal scan is a high resolution IAM sequence with whole brain and brainstem imaging.

· Your local radiology department will have a standardised protocol for MRI head which will cover all of the relevant sequences to look for central brain pathologies. Please ensure this is done along with the high resolution IAM.

Organising an MRI scan for children before referral is very helpful and can help speed up the assessment process for cochlear implantation. Time saved on early implantation can have significant benefits for hearing outcome.

Please attempt feed and sleep MRI in babies <4 months old as this can avoid the need for later imaging under GA. When doing this we recommend

· Completing the IAM sequence first (most useful in terms of congenital cochlear malformation and surgical planning)

· Other sequences are still important for looking at other causes of hearing loss but are not as high resolution, therefore not as susceptible to movement artefact.

Children with significant bilateral hearing loss should have an ECG to rule out the rare possibility of a prolonged QT interval seen with Jervell and Lange–Nielsen syndrome. This can cause fatal cardiac arrythmias and it is important to exclude before the child has any general anaesthetic.

Please send a copy of this on to us at the time of referral

Identifying the cause of hearing loss before referral helps predict cochlear implant outcomes, guide surgical planning and ensures families receive accurate counselling. Usually this process has already been started by the child’s local paediatrician/ ENT doctor.

We are happy to obtain and send any outstanding blood tests at the time of the child’s general anaesthetic for cochlear implantation. Please complete and send any request forms (either by post or with parents) to ensure the correct tests are requested.