Referrals

Most of our referrals come from audiologists (both NHS and private), ENT doctors and community paediatricians. This is because they are usually best able to provide the information we ask for in our referral form which can be accessed here:

We also welcome referrals from other medical professionals involved in an individual’s care (for example, their GP).

Candidacy

Cochlear Implant assessment looks at whether an individual is likely to get more benefit from a cochlear implant than they do from their hearing aid(s). We look at whether they meet the current NICE criteria which can be found here

If you are unsure whether someone meets criteria or if there are other complexities, or if you would like to discuss a potential referral further with us, please contact the clinic.

Pre-referral Assessments

Before referring a patient for cochlear implant assessment, completing key investigations can significantly streamline the process, support timely decision making and improve safety and outcomes. These assessments provide essential information about a patient’s overall health and suitability for surgery. While these assessments are recommended, please do not delay a referral if you don't have all of this information to hand. We can work with you to ensure that all relevant assessments are completed.

In the sections below, you’ll find detailed guidance on which tests are recommended.

For Adults

CT

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.

MRI

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

Auditory Brain Stem Response

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

For Paediatrics

ABR

For UNHS referrals and those not able to give reliable conditioned responses:

Please complete ABR prior to referral
ABR should evidence thresholds at 2 frequencies ≥80 dBeHL in both ears
ABR should include BC
ABR should include cochlear microphonics if indicated
Include tympanometry results from the day of ABR testing (if available).
Please include a copy of all ABR traces and reports completed as part of assessment
This will be reviewed, if it is incomplete we will request that further assessment is carried out locally before a referral is accepted

Older paediatrics who are giving reliable conditioned responses:

Please send a copy of any ABR traces and reports completed as part of assessment

MRI

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.

MRI should be completed prior to referral
This will be reviewed, if there isn’t sufficient detail we will request that this is repeated locally before a referral is accepted. Organising an MRI scan for children before referral will speed up the assessment process for cochlear implantation. Time saved on early implantation can have significant benefits for hearing outcome.

Advice for feed and sleep MRI in babies <4 months old

A feed and sleep MRI in babies < 4m old 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.

ECG

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

Aetiology assessments

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.