Referral and assessment

Referrals to the Nottingham Auditory Implant programme (NAIP) are accepted from ENT surgeons, GPs, audiologists, paediatricians and some other professionals.  

Quick referral guide for cochlear implant assessment

Patient referral form (optional)

We have a multi-disciplinary approach to assess whether cochlear implantation is the best way forward for anyone referred to us. Our clinical team includes professionals from audiology, ENT, speech and language therapy, specialist education for the deaf and psychology. We have access to the services based at Nottingham University Hospitals as required, such as medical physics and radiology, together with any additional professionals appropriate for each individual patient.

At each stage, we involve the patient, their families and local support services, as appropriate, in the assessment process.

We use slightly different assessment criteria for children and adults but both follow the guidance published by the National Institute for Health and Care Excellence (NICE)

NICE guidance

 

Children

Referrals for paediatric assessment for cochlear implantation are accepted from local ENT surgeons and other appropriate medical and audiological consultants (according to locally agreed protocol), but can also come from GPs, audiologists, teachers of the deaf or other professionals.

We consider children of all ages from babies to young people up to the age of 19. The length of time a child has been deaf should not prevent a referral being made.  However early referral for young children is important to obtain the best possible outcomes.

Refer me early

Every child accepted onto the Nottingham Auditory Implant Programme, undergoes careful multidisciplinary assessment. The guidelines and criteria which are considered include:

  • The child should undergo a minimum of a 3 month optimised hearing aid trial. In exceptional cases, such as those deafened by meningitis and certain other circumstances, this requirement may be waived. Referrals are accepted prior to this hearing aid trial
  • The child will typically have a profound sensorineural hearing loss ie greater than 90dB(HL) at 2 and 4kHz. In exceptional circumstances, for instances of certain causes of deafness, individuals with better hearing levels may be considered.
  • The child will typically fail to develop, progress or maintain speech, language, communication and listening skills appropriate to their age, development and cognitive ability.

 

Adults

Referrals for adults aged 19 years and above are accepted from local ENT surgeons, but can come from GPs, audiologists or other professionals, in agreement with the individual concerned.

We consider adults of all ages. Those with a long duration of deafness will be considered on an individual basis.

All adults accepted onto the Nottingham Auditory Implant Programme undergo careful multidisciplinary assessment. The guidelines and criteria which are considered include:

  • Candidates should undergo a minimum of a 3 month optimised hearing aid trial. In exceptional cases, such as those deafened by meningitis and certain other circumstances, this requirement may be waived. Referrals are accepted prior to this hearing aid trial
  • Patients with severe-profound hearing loss bilaterally, who obtain little or no benefit from hearing aids, are considered. Typically, candidates will have a profound sensorineural hearing loss ie greater than 90dB(HL) at 2 and 4kHz in the better hearing ear. In exceptional circumstances, for example, certain causes of deafness, individuals with better hearing levels may be considered. Occasionally, an auditory brainstem response (ABR) assessment may be required which is a different way of testing how well a patient can hear.
  • Speech discrimination with hearing aids is also assessed alongside information about the impact of the hearing loss on everyday life, practically and emotionally.

 

'Ski-slope' hearing loss

Technology has progressed at a rapid pace and there are now devices that combine a cochlear implant with a hearing aid known as a 'hybrid' speech processor. These are suitable for patients that have a profound hearing loss in the high frequencies ( >90dbHL at 2 and 4kHz) but still have significant residual hearing in the mid to low frequencies ie a 'ski-slope' hearing loss. The device combines the benefits of more 'natural' sound from the hearing aid and access to the high frequencies through the cochlear implant that hearing aids struggle to provide. The high frequencies are crucial in speech understanding, particularly consonants such as 'f' or 's'.

 

 

 

NHS Nottingham University Hospitals
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