At all levels of the candidacy process, an attempt is made to
involve the patient in the decision-making process. For younger
adolescents, this may involve allowing them to meet with cochlear
implant users or other candidates and giving them age-appropriate
information about the process of receiving a cochlear implant. For
older adolescents, they may actually be involved in making the
final decision about receiving an implant. The candidacy process
strives to involve the entire family as well as any other
professionals involved in the adolescent's care.
Deciding if a cochlear implant is right for a patient involves
testing in many different areas. The main areas of concern are:
This includes assessment of the auditory system by an MRI or CT scan. A patient is also
evaluated for their fitness for surgery.
Hearing tests are performed on all patients to determine the
type and severity of hearing loss. Tests are also completed to
determine the amount of benefit a patient is receiving from their
hearing aids. Testing with words and sentences will also be done to
determine the amount of speech that a patient is able to understand
when using their hearing aids.
Speech and language development
Speech and language ability will also be tested for most
candidates. This assessment includes measures of how well a
patient's own speech can be understood as well as tests of how well
they are able to understand and use language. Reading skills are
usually tested as well.
The patient's own expectations are assessed at every step of the
candidacy process. Appropriate expectations predict better success
with a cochlear implant and it is important that the patient
understands what will be expected after they receive their
Several pre-operative visits will be needed to determine if a
cochlear implant is the right choice. The following list is not
exclusive, but it outlines many of the visits that candidates will
make prior to surgery. Each patient is different and visits are
likely to take place in a different order for everyone.
Once a referral has been received by the centre, the family will
be scheduled for an initial meeting. The purpose of this visit is
to: obtain a full history; describe the pre-operative process to
the family; discuss the cochlear implant and some of the risks and
benefits; and, complete some hearing testing. Patients and their
families will be given the opportunity to ask questions at this
visit and they will be given an idea of what to expect for the rest
of the process.
Depending on the patient's history and outcome of the initial
visit, the patient may be scheduled for more tests of their hearing
or ability to understand speech. A full battery of tests may be
completed including pure tone air and bone conduction
audiometry, tympanometry, hearing aid
assessment, speech perception measures and any other tests felt to
be necessary or relevant.
Speech and language assessment
In order to determine if a cochlear implant is a good option for
a patient, their current level of speech and language development
may be tested using formal tests.
Patients will be listed for a scan relatively early on in the
pre-operative process as the wait lists for scans can sometimes be
quite long. A scan is required before the consultant can determine
if a patient is suitable for a cochlear implant. Generally, an MRI
scan is recommended with a CT scan in addition if necessary.
Meeting with a consultant
All patients referred to the programme will be offered a meeting
with the ENT
consultant even if they are not going to get a cochlear
implant. If they are going to get an implant, they will be listed
for surgery at this visit. The consultant will also discuss the
medical risks of surgery and discuss the surgical process.
Other tests may include vision testing, psychological testing,
developmental assessment, or other specialist referrals as
necessary. Vaccination records will also be checked and any further
vaccinations that may be required will be requested from the
patient's own GP