We use cookies to help us improve the website and your experience using it. You may delete and block all cookies from this site at any time. However, please note this may result in parts of the site no longer working correctly. If you continue without changing your settings we will assume you are happy to receive all cookies on this site.


Referral Criteria

Referral criteria is different for different children. Some children may have a progressive or acquired hearing loss while others may have been born with hearing loss.Paediatric2

Sudden, acquired hearing loss

Children with a sudden hearing loss should be referred to the programme immediately. Due to the risk of ossification(bony growth in the cochlea) after meningitis which can lead to surgical problems, children who have lost their hearing due to meningitis are placed in a fast-track option which enables surgical priority if necessary. Sudden hearing loss due to head trauma should also be given priority in referral.

Congenital Severe to Profound Hearing Loss

Children who were born with a severe to profound sensorineural hearing loss and who receive no benefit from hearing aids are accepted for referral until the age of four. When children have a hearing loss at birth, we know that the earlier a child receives an implant the better their outcome will be. It would be very difficult and unlikely for a child who receives an implant after the age of four years to develop the ability to use spoken language if they have never used speech before.

Children over the age of four with congenital hearing loss should only be referred if they have utilized powerful hearing aids for development of spoken language. Such children will be considered on an individual basis, and if it is felt that a cochlear implant may provide them with more benefit than their current hearing aids, they may be considered for candidacy

There is no minimum age limit for referral. The programme welcomes referrals of children who are suspected of having a significant hearing impairment even if they are very young and the extent of their hearing loss or progress with hearing aids is still unknown. This allows us to begin the process at the same time as local services and be able to determine candidacy as early as possible.

Progressive Hearing Loss

Children who have had some benefit from hearing aids in the past but whose hearing has deteriorated to a point where hearing aids are no longer useful will be accepted by the paediatric programme up to the age of 10. (Over 10 years of age, referrals should be made to the adolescent team). The team welcomes early referrals for children who are getting only limited aided benefit, even if it is felt that a cochlear implant may not be the best immediate option for the child.

Candidacy & pre-operative visits

The cochlear implant team determines candidacy by comparing a child's performance with traditional hearing aids with the performance that would be expected with a cochlear implant. If we feel that a cochlear implant offers a better chance for learning language, then we consider it a suitable option. The main areas we test when determining candidacy are:

Medical candidacy

This includes assessment of the auditory system by an MRI or CT scan. In order for a child to benefit from a cochlearimplant, the cochlea must be patent (or open) and an auditory nerve must be present. A child is also evaluated for their fitness for surgery.

Audiological candidacy

Hearing tests are performed on all candidates to determine the type and severity of hearing loss. Tests are also done to determine the amount of auditory benefit a child is receiving from their hearing aids.

Hearing aid trial

Every child must complete a hearing aid trial before their candidacy can be determined. This trial should consist of full time hearing aid use with an aid that is suitable for the type and degree of hearing loss. A child does not need to finish this hearing aid trial prior to referral to the team and we can offer the family help to encourage full time hearing aid use if needed.

Speech and language development

A child's speech and language performance is probably the most important factor in determining candidacy. It is necessary to have a full and accurate picture of a child's speech and language development with traditional hearing aids. We can then make a prediction about their ability to develop language with a cochlear implant. For the youngest patients, this may not be a separate, formal assessment, but an informal evaluation. For older children, this may consist of standardised tests in a more formal setting.


A family's readiness and acceptance of the process of cochlear implantation is essential. During every step of the assessment process, the family will be fully involved in the decision-making process. Every effort will be made to ensure that the pre-operative process is family-centred.

Pre-Operative vists

Several visits will be needed to determine if a cochlear implant is the right choice. The following list is not exclusive, but it does outline many of the visits that patients will make before surgery. Every child is different and visits are likely to take place in a different order for everyone.

  • Initial meeting
  • obtain a full history
  • describe the pre-operative process to the family
  • discuss the cochlear implant and some of the risks and benefits
  • if time permits, begin preliminary testing

Once a referral has been made to the centre, the family will be scheduled for an initial meeting. This meeting is generally attended by the family and at least two members of the paediatric cochlear implant team. The purpose of this visit is to:Parents 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.

Further audiology

Usually, the child will be scheduled for further testing of their hearing after the initial meeting. Information will be gathered about the type and severity of hearing loss and the benefit of hearing aids. This will take place over several sessions if necessary. A full battery of tests will be completed including pure tone air and bone conduction audiometrytympanometry, hearing aid assessment, otoacoustic emissions (OAE's) and any other measures felt to be necessary.

Speech and language assessment/Diagnostic Habilitation

In order to determine if a cochlear implant is a good option for a child, their current level of speech and language development must be assessed. In very young children, this assessment may consist only of parental report and observation during hearing testing. For older children, a more formal assessment may be scheduled. If a child is not making expected progress and if they have responses to sound which access spoken language, they may be scheduled for diagnostic habilitation sessions. The purpose of these sessions is to evaluate a child's ability to learn through listening and to find out if there are factors which may affect their ability to succeed with a cochlear implant.


Children will be listed for a scan following their first appointment. A scan is required before the consultant can determine if a child is suitable for a cochlear implant. Generally, an MRI scan is recommended with a CT scan in addition if necessary. Most young children will need to be sedated under general anaesthesia for this test. If scans are performed locally prior to referral or during the assessment process, these can be reviewed by our consultants and usually they will not need to be repeated.

Parent Information Session

All parents will attend an information session without the children present. The purpose of this session is to provide information about the pre-implant process and the cochlear implant itself without the distraction of children being present. Members of the extended family are encouraged to attend these sessions. Generally, this session takes place with a group, although if necessary we may schedule parents to attend on their own.

Meeting with a consultant

All children 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 a candidate and if the family elects to proceed with implantation, a formal decision will be made at this visit and the child will be listed for surgery. The consultant will also discuss the surgery itself and its risks.

Vaccination requirement

All children will be given guidance on the type of vaccinations that are recommended prior to surgery. These vaccinations must be started before the child's operation.

Other assessments

Other assessments 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 child's own GP. Parents will be given details of this at their pre-operative visits.


Parents will be advised of the risks of surgery in full prior to signing consent. The surgical process will be discussed in detail during the information session and consultant appointment and parents will be able to ask questions about the process during all stages of the pre-operative process.

In general, cochlear implant surgery takes between two and four hours. Children are in hospital for two or three days or less depending on the time of their surgery. The incision is small and requires a small amount of hair shaving. Surgery will take place at St. Mary's Children's Hospital in Manchester and parents may stay on the ward with children while they are in hospital. Dissolvable sutures are used and the incision is allowed to heal for two to three weeks before the external portion of the device is fit.