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Indications

Last edited Apr 1, 2019

bilateral profound sensorineural hearing loss.
no benefit from other hearing aids.
no surgical contraindication to cochlear implantation.
patient needs to be well motivated.

Summary features of the NICE guidance regarding cochlear implants is given below:

unilateral cochlear implantation is recommended as an option for people with severe to profound deafness* who do not receive adequate benefit from acoustic hearing aids **
simultaneous bilateral cochlear implantation is recommended as an option for the following groups of people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids:
- children
- adults who are blind or who have other disabilities that increase their reliance on auditory stimuli as a primary sensory mechanism for spatial awareness
sequential bilateral cochlear implantation is not recommended as an option for people with severe to profound deafness*
cochlear implantation should be considered for children and adults only after an assessment by a multidisciplinary team. As part of the assessment children and adults should also have had a valid trial of an acoustic hearing aid for at least 3 months (unless contraindicated or inappropriate)
when considering the assessment of adequacy of acoustic hearing aids, the multidisciplinary team should be mindful of the need to ensure equality of access. Tests should take into account a person's disabilities (such as physical and cognitive impairments), or linguistic or other communication difficulties, and may need to be adapted. If it is not possible to administer tests in a language in which a person is sufficiently fluent for the tests to be appropriate, other methods of assessment should be considered

* severe to profound deafness is defined as hearing only sounds that are louder than 90 dB HL at frequencies of 2 and 4 kHz without acoustic hearing aids

**adequate benefit from acoustic hearing aids is defined for this guidance as:

for adults, a score of 50% or greater on Bamford-Kowal-Bench (BKB) sentence testing at a sound intensity of 70 dB SPL
for children, speech, language and listening skills appropriate to age, developmental stage and cognitive ability

For detailed guidance then consult the full guideline (1).

Reference:

1. NICE (March 2019).Cochlear implants for children and adults with severe to profound deafness.

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