Assessments
Children
First stage
You and your child will be seen by a consultant and other members of the team in a children's cochlear implant centre. The centre will usually have asked you to complete a preliminary questionnaire with some basic information about your child. The centre may have asked your permission to approach your child’s doctors, audiologists, teachers and other professionals involved with your child for information.
Your child’s hearing will be assessed in some detail by an audiological scientist. It is very important to make sure that every child has had the best possible hearing aids and earmoulds, and has used them consistently before proceeding with decisions about cochlear implantation. Different hearing aids may be provided to ensure that the very best possible results have been obtained, and you will be asked to use them reliably for most of the child’s waking hours for several months. The child’s teachers and local therapists will also be asked to evaluate the Hearing Aid Trial and comment on the child’s auditory progress.
These initial visits may last for most of the day as there can be a lot of work to do.
A number of children will be found to be unsuitable for an implant as assessment progresses. Cochlear Implant centres will ensure that everyone understands clearly why the decision against cochlear implantation was made, and will offer the opportunity for alternative ideas to be explored.
Second stage
This involves detailed assessment at home and at school, and a named key-worker will help co-ordinate this and provide a contact for you. As well as visits by the cochlear implant team members to home and school, there will be assessments of language, communication, education and expectations by the advisory teachers, speech and language therapists and psychologists.
Certain specific tests will be important for most children.
A CT scan which is a specialised X-ray of the inner ear is carried out to establish whether it is possible to insert a cochlear implant electrode into the cochlea. It is often followed by an MRI Scan (Magnetic Resonance Image). The MRI will look carefully at the soft tissues, and the nerve of hearing.
Auditory Brainstem Response (A.B.R.) tests may also be required. This is a hearing test using temporary electrodes placed on the head to pick up the responses to sound.
The CT Scan, the MRI and the ABR are all painless, but do require the child to be completely still . It is for this reason that a short general anesthetic, given by a specialist children’s anesthetist is sometimes necessary. Most children under the age of six years, will require an anesthetic.
Some children may require additional tests which will be discussed with you.
This second stage can take quite some time to complete, especially if the child is asked to try a different type of hearing aid which can lengthen the process considerably. You will be in close contact with your keyworker who can inform you of how the various parts of the assessment are being organised.
Finally, there will be a meeting of the children's cochlear implant team with yourselves and appropriate local professionals at the end of the assessment period. Whether or not the team consider a cochlear implant to be the best option for your child will be discussed, and if an implant is offered, then you have plenty of time to consider your decision. If your child is going to have an implant, the date of the operation will be arranged at this stage.
Psychology
It is important to consider your psychological status before implantation. Some cochlear implant teams will refer you to a Clinical Psychologist or Psychiatrist.
At this appointment you will be able to discuss your reasons for wanting an implant. Cochlear Implant Teams need to be sure that you fully understand about all that is involved in having a cochlear implant as well as establishing that your expectations are realistic. The purpose of these discussions is to help you to make up your mind whether or not you want an implant and whether you would really benefit from one.