What to expect - children

Referral

WEHIP receives a referral from a GP, ENT Consultant or other healthcare professional. 
Early referral is best.

Months matter. Delay in implantation and a long period of deafness significantly affects the overall outcome. We aim to implant children who were born deaf at around their first birthday, when they are still at an age when learning language comes naturally.  We aim to implant adults and older children soon after they lose all or some of their hearing, especially if they have had meningitis, which can cause bony growth in the cochlea. 
Early referral and assessment makes a difference to long-term outcomes.

Initial clinic visit - St Michael's Hospital

On this visit you will meet several team members, including Audiological Scientists, a Consultant ENT Surgeon, a Paediatrician in Audiology and a Teacher of the Deaf or Speech and Language Therapist. We take a medical history and talk to you about cochlear implants. We carry out hearing tests to see if your child is likely to do better with hearing aids or with a cochlear implant. Sometimes this takes several visits and a hearing aid trial. If we think your child might benefit from an implant, we will arrange for a full assessment.

Full assessment

The full assessment takes several weeks. It includes:

• CT/MRI scans to assess the state of the cochlea, and whether the operation is possible (it usually is!)
• Medical reports - is the child fit for surgery?
• Counselling and information visit at home with WEHIP Teacher of the Deaf, to share and gather information. Get your questions ready!
• Assessments at home/school by WEHIP Teacher of the Deaf and Speech and Language Therapist. This will involve liaison with local services, functional hearing assessments and communication assessments.
• A visit to a Clinical Psychologist, to talk through your feelings and expectations relating to the implant. Your child's development, learning and cognitive abilities may be assessed.

Decision clinic

At this stage, if the team thinks your child would benefit, they will offer one or two cochlear implants, and you will decide whether or not you want your child to have them. Older children and teenagers need to be included in the decision making process. Once you've made your decision, the child will go onto the waiting list for surgery. 

If the team thinks the child is not likely to benefit from a cochlear implant, they will carefully explain why. We can also arrange a further follow up visit to talk things through, if you feel that would help.

Pre-op visit

A WEHIP Teacher of the Deaf visits home/school to answer any questions, explain what happens next and to complete the pre-operative agreements. She will also discuss the BCIG safety guidelines, which talks about what you can and can't do with an implant.

Download Safety Considerations for Cochlear Implant Users.

The operation

The operation is carried out at Bristol Children's Hospital by a team led by our experienced surgeons, Mr Robinson or Mr Hajioff. Both have performed hundreds of cochlear implant operations. The operation is usually straightforward and significant complications are rare.

Each ear takes 2-3 hours, but your child may be away from the ward for longer, because of the anaesthesia. The operation is straightforward and carries very few risks.  The risks will be discussed with you. Most children make a very swift recovery and are bouncing around at home within a couple of days.  We advise families to keep the child quiet at home (!) for a couple of weeks.

Your child won't hear anything until the speech processor is fitted, four weeks later.

Pre-tuning visits at home

These visits are to explain what happens next and check you are familiar with the new technology. Your child will have a chance to try a dummy processor. You will be given ideas to help your child learn to listen.

Fitting the speech processor - the 'switch on'

This is the moment your child's speech processor is switched on for the first time. The child's processor is linked up to a computer, and the audiologist plays a series of beeps and buzzes to set the parameters right for your child. Most families expect something extraordinary to happen, but it's usually very quiet - maybe a little eye widening here, or a blink there.
A series of individual programmes will be created and loaded into the speech processor.  The early programmes are very gentle, so as not to startle your child.  Your child will hear when they first go home, but they won't hear very much.  At this stage, they begin to learn what sound is, and that it matters. 

The first goal is for the child to wear their sound processor. The more they wear it, the faster they will make progress.

It takes weeks or months:

• For the audiologists to adjust the programmes so that they are right for your child
• For your child to learn to listen and possibly talk

Follow up visits at home or school

You will have follow up visits at home or school from your child's rehab worker, who will be a teacher of the deaf or a speech and language therapist. These visits help to ensure your child is making best possible use of their new hearing.

Every child is different and makes progress at their own rate.  Some children love the sound and launch straight in, others find it more bewildering, and may need to be coaxed into wearing their speech processors.  Visits from your rehab worker are designed to help you over any early hurdles, and to help your child learn to enjoy listening with their new cochlear implant.  Together, you will discuss ways to help your child progress.

Follow up visits to the hospital

In the first two years, your child will need regular 're-tuning' of their cochlear implant by the audiologist, to ensure their speech processor is perfect for them.

Every child is different, and the 'programmes' or 'maps' they need in the processors are different too. It takes time and careful testing to get the map right for your child. This means you will visit Bristol or a more local clinic many times in the first couple of years, and at least once a year after that. The West of England Hearing Implant Programme offers ongoing maintenance and support of your child's cochlear implant.

Download  Safety Considerations for Cochlear Implant Users.