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Assessment for a cochlear implant

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If you think your child may benefit from a cochlear implant, you need to talk to your child’s ENT specialist or audiologist. They will be able to tell you whether your child may be suitable for a cochlear implant assessment, and refer you to a specialist centre. There are a number of specialist centres in Australia. Usually you will be referred to your nearest one.

The cochlear implant team will send you an appointment for an initial assessment for your child. You may have to travel some distance to get to the cochlear implant centre. Financial support may be available for travelling and accommodation expenses. If you have any questions or concerns, speak to the Cochlear Implant Centre.

The assessment process involves a number of detailed tests and may require several visits to the specialist centre, especially if your child is very young or has any additional needs. During the assessment process you will meet lots of different professionals on the cochlear implant team including:

  • Audiologists
  • Doctors
  • ENT specialists
  • Speech pathologists
  • Teachers of the deaf
  • Social workers
  • Educational or clinical psychologists
  • Radiologists.

The implant team will carry out a range of assessments to decide if an implant is appropriate for your child. They will also work with the professionals that support your child locally.

The assessment process will include the following:
  • Detailed tests of your child’s hearing, both with and without hearing aids. To get the clearest possible picture of your child’s hearing loss, your local audiologist should make sure your child has the most appropriate hearing aids and well-fitted ear moulds, and is free from glue ear. Electrophysiological testing may be carried out to confirm the levels of hearing. These are tests to measure your child’s response to sound without your child needing to cooperate. These tests may be carried out under sedation or general anaesthetic.
  • A medical examination, including a full examination of your child’s ear. If your child hasn’t already had tests to try and find out the cause of their deafness, these may also be offered.
  • A radiological assessment. This will usually involve MRI (magnetic resonance imaging) and/or CT (computerised tomography) scans so the surgeons can see your child’s cochlea, auditory nerve and brain. Scans can show up problems such as ossification in the inner ear. Ossification can occur after meningitis and means that new bone starts to grow in the cochlea. This can make it more difficult for the surgeon to insert the electrodes. Scans can also show other problems in the inner ear and may alert the surgeon to increased risks during the operation. Occasionally children are born deaf because they do not have a cochlea or auditory (hearing) nerve. If the scan shows that your child has no cochlea or auditory hearing nerve, then a cochlear implant will not be possible in that ear.
  • An assessment of your child’s communication, language and speech skills. These may be carried out at the centre, at home, or at school, with the help of your child’s teacher, teacher of the deaf or speech pathologist.

Any extra hearing loss caused by glue ear may cause a child who is moderately to severely deaf to appear to have a much greater hearing loss. This could mean that without the glue ear, your child has enough hearing not to need a cochlear implant. Glue ear itself does not stop a child from having a cochlear implant, but it is very important that your child’s hearing is tested once the glue ear has cleared up to make sure that the true levels of permanent hearing loss are assessed.

Most parents find that the decision to go ahead with the implant is an ongoing process throughout the assessment. If at any time you or your child feel that a cochlear implant is not the right choice, feel free to say so. Towards the end of the assessment you will be invited to discuss the outcome of the various assessments and jointly make a decision with the implant team on whether your child would benefit from a cochlear implant. If possible, your child should be involved in making that decision with you. If you have any questions about the tests, the operation, and what it is like to live with an implant, talk to the professional working with you and your child.

Finding out more about cochlear implants

Before and during the assessment you and your child may like to talk to other families about their experiences of what it is like to live with an implant. You may also like to speak to deaf adults about their experiences. Some useful contacts:

  • If you would like to talk to parents of deaf children with cochlear implants, contact your local parent support group.
  • Children may like to talk to a trusted friend, family members or professional, such as their teacher, teacher of the deaf or their audiologist
  • The Deaf Society in your state can put you in touch with a deaf role model: a young deaf adult who will help promote a positive view of deafness, and be a positive role model for your child. Some deaf role models use implants, some hearing aids and some neither. They also communicate in a variety of ways and you can ask for a role model who most closely matches your child’s experiences.
  • There are online parent forums where you can share the experiences of other families whose child has a cochlear implant

There are several different makes and models of cochlear implants, but they all work in a similar way. If your child is offered a cochlear implant, you may be asked to choose a particular make and model for them. Some things you may like to think and ask questions about include the following:

  • Cosmetic features of the cochlear implant, such as considering how it fits on the ear and how it looks. Older children in particular should be given as much choice in how their implant looks as possible.
  • Practical features: how easily can you tell if the battery has run down? Is the system easy to use? For young children, can you tell easily whether the implant is switched on and working well using visual indicators etc? Is the device water resistant?
  • Most deaf children who use cochlear implants also use an FM system in school. How easily are the systems set up and how well do they work together? Is the implant easily compatible with other audio equipment?
  • What type of battery does the implant take and how long will it last? Can they be recharged? Young children may not be able to tell us when the battery is flat – will it last the whole school day?
  • Reliability of the external parts of the cochlear implant.
  • Reliability and safety record of the internal implant: how many people are currently implanted with it and how long the implant is likely to last (known survival rates). This information is usually available from the implant manufacturer and may be available on their website.

It is a good idea to do some research. Speak to other families about their experiences with different devices. Discuss any concerns with your implant team.

Why would my child not be suitable for a cochlear implant?

In certain cases the team may explain to you that your child is not suitable for a cochlear implant. Examples of when a cochlear implant would not be suitable include the following:

  • The scan may show there is no cochlea or auditory nerve, or there may be a problem within the cochlea which makes an implant surgically impossible.
  • It may be that your child has enough hearing to be able to benefit over time from conventional hearing aids. If this is the case, your local Australian Hearing centre will continue to provide audiological care and support for your child.
  • It could be that your child is older and progressing well using alternative methods of communication, such as sign language.
  • It may be that your child has additional needs, which may make it difficult or impossible for them to learn to use the new signal.

The cochlear implant team will discuss with you the ongoing care and support that is necessary to help your child get the most benefit from the implant. They will look at the long-term support that will be provided by parents, family, audiology and early intervention services. The cochlear implant team will go ahead with implantation only if your child has been through the assessment process and you and they agree that your child will consistently, continuously and effectively use a cochlear implant.

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Information supplied by the National Deaf Children’s Society. Reproduced with permission.
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