What to expect at the Hearing Implant Centre

Once your child has been referred to a Hearing Implant Centre they will receive an appointment date to meet the BCHI team. The time between referral and treatment (the operation), is usually 18 weeks but this may vary depending on your child’s needs.

You will be given information about what a BCHI looks like and how it works. Towards the end of the assessment process you and your child will meet an ENT liaison nurse. They will give you information about your child going into hospital, their care before and after surgery, and how you and your child will need to look after the sound processor and depending on the chosen device, the skin around the abutment afterwards. You and your child may also be able to visit the ward to have a look around so you know what to expect before surgery.

A member of the Hearing Implant Service may also arrange to visit your child and you at home, school or nursery and provide you with detailed information about the bone conduction hearing implant, and how it will work.

If you or your child have any worries or anxieties about their stay in hospital you should discuss them with your ENT liaison nurse.

Before the assessment the Hearing Implant Service will request the following information about your child from specialists:

• medical history, including developmental assessment
• history of hearing loss and cause of deafness (aetiology), if known
• results of audiological assessments
• use and benefit from hearing aids
• communication method(s) used, including sign and other language needs
• speech and language development
• educational support
• the support available to the child’s parents
• approval for funding.

During the assessment process:

• The audiologist will also include further testing to evaluate your child’s hearing, current hearing aid and speech understanding
• A speech and language therapist will assess your child in different environments, such as in the clinic, at home or at school
• An assessment will be made of your child’s communication skills as well as their speech and language development
• An X-ray will be recommended to assess the bone thickness and density
• MRI and CT scans may also be done if required
• Your child’s vision will be assessed if necessary
• The ENT surgeon will assess your child’s general medical health, the suitability of a BCHD and the need for any future procedures, such as reconstructive surgery. This might apply to children with microtia and atresia.
• Other considerations will be also taken into account, such as the position of the sound processor if your child wears a helmet for sport or other activities
• Your child will be given an opportunity to try a BCHD for at least 14 days to assess whether they would benefit from the device before going through surgery.

You can be referred to the Hearing Implant Team as soon as it is known that a BCHD or BCHI is a suitable option for your child. This can happen even if your child is still very young.

The Hearing Implant team will have a wide knowledge of the types of devices that your child can benefit from. They will monitor their progress and discuss any relevant surgical options with you as your child develops.

The skull bone needs to be of a certain thickness to be considered for implant surgery. It may be too thin in very young children which means the bone won't grow properly around the implant (osseointegration). The thickness of the bone may also be affected if the child has a craniofacial condition or syndrome that alters the development of the child’s head or face, such as Treacher Collins syndrome. The ENT surgeon will also consider your child’s size and development.

Depending on how old they are, your child should be involved in the assessment process and with the decisions made.

For these reasons, surgery for an implantable BCHD is not usually done until after the age of four or five years and the skull bone is at least 2.5mm thick, but this can vary depending on the child’s development, and device chosen.

If your child is found to be suitable for a BCHI after the assessments and BCHD trial period you will be given a date for surgery. The ENT consultant will then discuss the details of the operation and any associated risks with you. You‘ll get the result of the assessment and receive a written report with further information within three weeks of the final assessment. This report will also be shared with your child’s specialist and GP, your local education services, and any other local professionals who were involved with referring or assessing your child.

If a BCHI is considered suitable and you and your child decide that they should go ahead with the surgery, a management or care plan will be put in place.

It is really important that you fully understand, and are involved with developing, this plan. When you and the Hearing Implant Service have agreed on the plan, a copy of it will be sent to your child’s specialist and their GP as well as to other local professionals.

If you move to a different area, your child may need to transfer to another hearing implant service. Your existing service should arrange any relevant appointments with the new service before your child transfers.

At an agreed time, between the ages of 14 and 21, young people will transfer into an adult Hearing Implant service. The paediatric service will make an appointment for them to attend the adult service. The appointment will normally be within six months of transfer and the adult service will write to the young person, the paediatric service and their GP within two weeks of the paediatric service contacting them. All documentation for your child will be forwarded on to the new service. This not only includes personal data but also information on the BCHI, audiological results, surgical notes and any other relevant information.

The Hearing Implant service will carry out regular checks to evaluate how effective and family-friendly the service is. This should involve asking parents and young people for their views of the service they are receiving and how they think it could be improved.

What you can expect from your service:

• to receive all information in a language you prefer and in an easy-to-read format
• to have access to a sign language interpreter or other interpreter at appointments, if necessary
• to be given copies of all information and reports about your child’s hearing and communication development
• to be asked for your permission for the Hearing implant service to share information with all those working with your child, including those from local services and your child’s GP
• to be given information about and contact details of all relevant local and national voluntary groups and associations (such as information about NDCS)
• to be given the opportunity to meet other parents and people who use BCHIs
• for your child to be fitted with up-to-date and appropriate BCHDs and equipment that is efficiently maintained
• to be seen in a family-friendly environment
• have access to staff at short notice in case of problems (for example, in case of infection of the site of the abutment, when the abutment needs tightening, when the sound processor is faulty etc)
• that your child will be provided with a radio aid and receive guidance on other listening equipment that may help
• to be able to give feedback to the Hearing implant service to help it improve the service.