What to expect - children

Referral

WEHIP can receive a referral from a GP, ENT Consultant or audiologist with the family's consent. 

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 can offer older children cochlear implants if they lose their hearing or have a deteriorating loss that meets the audiological criteria. If their deafness is a result of meningitis, which can cause bony growth in the cochlea, then referral and possible surgery is seen as a priority. 

Initial clinic visit - St Michael's Hospital

On this visit you will meet different team members, including Audiological Scientists, a Teacher of the Deaf and a 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. If we think your child might benefit from cochlear implants and you are in agreement, we will arrange for a full assessment.

Full assessment

The full assessment can take several weeks. It includes:

• CT/MRI scans to look at the cochlea and auditory nerve.
• Medical reports to look at your child's overall health. 
• An information visit with a WEHIP Teacher of the Deaf.
• An initial assessment by a WEHIP Teacher of the Deaf and Speech and Language Therapist, typically at St. Michael's Hospital. This will involve liaison with local services, functional hearing assessments and communication assessments. Additional visits may be made to your child's nursery or school to gather more information. 
• An appointment with a Clinical Psychologist, may be offered, to talk through your feelings and expectations relating to the cochlear implant. Your child's development, learning and cognitive abilities may also 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 appointment

A WEHIP Teacher of the Deaf arranges an appointment to explain what happens next and to answer any questions. They will also discuss safety guidance for a cochlear implant. 

The operation

The operation is carried out at Bristol Children's Hospital by a team led by our specialist surgeons. The operation is usually straightforward and significant complications are rare.

Surgery times can vary, but generally take a few hours. 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 week.

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

Pre-tuning appointment

This session is to explain what happens next and check you are familiar with the new technology. You will be given ideas to help your child keep the processors on and to begin their listening journey. 

Fitting the speech processors - the 'switch on'

This is the moment your child's speech processors are switched on for the first time. Their processors are 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 processors. The early programmes are very gentle, so as not to startle your child. Your child will begin to hear when they first go home, but they won't hear very much and it will take time for their brain to make sense of sound.

The first goal is for the child to wear their sound processors. Consistent processor use is essential for all the child's waking hours for them to make best use of their cochlear implants. This can be challenging in the early stages and it is important to continue to persevere. The WEHIP team and your local ToD will be able to support you with this. 

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 a WEHIP ToD. These visits help to ensure your child is making best possible use of their new hearing and to monitor their progress. 

Every child is different and makes progress at their own rate.  Some children love the sound and launch straight in, others find it more confusing, and may need more support to wear their speech processors. The WEHIP rehab team will support you at this stage, and to help your child to develop listening with their new cochlear implant. 

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 processors are set appropriately 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.

Follow up Diagnostic Listening Therapy

Diagnostic Listening Therapy (DLT) sessions aim to provide focussed support to families in order to maximise their child's listening ability. For most babies and young children, the first 12 to 18 months after switch-on are especially important in building these new skills. In these sessions, the Speech and Language Therapist aims to coach and guide parents giving them the skills to develop their child's listening and communication potential. These sessions may be at St. Michael's Hospital, an outreach location or as a video call.