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CP35 Cochlear Implants Version: 4.0 Page 1 of 21
Specialised Services Policy:
CP35 Cochlear Implants
Document Author: Specialised Planner for Women & Children’s
Services
Executive Lead: Director of Planning
Approved by: Executive Board
Issue Date: 05 August 2014
Review Date: August 2017
Document No: CP35
CP35 Cochlear Implants Version: 4.0 Page 2 of 21
Document History
Revision History
Version
No.
Revision date Summary of Changes Updated to
version
no.:
0 27/03/2012 New Policy Developed & Published 1.0
1.0 May 2007 Include adult cochlear implants at rate
of 7pmp
2.0
2.0 February
2013
Moved to new template with minor
changes
2.0 May 2014 Provided greater clarity on criteria for
bilateral and unilateral cochlear
implant and information on clinical
indications for assessment and clinical
criteria for treatment.
2.1
2.1 March 2013 Ratified through Chair’s Action on
behalf of Management Group
3.0
3.0 June 2014 Minor changes made to language 3.1
3.1 05/08/2014 Approved by Executive Board.
Ratified through Chair’s Action on
behalf of Management Group
4.0
Date of next revision August 2017
Consultation
Name Date of Issue Version
Number
South Wales Cochlear Implant Programme
North Wales Cochlear Implant Programme
Central Manchester NHS Foundation Trust
South Wales Cochlear Implant Programme 8/6/2014
North Wales Cochlear Implant Programme 8/6/2014
South Wales Cochlear Implant Programme 7/7/2014
North Wales Cochlear Implant Programme 7/7/2014
Central Manchester NHS Foundation Trust 15/7/2014
Approvals
Name Date of Issue Version No.
HCW Clinical Policy Group Sept 2006 0.2
HCW Management Team/Director’s Group Oct 2006 1.0
WHSSC Joint Committee March 2012 2.0
WHSSC Management Group (Chair’s action) 05/03/13 3.0
WHSSC Management Group (Chair’s action) 05/08/14 4.0
Distribution – this document has been distributed to
Name By Date of Issue Version No.
Welsh Health Specialised
Services Committee
Website
WHSSC
CP35 Cochlear Implants Version: 4.0 Page 3 of 21
CP35 Cochlear Implants Version: 4.0 Page 4 of 21
Policy Statement
Background The Welsh Health Specialised Services
Committee is responsible for the commissioning of Cochlear Implant services including
assessment, surgical implantation, rehabilitation and maintenance of implants.
A cochlear implant is an implanted electronic
hearing device designed to produce useful hearing sensations to a person with severe to
profound nerve deafness by electrically
stimulating nerves inside the inner ear.
The implant consists of two main components: an externally worn microphone, sound processor
and transmitter and the implanted receiver and electrode system which contains the electronic
circuits that receive signals from the external system and send electrical currents to the inner
ear.
Summary of
Access Criteria
For the purpose of this policy, severe to
profound deafness is defined as hearing only sounds that are 90 dBHL or greater at 2 kHz and
4 kHz.
The clinical indications for assessment is where children or adults do not gain adequate benefit
from acoustic hearing aids for at least 3 months (unless contraindicated or inappropriate).
Children and adults should only be considered
for cochlear implantation after an assessment by the Cochlear multidisciplinary team.
Paediatric and adult cases are eligible for implantation as long as the following points are
met: The patient meets all of the agreed
audiological, physical and psychological criteria outlined in the relevant national
Guidelines (e.g. BCIG and NICE); The patient should be fit for general
anaesthesia; Parental and/or patient understanding of
the expectations and agreement to the
CP35 Cochlear Implants Version: 4.0 Page 5 of 21
long-term commitment of a cochlear
implant.
Unilateral cochlear implantation is recommended as an option for people with severe to profound
deafness who do not receive adequate benefit from acoustic hearing aids. Adequate benefit is
defined by national guidance and is reviewed on an annual basis with WHSSC through the All
Wales Cochlear Audit Day.
Simultaneous bilateral cochlear implantation is
recommended as an option for the following groups of people with severe to profound
deafness who do not receive adequate benefit from acoustic hearing aids (as defined above):
Children Adults who are blind or who have other
disabilities that increase their reliance on auditory stimuli as a primary sensory
mechanism for spatial awareness
Sequential cochlear implantation was recommended by the National Institute for
Health and Clinical Excellence (NICE) in 2009 for children who had previously received unilateral
cochlear implantation.
Sequential cochlear implantation may also be
used when there are complications during surgery for bilateral cochlear implantation or
where patients are blind or who have other disabilities that increase their reliance on
auditory stimuli as a primary sensory mechanism for spatial awareness.
Responsibilities Referrers should: Inform the patient that this treatment is
not routinely funded outside the criteria in this policy;
Refer via the agreed pathway.
Clinician considering treatment should: Discuss all the alternative treatment(s)
with the patient; Advise the patient of any side effects and
risks of the potential treatment;
CP35 Cochlear Implants Version: 4.0 Page 6 of 21
Inform the patient that treatment is not
routinely funded outside of the criteria in the policy; and
Confirm that there is contractual agreement with WHSSC for the treatment.
In all other circumstances submit an IPFR
request
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Table of Contents 1. Aim ..................................................................................... 8
1.1 Introduction .................................................................. 8 1.2 Relationship with other Policies and Service Specifications ... 8