Referral and assessment for cochlear implants
To get cochlear implants, a child or young person needs to be assessed by a cochlear implant team.
A child or young person may be a candidate for cochlear implants if they:
- have a severe to profound permanent deafness and
- get limited or no benefit from hearing aids
Before a child or young person can get cochlear implants, they need to be assessed by a cochlear implant team. You should also take time to think about the long-term commitment you’re making and whether cochlear implants are right for your child.
What to consider when making a decision about cochlear implants.
A note on terms
Throughout this page, we use the term 'your child'. However, we understand that many deaf young people may be making this decision for themselves. Whenever you see 'your child', please know it also includes any deaf young person considering cochlear implants.
Referral process
Before getting cochlear implants, your child must:
- be assessed by a multidisciplinary team at a specialist cochlear implant or auditory implant centre
- trial hearing aids for at least 3 months
There are several specialist centres around the UK, and you’ll usually be referred to your nearest one. The implant centre will accept referrals from your GP, ENT (ear, nose and throat) consultant, paediatrician or audiology professional.
Help with travel costs
If your nearest implant centre is far from home, you may be eligible for help with travel costs through the following schemes:
- England: Healthcare Travel Cost Scheme (NHS website)
- Northern Ireland: Hospital Travel Costs Scheme (nidirect website)
- Scotland: Help with health costs (NHS inform website). Travel outside your NHS Health Board area may be covered by your local NHS Health Board (NHS Scotland).
- Wales: Low Income Scheme: help with NHS costs (Welsh Government website)
If you or your child receive disability benefits, like Disability Living Allowance (DLA) or Child Disability Payment (CDP), you might be able to use these funds to cover your travel costs. Learn more about disability benefits.
Assessment process
Once you’ve been referred, the implant centre will normally give you an appointment for an initial assessment within one of the following timeframes, depending on where you live.
- England – 6 weeks
- Northern Ireland – 9 weeks
- Scotland – 12 weeks
- Wales – 8 weeks
The purpose of the assessment process is to find out if cochlear implants are suitable.
As part of the assessment process, the team may access scans or hearing tests that have already been done by your local healthcare professionals. If needed, they may schedule further hearing tests and scans.
The tests help the implant team build a picture of your child’s deafness to understand:
- how much benefit they get from using their hearing aids
- whether a cochlear implant is likely to provide additional benefit over their hearing aids
- your child’s ability to make the most of a cochlear implant
What happens during assessment
During the assessment process, the implant team will:
- take a detailed medical history, including your child's hearing and general development
- carry out a full examination of the ears
- use MRI or CT scanning to look at the anatomy of the cochlea, balance organs, auditory nerve (hearing nerve) and brain (where necessary). Young children and babies are usually given a general anaesthetic (a medicine which puts them to sleep) for these scans.
- carry out objective hearing tests (where necessary). This will include an auditory brainstem response (ABR) test to confirm the auditory nerve is working. If your child is under 8 years old, this test is also usually done under a general anaesthetic.
- carry out age-appropriate hearing tests to determine level of hearing, with and without their hearing aids
- carry out speech discrimination testing to understand how well they can understand speech through their hearing aids
- check how well the moving parts of the middle ear are working. To do this, they will conduct a ‘tympanometry’ test where they gently hold a small earpiece in the ear canal to measure how the eardrum responds to air pressure changes.
- evaluate communication, listening, language and speech skills
- record how long your child has been using their hearing aids on average each day
- apply for approval for government funding – this will be made to the appropriate government body by the implant centre
Depending on the situation, the team may also refer your child for:
- a balance or vestibular assessment
- a further 3-month trial of hearing aids
- a review appointment to assess how your child is progressing with hearing aids
Appointments can sometimes take most of the day. Depending on what’s being assessed, they may take place at the cochlear implant centre, an outreach clinic or at your home.
Throughout the process, the cochlear implant team will:
- provide information about your child’s deafness, cochlear implants, surgery and rehabilitation
- work alongside the professionals who support your child locally, such as their ENT doctor, paediatrician, audiologist, Teacher of the Deaf, or speech and language therapist
- discuss the ongoing care and support that’s necessary to help your child get the most benefit from the implant
How long the assessment process takes
The time it takes to assess a child for cochlear implants depends on many factors. For example, if:
- your child has additional needs
- your child needs repeated tests
- the cause of your child’s deafness means they need to be assessed over a longer period (for example, as with auditory neuropathy spectrum disorder)
- you want more time to think about the options available
All centres have different assessment pathways, and the implant team should keep you informed about how the assessment is progressing.
Assessment outcomes
Once all the assessments are complete, the implant team will meet with you to share the results. During this meeting, they will let you know whether cochlear implants are suitable. The cochlear implant team will only recommend implantation if:
- your child has been through the assessment process
- you understand the commitment that’s required to start this journey
- you and the cochlear implant team agree that your child will consistently, continuously and effectively use a cochlear implant
- your child will get more benefit from an implant than hearing aids
Conditions which may affect the assessment outcome
The assessment process sometimes highlights issues or conditions that may affect the assessment outcome. Although many of these are unlikely to prevent your child getting cochlear implants, they need to be understood and addressed.
Glue ear
Glue ear is a very common condition during childhood and happens when the middle ear (behind the eardrum) becomes filled with sticky fluid.
Glue ear is often temporary and may resolve without the need for any treatment. However, it may cause a child who has moderate to severe deafness to appear to have a more significant hearing loss. This could mean that without glue ear, your child has enough hearing not to need a cochlear implant.
If your child has glue ear, the implant team can assess their true hearing levels by draining any fluid from the ears and then testing their hearing immediately after, all under general anaesthetic.
Additional needs
Children with additional needs can and do benefit from implants. Many deaf children with additional needs are implanted early in life, before their other needs are identified or known about. Sometimes the assessment process helps identify other needs.
Very occasionally, a child’s additional needs could make it difficult or impossible for them to learn to use the new signal that they would hear through the cochlear implant. The implant team will discuss this with you and make alternative recommendations for supporting your child if needed.
Meningitis
If your child has had meningitis, they will be offered a ‘fast-track’ assessment for cochlear implants. This is because some children who have had meningitis experience an after-effect known as ‘ossification’ (an increase of new bone growth in the cochlea).
Ossification can make it more difficult or impossible to surgically implant the electrodes of the cochlear implant. The implant team will be able to assess the amount of any ossification using a CT or MRI scan.
If referred and treated quickly before any ossification, most children who have had meningitis can benefit from having a cochlear implant.
Underdeveloped or abnormal cochlea or auditory (hearing) nerve
Some children are born with:
- underdeveloped cochleas
- very thin (spindly) hearing nerves
- other abnormal anatomy
The implant team will assess your child’s scans and recommend whether surgery is possible and what the expected outcome may be. Generally, outcomes for these children are more variable than for children who have fully developed cochleas and nerves.
Absent cochlea or auditory nerve
Very occasionally, children are born without a cochlea or auditory nerve. If the scan shows that either is absent, then it will not be possible to have a cochlear implant in that ear.
The implant team may then discuss an auditory brainstem implant (ABI). An ABI stimulates the auditory brainstem directly, bypassing the ear and auditory nerve to provide a sensation of hearing. ABIs are still a fairly new development and the small numbers implanted in children so far have had variable results.
If cochlear implants are not suitable for your child
There will be times when the implant team feel that cochlear implants are not suitable for a child. This could be for the following reasons:
- Scans show that there is no cochlea or auditory nerve or that there is a problem with the cochlea which makes an implant surgically impossible.
- Your child may have enough residual hearing to benefit from conventional hearing aids. In this case, the implant team will make recommendations on hearing aids. Your local audiology department will continue to care for and support your child and monitor any changes in their hearing.
- Your child has had a significant period with no access to sound and has missed the critical period to develop spoken language. This would mean they are unlikely to gain much benefit from a cochlear implant.
The implant team will send a report to the relevant professional who referred you. The report will explain why they do not think a cochlear implant is suitable. They will make recommendations for future management and may suggest other possible options.
If your child’s hearing changes in the future, a referral back to the implant centre can be made for re-assessment.
Getting a second opinion
If you have any concerns or doubts about the outcome of your child's assessment, you can ask for a second opinion.
While the NHS is not required to offer a second opinion, most implant centres are open to these requests and will rarely refuse. If you would like a referral to another implant centre, you should ask your audiologist. If another NHS centre will not provide a second opinion, you can explore private providers. However, private assessments can be costly.
Find out more about getting implants privately.
Choosing a brand and model
Most cochlear implant centres in the UK offer a choice between 2 or 3 of the following manufacturers:
There is currently no evidence that children perform better with one manufacturer’s device over another. However, different devices have features that may better suit your child’s needs and lifestyle.
When choosing a device, you may want to consider the following:
- Talk to other families who have made this decision – their experiences can be helpful.
- Ask your implant team about their experience with specific models, particularly in children.
- Cosmetic design – including how the sound processor looks, fits on the ear, and whether your child can help choose colours or styles.
- Durability, safety and reliability – both of the internal implant and the external parts. Check the manufacturer's website to find out how many people are currently implanted with the make and model you’re interested in and the expected lifespan of the implant.
- Battery life – how long it lasts and whether it's rechargeable. Will the battery last a full school day?
- Ease of use – including whether there are clear visual indicators showing the device is working and if the battery needs replaced. Is the system easy to use?
- Water resistance – is the device splash-proof or fully waterproof?
- Safety features – such as a lockable battery door.
- Compatibility of the implant with radio aids or other assistive technology.
You can also explore online resources that offer comparison charts and detailed manufacturer information to support your decision-making:
Full references for this webpage are available by emailing
informationteam@ndcs.org.uk