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Referral and assessment for cochlear implants

Last reviewed: 25 June 2024

Your child may be a candidate for cochlear implants if they:

  • have a severe to profound permanent deafness and
  • they get limited or no benefit with hearing aids.

Before your child can get cochlear implants, they will 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. More on making a decision about cochlear implants.

Read on to learn about how the assessment process for cochlear implants works.

You can also find out more about the surgery and switch-on process.

Referral for cochlear implants

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 three 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

Depending on where you live, you may have to travel quite far to get to your nearest cochlear implant centre. You might be entitled to help with your travel costs through one of the following schemes.

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.

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 for your child.

As part of the assessment process, the team may access scans or hearing tests that have already been done by your child's 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 of your child, including their hearing and general development
  • carry out a full examination of your child’s ears
  • where necessary, use MRI or CT scanning (or both) to look at the anatomy of your child’s cochlea, balance organs, auditory nerve (hearing nerve) and brain. Young children and babies are usually given a general anaesthetic (a medicine which puts them to sleep) for these scans. If your child has already had these scans, the implant team may be able to access their previous scans instead.
  • where necessary, carry out objective hearing tests. This will include an auditory brainstem response (ABR) test to confirm the auditory nerve is working. If your child is under eight years old, this test is also usually done under a general anaesthetic.
  • carry out age-appropriate hearing tests to determine your child’s level of hearing, with and without their hearing aids
  • check how well the moving parts of your child’s middle ear are working. To do this, they will conduct a ‘tympanometry’ test where they gently hold a small earpiece in your child’s ear canal to measure how the eardrum responds to air pressure changes.
  • evaluate your child’s communication, listening, language and speech skills
  • measure how long your child has been using their hearing aids on average each day.

Learn more about the different types of hearing tests.

Depending on your child’s situation, the team may also refer your child for:

  • a balance or vestibular assessment
  • a further three-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:

  • give you information about your child’s deafness, cochlear implants, the procedure and the rehabilitation programme after surgery
  • 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 your 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 for your child. 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 might affect the outcome of the assessment. Many of these are unlikely to prevent your child getting cochlear implants, but they need to be understood and addressed during the assessment process.

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. Because the team needs to drain the fluid for this test, they will advise against treating glue ear with grommets if your child is a likely candidate for cochlear implants.

Find out more about glue ear.

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.

Find out more about deafness and additional needs.


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.

Find out more about meningitis and deafness.

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 very 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.

Useful resources

Chloe Gets Cochlear Implants

For a fun and child-friendly way to explain cochlear implants to your child, check out our free comic, Chloe Gets Cochlear Implants.