Referral and assessment for bone conduction implants

A child or young person may be a candidate for bone conduction implants if they:

• have permanent conductive, mixed or single-sided deafness
• are old enough to have enough bone and skin thickness to safely insert the implant
• cannot wear or get limited or no benefit from behind-the-ear hearing aids
• have been using a bone conduction hearing aid successfully

If bone conduction implants might be suitable for your child, and your local service is not able to provide them, their audiologist will refer your child to another centre. The centre will assess your child and discuss options for hearing devices and surgery with you. 

Bone conduction implants are available free of charge through the NHS if a child meets the criteria.

Learn more about the referral and assessment process on this page. You can also explore what to consider when making a decision about bone conduction implants.

Age for implantation

Most children need to be at least 5 years old before they can receive a bone conduction implant. This is because their skull bone needs time to develop and become thick enough for an implant to be attached. Their skin thickness also needs to be considered. 

Younger children can routinely use a bone conduction hearing aid on a softband before this age. Usually, these will use the same sound processor as implantable devices. 

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)
• Northern Ireland: Hospital Travel Costs Scheme (nidirect)
• Scotland: Help with health costs (NHS Inform). Travel outside your NHS Health Board area may be covered by your local NHS Health Board (NHS Scotland).
• Wales: Low Income Scheme (Welsh Government)

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.

Hearing implant service team

A hearing implant team is made up of different specialists, including ear, nose and throat (ENT) surgeons, audiologists and specialist nurses. The team will:

• work closely with you and your child, involving you in their care
• assess your child's needs
• explain the benefits and challenges of different hearing technologies
• determine if an implant is suitable for your child
• perform the surgery and fit the sound processor
• provide ongoing care and maintenance for the implant

They may also involve other specialists, like speech therapists, if needed.

Assessment process

Once you’ve been referred, the implant centre will normally give you an initial assessment appointment within 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 bone conduction implants are right for your child. During the process, the team will give you information to help you make an informed choice. They will explain:

• what a bone conduction implant is, how it works, and the types available
• the surgery process and aftercare
• how to care for the implant after surgery and in the long term
• whether the implantable device is likely to offer additional benefit over other devices

If bone conduction implants are not suitable for your child

There will be times when the implant team feel that bone conduction implants are not suitable for a child or are unlikely to offer additional benefit over their current hearing aids. 

The implant team will send a report to the relevant professional who referred you. The report will explain why they do not think a bone conduction 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 implant centres in the UK offer a choice between 2 or 3 of the following manufacturers:

• Cochlear
• MED-EL
• Oticon Medical

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, and what the pros and cons of magnetic vs abutment implants are.
• Cosmetic design – including how the sound processor looks 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.
• 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?
• Safety features – such as a lockable battery door.
• Compatibility of the implant with radio aids or other assistive technology.