Cochlear implants in the United Kingdom: Awareness and utilization

Chris Raine

doi:10.1179/1467010013z.00000000077

Abstract

IntroductionEvery child and adult in the United Kingdom who fulfils the criteria for cochlear implantation is entitled to receive treatment under the National Health Service (NHS); children since 2009 are eligible for bilateral simultaneous implants and adults single implants unless they have additional sensory needs.HistoryDuring a period between 1982 and 1990, when a number of individual teams ran programmes using charitable funding, the British Cochlear Implant Group approached the UK Department of Health, who agreed to set up a 4-year pilot study of 10 programmes, including one children's programme. The outcomes were collected and analysed by the Medical Research Council's Institute of Hearing Research. The results, showing positive outcomes for adults and children, were published in 1995 and subsequently funding was provided directly by the NHS.AccessBetween 2001 and 2006 the Universal Newborn Hearing Screen (UNHS) was implemented in England and Wales and also in Scotland and Northern Ireland. Data from UNHS and also data from the three main cochlear implant manufacturers have allowed estimates of access to cochlear implants for children and adults within the criteria for implantation.ChildrenBetween 2006 and 2011 the figures show that 74% of estimated eligible children aged 0–3 years have received implants and 94% by the age of 17.AdultsFor adults the figures are considerably lower, with only about 5% of those eligible for an implant actually receiving one. The reasons for this include, to a lesser degree, the fact that guidelines by the National Institute of Clinical Excellence (NICE) are stricter than in some other European countries, but chiefly because of lack of awareness among candidates and professionals, both of criteria for eligibility and of the potential advantages from cochlear implantation.

Highlights

Every child and adult in the United Kingdom who fulfils the criteria for cochlear implantation is entitled to receive treatment under the National Health Service (NHS); children since 2009 are eligible for bilateral simultaneous implants and adults single implants unless they have additional sensory needs
In the United Kingdom (UK) all adults and children who fulfil the criteria for cochlear implantation (CI) are eligible for this treatment under the National Health Service (NHS)
It is acknowledged that following Djourno and Eyries’ direct stimulation of the auditory nerve in Paris in 1957, significant strides were made in the USA, initially in Los Angeles and subsequently in San Francisco

Summary

Introduction

In the United Kingdom (UK) all adults and children who fulfil the criteria for cochlear implantation (CI) are eligible for this treatment under the National Health Service (NHS). Over the last couple of years significant additional workload has been placed on centres to review children with unilateral devices to see if they would be suitable for sequential surgery, especially as there appears to be evidence of a ‘critical age’ after which a second, sequential implant may be relatively ineffective for a congenitally deaf child who is already making good use of an implant in the original ear (Graham et al, 2009). Surgical registrations up to 17 years were plotted against UNHS figures for the cohort of children with estimated severe to profound loss for this age range (Fig. 3). For the cohort 0–17 years the implantation rate on average was 94% of the estimated number of children with severe to profound hearing loss from UNHS.

Findings

Discussion

Conclusion