Bilateral cochlear implants Q & A

Some families have done exactly that. The case for a simultaneous bilateral CI is very strong where there is evidence that second ear would not gain any significant benefit from a hearing aid. The medical case is even stronger for babies and children deafened by meningitis. The cost to the NHS is minimised if the two CIs are implanted simultaneously and the gains to the patient, in terms of early habilitation and only one operation, are maximised. It is worth exploring fully with the CI centre and your PCT but it is also important that you balance this against avoiding any undue delay in implantation. Finally, NICE is recommending that prelingually deaf children receive simultaneous bilateral implants.

NHS PCT funding has been provided for nearly two thirds of the children with bilateral CIs whose cases are known to the charity CICS (see ‘what is happening in the UK’). The NICE evaluation may improve access for certain patients but there is still a chance of considerable uncertainty for others. Some families have won the battle for funding with their PCTs and others have not and there appears to be no logic or consistency to PCT decision-making. It remains a lottery. The family Case studies and the other pages on this web-site should give you some pointers.

Some patients or parents of patient have chosen to self-pay but it is an expensive procedure. There is every reason to argue that it is a wise investment of public healthcare expenditure by the NHS and patients should not have to pay themselves. Funding may be available through private medical insurance, particularly with insurance cover that pre-dates the diagnosis of deafness. At least five parents of children have been able to fund bilateral CIs in this way in the UK (also see ‘what is happening in other countries’ for details of some US private insurance stances on bilateral CIs).

There is evidence to indicate that the shorter the interval the better with optimal results coming from simultaneous implantation or a short time interval. However, many of the children and young adults in the UK who have had second CIs have had a long time interval (up to 15 years) between operations. The international medical consensus paper states: “The maximum delay between the two surgeries in order to avoid contralateral cortical atrophy is not yet known. The duration of deafness is not considered a contraindication for bilateral cochlear implantation because monoaural input may maintain some stimulation of the auditory pathways….Although the time interval between the two surgeries does not seem to be as critical in postlingually deaf adults as in children it should not exceed 12 years”

While bilateral CIs are likely to increasingly become the norm for the future generation, there are many thousands of cochlear implant users around the world who are gaining and will continue to gain immense benefit from one CI alone. A single CI will serve these people very well.

The British Cochlear Implant Group’s web site outlines the risks associated with a CI operation and use of CIs. Anyone contemplating a CI should seek advice from their CI team and their consultant about risks and any matters that concern them.

The important thing is to seek advice from your CI team and consultant. The idea of ‘preserving’ an unimplanted ear for future medical breakthroughs such as cochlea hair cell regeneration has to be weighed against a number of considerations. The key consideration is the advantages of gaining and maximising auditory stimulation on that side vs the uncertainty of having no or minimal auditory stimulation with the associated risk of atrophy. Another key factor is the fact that developments such as hair cell regeneration remain a theoretical, uncertain and distant prospect rather than a near-term prospect. Finally, in the light of an increasing knowledge base arising from explants and reinsertions, you might want to ask your consultant’s advice about the effect of the presence of a modern electrode in the cochlea if you are worried about its effect on the viability of future hair cell regeneration.