Hundreds more patients to be eligible for cochlear implants

The update from the National Institute for Health and Care Excellence comes after a review of the definition of severe to profound deafness that is used to identify if an implant might be appropriate. Expert stakeholders concluded that the previous definition from 2009 was outdated. 

“The appraisal committee listened to stakeholder concerns regarding the eligibility criteria”

Meindert Boysen

Charities said it meant the NHS would go from having some of the “strictest” criteria in the developed world for getting implants to being at the “forefront” of providing them to children.

Following the change, severe to profound deafness is now recognised as only hearing sounds louder than 80dB HL at two or more frequencies without hearing aids, noted the institute.

Previously, it was defined as only hearing sounds louder than 90dB HL. The move follows a suggestion from the British Cochlear Implant Group, which was backed by experts, said NICE.

Meanwhile, experts suggested that testing should be at a wider range of frequencies than stated in the original guidance, with those “important” for speech perception between 750 Hz and 3000 Hz.

“Cochlear implants can have an incredible impact on the lives of thousands of deaf children”

Vicki Kirwin

The institute noted that cochlear implants should still only be considered in those who do not receive adequate benefit from acoustic hearing aids.

However, the method that should be used to assess this has also been updated, said NICE in its statement announcing the updated guidance, which is currently in the form of a final appraisal document.

The new guidelines state that expert stakeholders highlighted that the Bamford-Kowal-Bench (BKB) sentence test was “no longer considered appropriate for assessing benefit of acoustic hearing aids”.

“The consensus among the professional and patient organisations was that the Arthur Boothroyd word test is a more appropriate test,” said the updated guidance.

NICE said that changing the criteria of its guidance was “not expected to have a substantial impact on the cost effectiveness of cochlear implants”.

The price of a cochlear implant for the NHS ranges from around £12,250 to £15,600 depending on the type. Additional discounts may also apply for a second implant, said NICE.

It said NHS organisations should compare their current practice with its new recommendations and consider what changes may need to be made to put them into practice.

In considering any changes, they will need to take into account any extra costs and savings involved, it stated.

The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with, noted NICE.


Meindert Boysen

Meindert Boysen

Meindert Boysen, director of the NICE Centre for Technology Evaluation, said: “The appraisal committee listened to stakeholder concerns regarding the eligibility criteria for cochlear implants being out of date. Upon review it was concluded this needed to be updated.

“The new eligibility criteria for cochlear implants will ensure that they continue to be available on the NHS to those individuals who will benefit from them the most,” he said.

Vicki Kirwin, a children’s audiologist at the National Deaf Children’s Society, said: “Cochlear implants can have an incredible impact on the lives of thousands of deaf children.

“With this updated guidance, Britain will go from having some of the strictest criteria in the developed world for accessing cochlear implants to being at the forefront of giving this technology to deaf children,” she said.

“With the right support, deaf children can achieve anything in life,” she said. “Today’s announcement means NICE is going a long way towards making that promise a reality for all those children who can benefit from this technology.”

A common cause of deafness is structural changes in the inner ear or hearing nerve. There are more than 613,000 people older than 16 years with severe to profound deafness in England and Wales.

A cochlear implant has parts worn outside the body – microphone, sound processor and transmitter coil – and parts placed under the skin – receiver-stimulator – and in the inner ear – electrodes.

The microphone picks up sounds which are turned into electrical signals and are sent to the brain. It provides a sensation of hearing, but does not restore hearing.