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The National Institute for Health and Clinical Excellence (NICE) has today (28 January) published final guidance on the use of cochlear implants for severe to profound deafness in children and adults. The guidance makes recommendations on the implantation of cochlear implants in one ear (unilateral implantation) and in both ears (bilateral implantation):

• Unilateral cochlear implantation is recommended as an option for people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids. If different cochlear implant systems are considered to be equally appropriate, the least costly should be used. Assessment of cost should take into account acquisition costs, long-term reliability and the support package offered.

• Simultaneous bilateral cochlear implantation is recommended as an option for the following groups of people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids:
o Children
o adults who are blind or who have other disabilities that increase their reliance on auditory stimuli as a primary sensory mechanism for spatial awareness.

Acquisition of cochlear implant systems for bilateral implantation should be at the lowest cost and include currently available discounts on list prices equivalent to 40% or more for the second implant.

Bilateral cochlear implantation carried out in separate operations is not recommended as an option for people with severe to profound deafness. However, people who had a unilateral implant before publication of this guidance, and who fall into one of the categories described for bilateral implantation, should have the option of an additional implant in the other ear if this is considered to provide sufficient benefit by the responsible clinician after an informed discussion with the individual person and their carers.

The guidance also outlines the following considerations:

• Cochlear implantation should only be considered after an assessment by a multidisciplinary team. As part of the assessment, children and adults should also have had a valid trial of an acoustic hearing aid for at least 3 months (unless contraindicated or inappropriate).

• When considering the assessment of adequacy of acoustic hearing aids, the multidisciplinary team should be mindful of the need to ensure equality of access. Tests should take into account a person’s disabilities (such as physical and cognitive impairments), or linguistic or other communication difficulties, and may need to be adapted. If it is not possible to administer tests in a language in which a person is sufficiently fluent for the tests to be appropriate, other methods of assessment should be considered.

Professor Peter Littlejohns, Clinical and Public Health Director and Executive Lead for this guidance said: “The independent Appraisal Committee carefully considered the evidence and concluded unilateral and bilateral cochlear implantation to be a cost effective use of NHS resources. These recommendations will help improve the quality of life of those adults and children with severe to profound deafness, maximising their ability to communicate on a day to day basis.” Ends For more information call the NICE press office on 0845 003 7782

Notes to Editors

About the guidance

1. Information on this appraisal can be found on the NICE website at - http://www.nice.org.uk/TA166.

2. About 1 in every 1000 children is severely or profoundly deaf at 3 years old, this rises to 2 in every 1000 children aged 9 to 16 years. There are approximately 613,000 people older than 16 years with severe to profound deafness in England and Wales.

3. For the purposes of this guidance, severe to profound deafness is defined as hearing only sounds that are louder than 90 dB HL at frequencies of 2 and 4 kHz without acoustic hearing aids. Adequate benefit from acoustic hearing aids is defined for this guidance as:
• for adults, a score of 50% or greater on Bamford–Kowal–Bench (BKB) sentence testing at a sound intensity of 70 dB SPL
• for children, speech, language and listening skills appropriate to age, developmental stage and cognitive ability.

About NICE

4. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

5. NICE produces guidance in three areas of health:
• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.