Manchester CI Programme
Programmed for success
Performing more than 70 cochlear implant operations a year and accepting referrals from more than 50 Primary Care Trusts in the North West, Manchester Cochlear Implant (CI) Programme is regarded as one of the leading multi-disciplinary CI centres in the country and a beacon of best practice.
The programme consists of three teams: adult, adolescent and paediatric. During 2005-06, a total of 78 cochlear implant operations were performed, including 45 on children, 27 on adults and six on adolescents.
Patients are referred to the programme from a wide geographical area, covering three main strategic heath authorities. The age range of recipients is almost as wide as their geographic coverage. The oldest implant recipient was 81 – Manchester does not have a maximum age for referral – and the youngest was six months.
Shakeel Saeed, Consulltant ENT Surgeon at the Manchester CI Programme says: “An increased awareness and wider acceptance by patients, parents and referrers means that we have seen a welcome increase in referral rates since we set up in 1988.
“Successful and well-publicised outcomes, in terms of speech perception and spoken language development, clearly indicate significant benefit for the majority of cochlear implant recipients and have also added to an increase in the referral rate. There have also been changes in referral criteria, such as, that a cochlear implant is now considered to be an option for patients with some useful residual hearing”.
Applications almost always rely on a good relationship between the purchaser and provider (cochlear implant programme and PCT) and when a trust and understanding is built up between the two parties.
Particular areas of expertise
It is with the younger end of the age range that the Manchester programme has developed a particular expertise, especially with children under 24 months.
Since its paediatric implant programme was established in 1991, 374 children have been implanted. The team has built up extensive experience of working with children of varying ages, from different cultural and educational backgrounds.
The programme has seen an increase in referrals since 2002, after neonatal screening was introduced. Since that time, the average age of children being seen has been getting steadily lower. “There will of course always be some older children being referred,” says Lise Henderson, Paediatric programme co-ordinator, “but in a couple of years, we expect to be seeing predominantly babies.”
Manchester was one of the first CI programmes in the UK to recognise the need for services aimed specifically at the adolescent population. The adolescent programme currently supports a total of 113 young people. Children can be referred directly to the programme from the age of 10 until they leave full-time education.
Christine Melling, who runs the adolescent programme explains: “In most cases they are referred by a hospital consultant or audiologist, or via a local GP. All children who receive implants on our paediatric programme automatically transfer to the adolescent programme as they grow older. After they have left full time education they transfer to the adult programme.”
The adult cochlear implant programme at Manchester was established in 1988 and was the first in the country to use multi-channel implant devices. The adult programme co-ordinator, Deborah Mawman, says: “Since then, nearly 400 adults have been implanted. The team has built up extensive experience of working with young adults who have just left full time education and are embarking on careers for the first time, to elderly patients in retirement. Many of the patients come from different cultural backgrounds with different histories of hearing loss and durations of deafness”.
As speech perception outcomes have improved following implantation, patients with greater degrees of residual hearing have become candidates for cochlear implantation. This development has resulted in further improvement in outcomes because patients with more residual hearing before cochlear implantation may perform better afterwards.
Funding
“Generally we have found that the number of children receiving cochlear implants has increased year on year.”
Speedy referral
As the Manchester team has found, speed of referral is essential when it comes to treating children. “The younger the child, the more successful the outcome is likely to be,” said Lise.
“A child who receives a cochlear implant at the age of four is likely to be less successful at acquiring spoken language than if they received their implant at 18 months.”
For patients – children, adults and adolescents – with sudden, acquired hearing loss, particularly post meningitis where there is a potential risk of cochlear ossification leading to surgical complications, Manchester has put in place a fast-track programme, giving them surgical priority.
Post-implant support
Manchester’s programme differs from many others around the country in its emphasis on providing post-implant support at the centre, rather than as an outreach service.
“We put a lot of effort into working with patients post-implant. We are especially strong on speech therapy, or habilitation as it is also known,” said Lise. “We do offer an outreach service, but the main focus of our support is on working directly with the patients and their families at our centre.
“With centre-based habilitation, we can work efficiently and it allows us to provide therapy sessions where we can coach the parents in methods that allow them to maximise the auditory potential of the cochlear implant. It also allows us to video therapy sessions which many parents feel is an invualable additional teaching support.”
Maltese connection
Manchester receives a small number of referrals from other areas and from abroad. Among those treated during 2005-06 were a child from Malta, an adolescent from Lothian in Scotland, and an adult and a child from the Isle of Man.
The Manchester programme has special links with Malta. To date, 15 patients, both adult and paediatric, from the island have received cochlear implants, through a reciprocal health agreement. Surgery and initial follow-up consultations take place in Manchester, and staff members from the Manchester team travel to Malta once a year to liaise with the families and local professionals.
Shak Saeed concludes: “Our success is entirely reliant upon the team of professionals at Manchester, who work hard to build up a good understanding with the PCTs that providing the funding so that our patients can benefit from the latest cochlear implant technology available today.”
