BC Adult Cochlear Implant Program

You must be 18 years or older to be referred to our program. You can be referred to our program by a:

• Family doctor
• Ear nose throat (ENT) specialist
• Registered audiologist
• Registered hearing instrument practitioner

When we receive your referral, we will send you a package that will include:

• Hearing Aid Check: Take the form to your audiologist or hearing aid provider and ask them to fill it out. The audiologist will test your hearing aids and check if they fit properly. They will also do real ear measurements (REM) to make sure the hearing aids are fit well. Please also send us a copy of a recent (within six months) complete hearing test. Copies of previous hearing tests are also helpful.
• Cochlear Implant Dizzy Questionnaire: You or a support person are to complete this questionnaire that outlines your history with dizziness.
• Cochlear Implant Questionnaire: You or a support person will complete this questionnaire which will provide us detailed patient information.

Complete these forms and return them to our clinic. Our team will review them and respond in one of three ways:

• We will contact you to schedule an assessment to see if you are a candidate for a cochlear implant.
• We will send you a letter letting you know that you are not/not yet a candidate for a cochlear implant. This is based on the results of your most current hearing test or other information.
• We will ask you to have your hearing aids adjusted. Before scheduling an assessment, we may also ask you to try more appropriate hearing aids.

If you have a hearing loss that might be helped by hearing aids, you need to wear them daily or be willing to undergo a trial before we can assess you for a cochlear implant. This is the case even if you have tried hearing aids in the past and did not like them or did not feel they were helpful.

It may take a few months to complete the above process due to the number of referrals we receive at this clinic. We thank you for your patience.

We accept adult patients (18 years and older) who meet the following criteria. Note: there is no upper age limit on receiving a cochlear implant:

• Patient has moderate (in the low frequencies) to profound hearing loss in both ears.
• Patient has little benefit from well fit hearing aids.
• Patient’s speech perception scores on a sentence recognition test are 50% or less in the ear to be implanted. The score is 60% or less in the non-implanted ear or in both ears.
• Patient is motivated and has realistic expectations of the cochlear implant.
• No medical contraindications.

Note: As of January 2020, the BC Adult Cochlear Implant Program expanded the cochlear implant candidacy criteria to include patients with single-sided deafness (with duration of deafness of no more than 15 years), asymmetrical hearing loss, and bilateral sequential cochlear implantation for those that no longer benefit from amplification on their non-implanted side. These patients will need to be assessed to determine candidacy. Once the completed documents have been received by the program, they will be reviewed by the cochlear implant team to determine if a candidacy assessment is appropriate.

Send your referrals to the BC Adult Cochlear Implant Program:

St. Paul’s Hospital
BC Rotary Hearing & Balance Centre
2600 Providence Building
1081 Burrard Street
Vancouver, BC, V6Z 1Y6

Phone: 604-806-8540
Fax: 604-806-8435

1. We will send a referral package to the patient. It will include:
   1. Cochlear Implant Questionnaire: The patient or their support person provides relevant patient history.
   2. Cochlear Implant Dizzy Questionnaire: The patient or their support person provides information on the patient's history with dizziness.
   3. Hearing Aid Check: The hearing aid provider provides information on the patient's hearing aids.
2. The patient will schedule an appointment with their hearing aid provider. They will drop off the completed questionnaires. The hearing aid provider will complete the Hearing Aid Check form.
3. The hearing aid provider will fax or email the completed documents to the BC Adult Cochlear Implant Program. The provider will also include a current audiogram and any older audiograms

We will not accept incomplete referral packages. Fax: 604-806-8435 or email: ci@providencehealth.bc.ca. Complete referral packages include the following:

1. Cochlear Implant Referral Document Checklist
2. Copy of Referral Letter to Cochlear Implant Surgeon
3. Cochlear Implant Questionnaire
4. Cochlear Implant Dizzy Questionnaire
5. Hearing Aid Check
6. Current audiogram: Including air, bone conduction pure tone testing and speech testing (word recognition scores).
7. Historical audiograms: Any additional previous audiograms.

Please note the Unilateral and Sequential Bilateral referral documents are different.

Cochlear implant intake meeting: Once we have received all the documents, we will review the referral at our weekly intake meetings.

• If the patient is NOT a candidate, we will send them a letter advising that they do not yet meet the candidacy criteria.
• If the patient MIGHT be a candidate, we will contact the patient and schedule a candidacy assessment when they reach the top of the list.
• If the patient requires a hearing-aid trial or hearing-aid adjustment before a candidacy assessment, we will send the patient, the referrer and the hearing-aid provider a letter to advise them.
• Hearing Aid Trial/Adjustment: Once the patient has the hearing-aid trial or adjustment, the hearing-aid provider will need to complete a new Hearing Aid Check form and send it in. We will re-review it and decide at a second cochlear-implant intake meeting.

NOTE: Cochlear implant candidates who were originally referred to the program by an audiologist or a hearing instrument practitioner will be required to obtain a referral from their primary care provider to the office of Dr. Brian Westerberg and Dr. Jane Lea to complete the medical/surgical candidacy assessment. CI candidate - referral to surgeon required