NICE rule change on cochlear implants

19754645 - clown faceThe clown with the funny face has gone.  Or almost so.

I’ve been putting off writing this post because the initial announcement from NICE* on changed eligibility criteria for cochlear implants in England and Wales was flagged as confidential, with a publication date of 27 February.  But the National Cochlear Implant Users Association has gone public so if they can, I can.  It’s excellent news.  The new criteria are more generous and many more people should qualify for an implant as a result.

What’s with the clowns?  They were part of the dreaded Bamford-Kowal-Bench (BKB) test and it will go.  No longer will people sit in soundproof rooms and listen to a tape of someone with very clear diction, speaking very loudly, working through a list of sentences and pausing for a lengthy period between each one.

“The clown has a funny face.”

“Children like strawberries.”

“The postman shut the gate.”

“The ice cream was pink.”

Many people “failed” this test as part of an assessment for an implant, including me (in 2015).  My hearing was bad enough to qualify but the BKB test seemed to indicate I was still “getting a lot of benefit from my hearing aids”.  Or that’s what the audiologist at the Cochlear Implant Centre said, looking sorry and sympathetic, when it became clear I wouldn’t be getting a CI.

I remember coming home and describing to Nigel what had happened in the test.  “And I could understand quite a few of the sentences”, I said.  He was totally bemused.  We both knew that, in real life, understanding speech without lip reading had become virtually impossible for me, but in real life you are not sitting in a silent room.  In real life someone wanting to talk to you very rarely bellows out a short sentence at high volume and then waits whilst you work out what has been said, before saying anything else.  When I first wrote about this test, in April 2017, I described what was going on in that pause as the brain shuffling around a few options and coming up with a plausible candidate for the translation.  I can’t explain it better today.

Audiology professionals have been lobbying for the BKB test to be changed for some years now.  It will be replaced by the Arthur Boothroyd (AB) Test, which is about word recognition rather than sentence recognition.  This is a LOT harder for us deafies.  I won’t give you examples of the words because some readers of this will be taking cochlear implant assessment tests in the future, but correctly deciphering the word “cream” (say) on its own is vastly harder than figuring out “the ice cream was pink”.  Today, post implant, I have a score of around 98% on the BKB test but only 72% (only! hark at her…..) on AB.  Prior to the operation my AB score was about 25%.  The new threshold will be 50%.

In addition to this change the hearing loss thresholds for qualification have changed; people won’t need to be quite so deaf to qualify and assessment will be at a wider range of frequencies.

It is massively, massively good news.  Hurrah, hurrah and yet more hurrahs.  Hopefully there will be a LOT of publicity for the final announcement and GPs and audiologists will be sending many more people for assessment.



*For non UK readers – NICE is the National Institute for Health and Care Excellence, which determines clinical guidelines for the National Health Service in England and Wales.  What they decide the NHS must implement.


Image copyright: Yael Weiss / 123RF Stock Photo


2 thoughts on “NICE rule change on cochlear implants

    1. True, but the document posted by NICE on 4 January clearly says “confidential until published” and there was a period after 4 January for consultees to appeal against it or notify NICE of any factual errors. The actual expected publication date is given as 27 February. I’m just being careful!
      On the issue of some centres already using the new guidelines I completely agree. I met a man at the Bradford centre last week who’d been told he didn’t qualify under the old criteria but was being progressed through the system because he should qualify under the new ones. Bradford promised me in 2015 that I would be recalled when the NICE review was over, if it looked like any new guidance would make a difference and I’m sure that’s what they will be doing (as will all the centres).

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