Professionals

The BC Adult Cochlear Implant Program accepts referrals from the following members of the hearing healthcare team:  otolaryngologists, family physicians, audiologists and hearing instrument practitioners.  We are cognizant of your busy schedules and have streamlined the referral process to minimize the work/time required.  Below, you will find an explanation of our referral process.  You will also find our current program forms available to you for download.  Should you have any questions, please do not hesitate to contact us.    

Traditional criteria for cochlear implantation

Adult patients (18 years and older) eligible for cochlear implantation must meet specific criteria. These include:

• Moderate (in the low frequencies) to profound sensorineural hearing loss in both ears.
• Limited benefit from well fit hearing aids.
• Speech perception scores on sentence recognition test of 50% or less in the ear to be implanted and 60% or less in the non-implanted ear or binaurally.
• Motivated and with realistic expectations of the cochlear implant.
• No medical contraindications.
• There is no upper age limit to obtaining a cochlear implant.  

Please 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.

Referral Process

Referrals can be sent to 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. A referral package will be sent to the patient which will include the documents as indicated below. Please note the Unilateral and Sequential Bilateral referral documents are different.
2. The patient will request a referral to the CI Surgeon from their family doctor or through a Walk-In Clinic.  Please be sure to request a copy of the Referral Letter. 
3. The patient will schedule an appointment with their Hearing Aid Provider to complete the Hearing Aid Check form. 
4. Once all documents have been completed, the Hearing Aid Provider will either fax or email all documents to the BC Adult Cochlear Implant Program.  Incomplete referral packages will not be accepted.  Fax:  604-806-8435  Email:  ci@providencehealth.bc.ca:

                         A Complete Referral Package will include: 

                                   - CI Referral Document Checklist

                                   - Copy of Referral Letter to CI Surgeon.

                                   - CI Questionnaire

                                   - CI Dizzy Questionnaires

                                   - Hearing Aid Check form with Real Ear Measurement tracings

                                   - Current Audiogram

                                   - Historical Audiograms

To expedite referrals, otolaryngologists, family physicians, audiologists and hearing instrument practitioners may choose to download the relevant referral documents below and request the patient to follow the above steps.  Incomplete referral packages will not be accepted.

Documents for Unilateral cochlear implant referrals: 

1. Referral to CI Surgeon:  A referral to the CI Surgeon from a doctor is required as part of the initial referral package submission.
2. CI Referral Document Checklist:  A checklist to ensure all required documents have been included in the referral package submission.
3. Historical audiograms:  Any additional previous audiograms.
4. Current audiogram:  Including air, bone conduction pure tone testing and speech testing (word recognition scores).  
5. Hearing Aid Check:  Provides information on the state of the patient's hearing aids.  To be completed by patient's hearing aid provider. 
6. CI Dizzy Questionnaire:  Provides to the clinic information on patient's history with dizziness.  To be completed by patient or by patient's support.
7. CI Questionnaire:  Provides to the clinic relevant patient history.  To be completed in detail by patient or by patient's support.

Documents for Sequential Bilateral cochlear implant referrals:

• Referral to CI Surgeon:  A referral to the CI Surgeon from a doctor is required as part of the initial referral package submission.
• CI Referral Document Checklist:  A checklist to ensure all required documents have been included in the referral package submission. 
• Current audiogram:  Including air, bone conduction pure tone testing and speech testing (word recognition scores).  
• Historical audiograms:  Any additional previous audiograms.
• Hearing Aid Check -Seq Bilateral:  Provides information on the state of the patient's hearing aids.  To be completed by patient's hearing aid provider. 
• CI Questionnaire - Seq Bilateral:  Provides to the clinic relevant patient history.  To be completed in detail by patient or by patient's support. 
• CI Dizzy Questionnaire:  Provides to the clinic information on patient's history with dizziness.  To be completed by patient or by patient's support. 

Cochlear implant Intake meeting:  Once all documents have been received, each referral will be reviewed on an individual basis at our weekly cochlear implant intake meetings.

• If the documents reviewed indicate that the patient is clearly NOT a candidate, a letter will be sent advising the patient that they do not yet meet the candidacy criteria.  
• If the documents indicate that the patient MIGHT be a candidate, a candidacy assessment will be scheduled.  
• If the documents suggest that a hearing aid trial or hearing aid adjustment is required prior to completing a candidacy assessment, a letter will be sent to the patient, the referrer and the hearing aid provider notifying them of this.  

Hearing Aid Trial/Adjustment: Once the hearing aid trial or adjustment has been completed, a new Hearing Aid Check form will be required completed and sent in. This information will be reviewed at a second cochlear implant intake meeting where a decision will be made.