World-leadingexpertise in children’s ENT and hearing implant surgery

Evelina London Children’s Hospital is a world-leading children’s hospital and among the few with the extensive experi­ence, expert surgical skills and advanced facilities needed to perform complex paedi­atric Ear, Nose and Throat (ENT) surgery.

Our children’s ENT service has one of the UK’s largest specialist teams, offering life-enhancing care. We perform surgical procedures for common conditions and offer comprehensive treatments in sub-specialist areas such as complex ear surgery and hearing implant insertion where we have in-depth experience and knowledge.

Evelina London is part of Guy’s and St Thomas’ NHS Foundation Trust, a presti­gious, internationally renowned teaching centre. We have a global reputation for exceptional medical and surgical services from before birth to later life.

Evelina London’s co-location with St Thomas’ Hospital is a significant advan­tage for patients and their families. With two hospitals on the one central London site, our top-rated ENT surgeons can ac­cess expert support should children present with complex hearing issues and associated airway, heart or lung problems. This multi­disciplinary team (MDT) approach helps us achieve the best outcomes for our young patients.

Cochlear implant surgery
We are one of a few centres in the UK that provide every kind of hearing implant surgical solution, including bone conduc­tion, middle ear, cochlear, and auditory brainstem surgery. We also offer middle ear surgery in patients with complex diseases, including advanced cholesteatoma.

Consultant ENT surgeon Nikul Amin said: “We offer a cochlear implant when a patient’s hearing levels are so poor that they will not benefit from a regular hearing aid. In children born with significant hear­ing loss, we aim to start assessments early and provide a cochlear implant by their first birthday.”

A cochlear implant is a small electronic device that can help people with severe hearing loss by bypassing damaged parts of the inner ear and directly stimulating the hearing nerve. Unlike hearing aids, which simply amplify sound, cochlear implants convert sound into electrical signals that stimulate the hearing nerve, which then transmits these signals to the brain, allow­ing the person to perceive sound. However, they are unsuitable for people who lack the necessary cochlea parts or the hearing nerve, as the implant needs these structures to transmit sound signals effectively. Such patients may require an auditory brainstem implant.

Auditory brainstem implant service
Evelina London is home to the UK’s lead­ing paediatric auditory brainstem implant (ABI) service. As one of Europe’s most ex­perienced centres, we treat children from the UK and worldwide.

ABI provides a transformative solution for children with profound hearing loss. It can help those who cannot benefit from conventional hearing aids or cochlear im­plants due to the absence or injury of the cochlear or auditory (hearing) nerve.

The implant bypasses damaged areas by placing electrodes at the first relay station of the hearing pathway in the brainstem, stimulating the auditory brainstem directly and allowing the brain to perceive sound.

Professor Dan Jiang, ENT consultant and skull base surgeon and lead of the Hearing Implant Service, explains “our multidisci­plinary team combines expertise from Eve­lina London, UCLH, and King’s College Hospital, and partners with local hearing services, to provide long-term rehabilita­tion close to home for every patient.”

Complex syndromes and CHARGE
CHARGE Syndrome (CS) is a condition that affects multiple systems in the body, including the heart, eyes, kidneys, and hearing. While some children with CS are suitable candidates for cochlear implants, others may not be, depending on the sever­ity of their medical conditions. In addition to CHARGE, we manage children with other complex issues, such as Down, Usher, and Waardenburg syndromes, which also impact hearing and development.

As a specialist centre, Evelina London has the expertise and experience to evalu­ate these unique cases and decide whether cochlear implantation is appropriate. Our MDT ensures that each child receives tai­lored care suited to their specific needs.
In patients whose anatomy isn’t suited to a standard device, we can arrange for a specialist manufacturer to make tailored devices through our close relationship with all the major implant manufacturers. We can also provide cochlear implants to a subset of patients with single-sided deaf­ness or sudden hearing loss.

Treatment for microtia and atresia
Another sub-specialist area is hearing im­plant surgery for children with under-devel­oped outer ears (microtia), absent ear canals (atresia) and narrow (stenotic) ear canals.
Consultant ENT surgeon, Mr Amin said: “The inner ear parts, including the auditory (hearing) nerve, are often normal. So, we can provide hearing surgery that bypasses the absent ear canal. It’s challenging be­cause the abnormally small outer ear often means multiple abnormalities in the middle part of the ear, including the hearing bone. We need access to the middle ear and be­yond, which includes navigating the abnor­mal positioning of the nerve supplying the face muscles.”

In light of these challenges, the combined expertise of a hearing implant surgeon, plas­tic surgeon, audiologist and radiologist is needed to determine the best type of hear­ing provision for the child. The answer is often either a middle ear or bone conduc­tion implant. We provide one of the largest and most experienced MDT approaches to this condition.

Supporting international patients
Our ability to provide high quality care means we can manage everything from infections associated with hearing loss to surgery and subsequent hearing rehabilita­tion which can be a long process.

We’re building ties with our interna­tional partners and hospitals to educate on children’s rehabilitation so that care can be continued closer to home with a return to Evelina London for future assessments.

Our surgical expertise combined with support from leading specialists and criti­cal care facilities, enables us to provide complete care, even for the most complex patients, all in one place.