Concierge otology · London
Cochlear implants, a patient guide.
For severe-to-profound hearing loss that hearing aids can no longer reach — a proper candidacy work-up, a consultant otologist in a microsurgical theatre, and the audiology-led rehabilitation that decides how well you actually hear.
Why patients choose us
- 01
A consultant otologist, in theatre
A named ear surgeon with subspecialty otology and skull-base training — operating in a microsurgical theatre with facial nerve monitoring, not a general ENT list.
- 02
Audiology-led rehabilitation team
Switch-on, MAPping and speech rehabilitation with a dedicated implant audiologist and speech-and-language therapist — the part that actually decides how well you hear.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — device brand, unilateral vs bilateral, EAS vs standard — is impartial and costs you nothing.
Indicative pricing
What a private cochlear implant pathway costs in London.
Indicative ranges across our partner otology teams. Send the details and we quote firm figures across the full pathway — assessment, surgery, device and rehabilitation.
In short
A unilateral cochlear implant in our network: £28,000–£40,000, with switch-on at two to four weeks.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation with consultant otologist | £250–£450 | 30–45 min | Same visit |
| Pure-tone audiometry and tympanometry | £120–£220 | 30 min | Same visit |
| Aided speech audiometry in noise (BKB) | £180–£320 | 45 min | Same visit |
| HRCT and MRI temporal bones (candidacy) | £900–£1,600 | 45 min | 24–48h report |
| Unilateral cochlear implant (surgery + device) | £28,000–£40,000 | 2–3 h GA | Day case / 1 night |
| Bilateral cochlear implants (simultaneous) | £52,000–£72,000 | 3–4 h GA | 1 night stay |
| Hybrid EAS implant (high-frequency loss) | £30,000–£42,000 | 2–3 h GA | Day case / 1 night |
| Switch-on, MAPping and rehab (12-month package) | £3,500–£6,500 | Multi-visit | 12 months |
Prices vary by device manufacturer, by whether one or both ears are implanted, and by which surgeon and audiology team lead your care. Rehabilitation packages are usually quoted as a 12-month bundle. We come back with a firm quote within one working day.
The problem
The right candidacy call, the right device, the right rehab.
Cochlear implantation is a surgical, audiological and psychological project. Getting one part right and the other two wrong is how patients end up as non-users. We hold all three in view from the first consultation.
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Not sure you qualify?
We arrange aided BKB sentence testing and audiometry against the NICE TA566 criteria — a clear yes or no, in writing.
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Which device — and one or two?
Cochlear, MED-EL or Advanced Bionics; unilateral, bilateral or bimodal; hybrid EAS if your low-frequency hearing is worth preserving. Discussed on the merits, not on the brochure.
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What about after surgery?
Switch-on, MAPping and structured rehab — the twelve months that decide whether the implant actually gives you speech. Booked in from day one.
The pathway
From enquiry to switch-on and beyond — what happens, in order.
One team from candidacy through surgery and rehabilitation — the audiology relationship lasts years, not weeks.
Phase 1 · Candidacy and consent
Assessment and device choice
Phase 2 · Surgery
Day case or one-night stay
Phase 3 · Switch-on and rehab
MAPping across the first year
- 01
Before
You tell us what is going on
A short, confidential form. Hearing history, current aids, whether you meet the NICE TA566 criteria on paper, and any previous audiology or imaging.
- 02
Before
Candidacy assessment
Pure-tone audiometry, aided BKB sentence testing in quiet and noise, HRCT and MRI of the temporal bones, vestibular testing and a psychology review — the full candidacy work-up.
- 03
Before
Device choice and consent
A discussion of Cochlear, MED-EL and Advanced Bionics devices, unilateral vs bilateral vs bimodal, and hybrid EAS for high-frequency loss. Pneumococcal vaccine confirmed before surgery.
- 04
On the day
Arrival at the hospital
Admission, consent and a chat with the otologist and anaesthetist. Cochlear implantation is done under general anaesthetic as a day case or one-night stay.
- 05
On the day
The surgery itself
Two to three hours in theatre — a post-auricular incision, cortical mastoidectomy, posterior tympanotomy through the facial recess, and electrode array insertion via the round window.
- 06
On the day
Home the same day or next morning
A light head dressing, simple painkillers and written aftercare. Most adults go home the same day; some stay one night.
- 07
After
Switch-on and rehabilitation
Switch-on at two to four weeks, then MAPping and structured aural rehabilitation. Open-set speech understanding usually improves markedly over six to twelve months.
Candidacy to surgery: 6–10 weeks. Switch-on to open-set speech: 6–12 months.
Who qualifies
When a cochlear implant is the right answer.
The situations we see most, mapped against the NICE TA566 criteria — plus the one red flag that changes the timeline.
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Severe-to-profound bilateral SNHL
Bilateral sensorineural hearing loss with pure-tone thresholds worse than 80 dB HL at 2 and 4 kHz on the better ear — the NICE TA566 audiometric threshold.
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Poor aided speech understanding
BKB sentence scores below 50 per cent in the better ear with well-fitted hearing aids — the functional half of the NICE criteria.
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Adult-onset progressive hearing loss
A steady decline over years — presbycusis, ototoxicity, otosclerosis or genetic — where hearing aids no longer give useful speech.
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Sudden sensorineural hearing loss
Bilateral sudden SNHL that has not recovered with steroids, or single-sided sudden loss now considered for an SSD implant.
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Single-sided deafness (SSD)
Profound loss in one ear with a normal contralateral ear — now a licensed indication for cochlear implantation to restore binaural hearing.
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Post-meningitis hearing loss
Urgent referral pathway — cochlear ossification can start within weeks of meningitis and closes the window for straightforward implantation.
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Paediatric congenital deafness
Bilateral severe-to-profound congenital loss identified on newborn screening — early implantation (before 12 months where possible) gives the best speech outcomes.
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Red flag: pneumococcal vaccine due
Pneumococcal vaccination is mandatory before implantation to reduce the small but serious risk of post-operative meningitis — do not skip this.
Device and configuration options
One implant is not the only option.
What each configuration and manufacturer actually offers — and which fits which pattern of hearing loss.
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Unilateral cochlear implant
A single implant in the worse-hearing ear — the standard NHS route in many regions, and often self-funded where bilateral is preferred.
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Bilateral cochlear implants
Simultaneous or sequential implants in both ears — better sound localisation and speech-in-noise, the standard for children and increasingly for adults.
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Bimodal: implant + contralateral aid
A cochlear implant in one ear and a well-fitted hearing aid in the other. Suits asymmetric loss where the aided ear still gives useful low-frequency hearing.
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Hybrid EAS (electric-acoustic)
A shorter electrode that preserves residual low-frequency hearing, combined with acoustic amplification. For steeply sloping high-frequency losses.
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Single-sided deafness (SSD) implant
An implant in the deaf ear to restore binaural hearing — now licensed and NICE-approved for adults and children with intractable SSD.
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Cochlear (Nucleus) devices
The Australian market leader — reliable electrode arrays, robust processors and the largest global user base.
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MED-EL devices
Austrian manufacturer known for long, flexible electrodes designed for full cochlear coverage and residual hearing preservation.
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Advanced Bionics devices
US manufacturer, part of Sonova — high-rate stimulation strategies and strong compatibility with Phonak hearing aids for bimodal use.
Our vetted London network
A small panel of otologists and implant audiologists, we picked them.
Consultant otologists and dedicated implant audiology teams across central London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every implant team in our network.
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Consultant otologists with subspecialty cochlear implant training, not general ENT surgeons
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A dedicated implant audiology and rehabilitation team, not a bolt-on service
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Facial nerve monitoring and intraoperative neural response telemetry as standard
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All three major device manufacturers offered — Cochlear, MED-EL and Advanced Bionics
Safety and expectations
The risks, honestly — and what to expect after.
Cochlear implantation is a well-established operation with a very good safety record. The risks are small but real, and worth knowing before you consent.
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Facial nerve injury is rare but serious
The facial nerve runs millimetres from the surgical corridor. Continuous facial nerve monitoring is used throughout — permanent weakness occurs in well under one per cent.
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Meningitis — vaccinate first
Cochlear implantation carries a small increased risk of pneumococcal meningitis. Pneumococcal vaccination is mandatory before surgery, and non-negotiable in our network.
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Vestibular dysfunction after surgery
Some patients feel dizzy or unsteady for days to weeks. Persistent vestibular loss is uncommon but real, and worth discussing before you consent.
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Taste disturbance from chorda tympani
The chorda tympani nerve crosses the surgical field. Metallic taste or numbness on one side of the tongue can occur — usually temporary, occasionally permanent.
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Device failure and reimplantation
Modern implants are highly reliable, but a small percentage fail electrically or mechanically over decades and need reimplantation.
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Wound infection or flap breakdown
Uncommon with modern low-profile receivers, but worth watching for — redness, swelling or discharge over the receiver site is not normal.
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Non-user outcomes
A small minority of adults do not adapt to the sound and stop wearing the processor. Realistic expectations and committed rehabilitation matter enormously.
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Non-auditory stimulation
Occasionally an electrode causes facial twitching or dizziness on stimulation. MAPping deactivates the offending electrode without losing the whole implant.
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Red flags
New facial weakness, severe vertigo, spreading redness over the receiver, or fever with headache after surgery are not normal — call the team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever device was implanted, the note the surgeon and audiologist send you keeps to the same shape.
A quiet reminder
Surgical and audiological language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the operation note or the first MAP report before your review, just ask.
- 01 Header
Indication, ear operated and device
Why you were implanted — bilateral severe SNHL, SSD, EAS candidacy — which ear, and the exact device and electrode array used.
- 02 Technique
Surgical approach and insertion
Post-auricular incision, cortical mastoidectomy, posterior tympanotomy, round window insertion, insertion depth and any intraoperative findings.
- 03 Findings
Neural response telemetry and integrity
Electrode impedances, neural response telemetry thresholds and the intraoperative integrity check — the objective evidence that every electrode is working.
- 04 Impression
Switch-on date and rehab plan
Read this first: your switch-on appointment, the MAPping schedule for the first year, and expectations for open-set speech at three, six and twelve months.
Recognised by major UK insurers
Cochlear implantation is usually funded on the NHS where NICE TA566 criteria are met. Private cover varies by insurer and by indication — we confirm cover and any funding pathway before booking.
Frequently asked
Everything we get asked about cochlear implants.
Quick answers on candidacy, devices, surgery, switch-on, and what hearing actually sounds like at the end.
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Who qualifies for a cochlear implant on NICE TA566 criteria?
Adults and children with severe-to-profound sensorineural hearing loss in both ears (pure-tone thresholds of 80 dB HL or worse at 2 and 4 kHz) who do not gain adequate benefit from well-fitted hearing aids — defined as a BKB sentence score below 50 per cent in the better ear when aided. Single-sided deafness is now a separate NICE indication.
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Is a cochlear implant the same as a hearing aid?
No. A hearing aid amplifies sound to a damaged inner ear. A cochlear implant bypasses the damaged hair cells entirely — an electrode array in the cochlea stimulates the auditory nerve directly, driven by an external speech processor worn behind the ear.
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How long does the surgery take and is it painful?
Two to three hours under general anaesthetic. Most adults go home the same day or after one night. Post-operative pain is usually mild and controlled with simple painkillers — the operated ear feels bruised and full for a week or two.
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When is the implant switched on?
Two to four weeks after surgery, once the wound has settled. The first sound is often described as robotic, tinny or unnatural — the brain then re-learns to interpret it over weeks and months. MAPping (fine-tuning the electrode programming) continues throughout the first year.
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How well will I actually hear?
Most adults with post-lingual deafness achieve open-set speech understanding — meaning conversation without lip-reading — within six to twelve months. Speech in noise and music are harder. Outcomes are best when hearing loss has been shorter, the auditory nerve is healthy, and rehabilitation is committed.
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Unilateral, bilateral or bimodal — which is right?
Bilateral implants give better sound localisation and speech in noise, and are standard for children. Bimodal (implant plus a hearing aid on the other side) is a good option when the non-implanted ear still gives useful low-frequency hearing. Unilateral remains common where bilateral is not funded.
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Why is the pneumococcal vaccine mandatory?
Cochlear implantation carries a small increased risk of pneumococcal meningitis. The pneumococcal vaccine (PCV13 followed by PPV23 for adults) is required before surgery to reduce this risk to near-baseline. This is non-negotiable in our network.
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Can I have an MRI after a cochlear implant?
Modern implants from all three manufacturers are 1.5 T MRI conditional, and most are 3 T conditional with specific protocols. Older devices may require magnet removal for scanning. Always tell the radiographer you have a cochlear implant and which model.
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Can I swim, run and travel with a cochlear implant?
Yes to all three. The internal implant is fully sealed. The external processor is removed for swimming, or you can use a waterproof accessory. Airport security and MRI need a device identity card, which is issued after implantation.
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What if I do not get on with the implant?
A small minority of adults become non-users — usually because expectations were unrealistic or rehabilitation was not sustained. This is why the pre-op counselling and post-op audiology relationship matter more than the surgery itself, and why we insist on both.
Sources
- National Institute for Health and Care Excellence. Cochlear implants for severe to profound deafness (TA566).
- British Cochlear Implant Group. UK quality standards for cochlear implant services.
- European Cochlear Implant Group (Euro-CIU). Position papers on candidacy and outcomes.
- American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guideline: cochlear implants.
Reviewed by Pulse Atlas Editorial Board (). Published 2026-07-30. Next review 2027-07-30.
Related tests
Looking for something else?
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Pure-tone audiometry
The baseline hearing test — the first number in any candidacy work-up.
Learn more -
Speech audiometry
Aided BKB sentence testing — the functional half of NICE TA566.
Learn more -
Private audiology assessment
A full private audiological work-up with a consultant audiologist.
Learn more -
All tests
Every test and procedure we arrange.
Learn more -
Tinnitus
Related condition guide.
Learn more -
Chronic Sinusitis
Related condition guide.
Learn more
In practice, in London
Where cochlear implants sits in a private London pathway
For cochlear implants, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. Waiting lists on the NHS for cochlear implants vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
In practice, a private cochlear implants appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For cochlear implants in particular, we bias towards consultants who do this every week rather than every month.
There are a lot of consultants in London who can technically handle cochlear implants. Fewer who do it week in, week out for the exact question you’re bringing. We spend most of our time working out which is which — and being straight when a different test or a different specialist would serve you better. Everything runs to CQC, GMC and Royal College standards; the choice is about fit, not floor.