The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on auditory brain stem implants.
This procedure is used to treat deafness caused by damage to the vestibulocochlear nerve due to tumours or surgery.
In people with vestibulocochlear nerve damage, hearing is not improved by hearing aids or cochlear implants.
Auditory brain stem implants are electrodes placed in a part of the brain (the cochlear nucleus) responsible for processing sound signals carried to it from the ear through the vestibulocochlear nerve. This nucleus lies in the lower part of the brain, called the brain stem.
Removal of vestibulocochlear nerve tumours and placement of auditory brain stem implants is often done at the same time. The surgeon makes an incision in the skin of the side of the head, and removes some of the bone behind the ear. This exposes the tumour so that it can be removed and also allows access to the brain stem beneath it. Sometimes the surgeon approaches the brain stem through the back of the head.
People with auditory brain stem implants wear an external receiver and speech processor. This device converts sounds into electrical signals, which are then sent to the implant.
A09.1 Implantation of neurostimulator into brain
Z01.6 Tissue of brain stem
When the removal of a vestibulocochlear nerve tumour is performed at the same time, this can be reflected by the addition of A29.5 Excision of lesion of acoustic nerve (viii).
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.