The CIRCA Audit has now been published in PLOS Medicine! Read the article here!

What is the UK Cochlear Implant Referral Criteria Audit (CIRCA)?

CIRCA is an INTEGRATE-led multicentre retrospective audit aiming to identify all patients within a 6-month period (July – December 2021) who had audiograms that were potentially eligible for a cochlear implant. 

This study has been made feasible by a grant from the British Society of Otology.

Why is it required?

Cochlear implantation remains by far the most effective treatment for people with profound hearing loss. Patients presenting for cochlear implant assessment represent a small proportion of patients that may benefit from implantation. We do not currently understand what factors influence patterns of referral or acceptance of implantation once patients are referred for assessment.

CIRCA Objectives

  1. To assess the proportion of adults meeting NICE audiometric criteria for cochlear implantation that are referred for assessment
  2. To report adherence to relevant audit standards based upon NICE guidance for consideration of CI referral
  3. To report adherence to BCIG / BAA recommendations that each site should have a CI champion
  4. To identify potential predictors of discussion of implantation, referral for assessment and implantation

When will the project run?

To enable adequate time to perform the searches and data collection, it is estimated that this retrospective audit will run between 1st April to 30th June 2022.

how can I get involved?

Any hospital performing audiograms can be involved! You DO NOT need to be a CI centre.

We are currently looking to recruit Regional Leads and Site Leads. To ensure the success of this project, we hope to recruit both an ENT and Audiology (and AVM where present at your hospital) Site Lead. 

Please note, due to the study search methodology, only departments that use Auditbase will be eligible to participate.

What is required of a Regional Lead?

  • To identify, coordinate and support local Site Leads.

What is required of a Site Lead?

  1. Register the study via local audit processes within your trust
  2. Partner with a local audiologist / ENT / AVM
  3. Identify your patients
    • Run searches within Auditbase using the BCIG CI referral Crystal report – instructions will be provided
  4. Collect your data
    • Follow the instructions on the Excel Data Collection tool
    • Make a backup copy of the file, then create an anonymised version by deleting all dates/identifiables (leaving only durations)
  5. Submit your data
    • Send the anonymised datasheet to the central coordinating team. NB for the IMD Eng form please only delete content of columns B&C
    • Deadline – 30th June 2022


Regional Leads, ENT/AVM Trainee Site Leads, Audiology Site Leads, and Consultant Leads will be acknowledged in any subsequent outputs (PUBMED cited as collaborative authors on publications/presentations as per the ICMJE model and in line with all previous INTEGRATE projects). 


Please find a link to all required documents to complete this audit.

  1. Instructions
  2. How to run the BCIG CI referral report
    1. CI referral report
    2. Cochlear Patient Decode Report
  3. Site information form
  4. Data extraction form
  5. Anonymisation of NHS numbers
  6. Indices of multiple deprivation (use the relevant form depending on your location within the UK)
    1. England (please only delete the contents in columns B&C prior to submission NOT A-D)
    2. Northern Ireland
    3. Scotland
    4. Wales
  7. Protocol