Your First Cochlear Implant Fitting

Approaching the first programming session (also known as initial stimulation or initial stim, for short), everyone wants to know if they will hear right away, what sound will sound like, and if they will understand speech and music.

Every person is unique, with different medical and hearing histories and life experiences. What you will hear depends on many factors, such as how long you have had hearing loss, how much has been heard or not heard in the past, and other medical and physiological factors affecting the inner ear and auditory nerve. Everyone responds differently to what they hear at first.

What Could It Sound Like?
At first, speech and sound from the environment can sound or feel like vibrations, clatter, or garbled noise. Some people can recognize speech right away, but it might sound high pitched or mechanical and artificial. To others, it may start out sounding natural, just like they remember.

For adults with long-standing hearing loss, the brain may have been deprived of meaningful sound for a very long time, in some cases since birth, and it takes time to learn or re-learn what sound is. It’s important to realize that the initial experience of hearing with a cochlear implant does not set the stage for what sounds you will hear and interpret after a period of listening and practicing.

High pitches (frequencies) are usually the first sounds people with hearing loss lose. When high frequencies are first brought into the sound picture, it can make things sound unnatural or “tinny.” It takes time for these sounds to become natural. Being able to associate sounds with meaning can take time too.

Since many more sounds are coming all at once, it takes the brain time to learn, or re-learn, how to separate and identify individual sounds in the environment. People forget or are not aware of how many things make sound, since so many sounds haven’t been audible. With patience and practice, it all begins to make sense. As the brain adjusts and learns the complete sound picture, what you hear will become more natural.

Getting Ready For The Appointment
If you want to know firsthand about the process, it’s a good idea to talk to someone who has been there before. The Bionic Ear Association will put you in contact with other cochlear implant recipients or parents who can share their personal experiences with you. Also, be sure to watch the Initial Stimulation DVD (or VHS) available free of charge from Advanced Bionics.

• At least one night before your appointment, plug in the Charger
• Slide in the PowerCel™ Batteries to charge them overnight.
• Remember to take PowerCels with you to the appointment, along with the entire Patient Processor Kit.

Some audiologists keep the kit in their office and charge the batteries for you. Refer to the Quick Start Guide, User Manual or Instructional DVD for further instruction on how to charge your batteries.

Who Should Attend The Appointment With You?
Although you can bring people to the first programming appointment, you should consider having only your closest immediate family member or friend attending. Your audiologist may also have some input on who they recommend you bring, if anyone.

What Happens At The First Appointment
The objective of the first programming day is simple: to find a comfortable volume level across the frequency (pitch) spectrum so that the first hearing program (called a sound processing program or “map”) can be set.

System Set-up
Your audiologist will connect the programming system to your processor and place the headpiece over your implant. Your audiologist may begin by running diagnostics and testing the software to be sure everything is active, including your auditory nerve.

The audiologist will slowly increase the volume and ask you to indicate when you hear something. You may also hear a beeping noise, depending on the programming method used by the audiologist. It doesn’t matter what you are hearing or whether you recognize the sound, just say when you start to hear or perceive something.

There are 10 levels of sound that you will use to describe VOLUME (see picture). After you identify the first moment you hear sound, the audiologist will begin looking for the most comfortable level for various sounds.

Most Comfortable is defined as the level that has the highest volume that you can listen to with ease and comfort over time.

This is not a contest to see how loud you can take it. It is simply about finding a comfortable, audible level so that you don’t have to strain to hear. Usually the most comfortable level is made up of a range of sound volume, so don’t worry about having to determine the exact level.

Also, your sound comfort level will change over time, so the volume you select on the first day is not necessarily what you will be listening to after future programming sessions.

Pitch Versus Volume
You may also be asked to compare the volume of two sounds so that your audiologist can set the volume for different pitches. This may be repeated for multiple sounds. Just remember that volume refers to the loudness of sounds, while pitch refers to the tonal quality. A sound that is lower in pitch sounds deeper, like a bass drum or a man’s voice. A sound that is higher in pitch sounds like a whistle or a woman’s voice. You want the volume levels the same, even when the pitch is different. If you are not sure whether the volume is different for two sounds, let your audiologist know.

Programs
The Harmony Sound Processor and Platinum Series™ Processor (PSP) can each store three hearing programs. At your first appointment, your audiologist may start with only one program or may provide a few programs to try before the next appointment. Your audiologist will tell you what each program is for, when to use each one, and how to compare them. You will want to evaluate the program or programs as instructed. It is helpful to note your observations on a daily basis in your Harmony Listening Journal.

For adolescents, teenagers, and adults, you can evaluate what works best as you get used to your new hearing. It is important to keep track of what programs sound like, and your successes and difficulties hearing certain sounds or in certain environments. Your input can be used to optimize the programs.

Next Appointments
You will have several appointments over the next few months to make adjustments and evaluate your progress. Continue to write in your Harmony Listening Journal to track your experiences over time and share your observations, triumphs, and challenges with your audiologist. The information you provide about your experiences with sounds and different programs will help the audiologist optimize your Harmony HiResolution Bionic Ear System.

Typically, adults adjust to the implant quickly, within a few months. After this initial adjustment period, your follow-up appointments will be less frequent. Most clinicians recommend an annual programming visit at a minimum. You should discuss your specific follow up appointment needs with your audiologist and surgeon.

Hearing The First Day And Thereafter
Using your cochlear implant, sound begins to transform over the first days, weeks, and months. This transformation occurs with changes in the auditory system as the nerves and brain acquaint or reacquaint with sound. There are three aspects that will affect hearing development: time, programming, and listening experiences. Sounds on the first day will not seem the same to you a week later, or even a few months later. Be patient as your auditory system develops.

The amount and speed of progress will vary for recipients. Rehabilitation, practice and repeated experiences for adults are essential components of maximizing outcomes with cochlear implants. Be sure to discuss and devise an appropriate rehabilitation plan with your audiologist and cochlear implant team. Advanced Bionics offers rehabilitation materials to assist in the rehabilitation process.

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