Your Child's First Cochlear Implant Fitting

Following a recovery period of three to six weeks, the child will return to the audiologist for fitting of the external components. This first fitting is often referred to as the initial stimulation or hook-up. An audiologist programs the device during the fitting process. Programming involves setting specific parameters of stimulation for the recipient, particularly the levels perceived as soft and comfortable. Programming children is different than programming adults. Children typically do not have the language or experience with sound to report when stimulation is perceived as soft or loud. In addition, children do not have the attention span to sit for an hour of programming. Audiologists who specialize in pediatrics use their experience to fit the device for your child’s unique needs.

How Will My Child Respond?
Because children come to the process at different ages, with different hearing experiences and different levels of language development, they have a wide variety of responses to sound.

In the case of young children who have not yet developed auditory skills and oral language, they have some catching up to do. Language is not created overnight, nor is awareness and comprehension of sound. Hearing children begin associating sound at, or even before, birth! A two-year-old child who has been deaf since birth has to catch up on associating sound with words and words with meaning. It’s impossible to predict how your child will react on the day of initial stimulation. These new sounds may be scary, confusing, exciting, or even funny to an infant or toddler.

Some children are too young to communicate what they are experiencing. Your audiologist is trained to identify a child’s responses to sound, so that they can create appropriate hearing programs.

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 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.

Learn the System Before The Appointment
If your audiologist provides you in advance with a Harmony HiResolution Bionic Ear System DVD and instruction booklet, be sure to read and watch the materials before going to the appointment. (You can also request one from the Bionic Ear Association ). It’s important to become familiar with the parts of the system, so that you’ll feel more comfortable operating the equipment on the first day.

Preparing The New Processor System For The Appointment
Some audiologists will provide you with a Patient Processor Kit before the first appointment. If you have the kit, you will need to charge the batteries the day before the appointment.

• 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?
For young children, sometimes people want extended family, such as grandparents, siblings, or others to share in the wonder of these first hearing moments. However, a child can be overwhelmed or afraid during the process of programming. Having too many people around can potentially distract a young child. In addition, a child can have many different reactions to hearing sound, and it may not necessarily be an exciting time for others to participate. Your audiologist may also have some input on who they recommend you bring, if anyone. 

What Happens At The Appointment

System Set-up
Your audiologist will connect the programming system to your child’s processor and place the headpiece over the implant. Your audiologist may begin by running diagnostics and testing the software to be sure that everything is active, including your child’s auditory nerve. Neural Response Imaging (NRI) is a method often used to gain information about a child’s auditory nerve and the levels at which a response to sound input can be achieved. NRI is helpful in setting appropriate programming levels, particularly for young children who are not immediately able to give reliable responses to sound. Your child may or may not react to hearing sounds during this test and can move around and play with toys while it is being conducted.

Setting Volume Levels
The audiologist will begin increasing the volume and will be evaluating your child’s responses. The first sounds can produce a variety of reactions, including crying, laughing, looking up, bewilderment, and even ignoring it. Because sound has no meaning to a child born deaf, he or she may not have any obvious reaction at first. This is where audiologists apply their skills and can identify behavior that might otherwise go unnoticed. A parent’s input during this process may be valuable as well.

How You Can Help
Fitting the processors and conducting initial programming can take anywhere from 30 minutes to over an hour. Often, a child reacts to having the headpiece put on or to hearing sound for the first time by pulling the headpiece off. You can help by keeping your child distracted with toys and games as your audiologist manages the equipment and programming. Plan to bring his or her favorite toys to the appointment. It is important to convey to the audiologist your observations about your child’s responses, as your input may be very helpful in the programming session.

Programs
The Harmony Sound Processor and Platinum Series™ Processor (PSP) can each store three hearing programs. At your child’s 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.

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

Typically, children 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. Children may be seen more frequently to monitor progress in speech and language development. You should discuss your child’s specific follow-up appointment needs with your audiologist and surgeon. 

Hearing The First Day And Thereafter
Sound typically begins to transform over the first days, weeks, and months following your child’s initial stimulation. 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 your child a week later, or even a few months later. Be patient as your child’s auditory system develops. The amount and speed of progress will vary. Rehabilitation and teaching for children 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 for parents, therapists, adolescents, and adults to assist in the rehabilitation process.

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