Starting the Miracle of Sound

The day of your initial activation will be life-changing. Typically scheduled two to four weeks after implantation, your anticipation of this important day may be filled with hope, excitement, and varied expectations. When your cochlear implant system is first activated, the objective is simple: to find a comfortable volume level across the frequency (pitch) spectrum so that your first sound program or “map” can be set. If you can tell the difference between a loud or soft sound at your first activation appointment, the day has been a success and you’re on your way to hearing your best. 

“One of my most memorable hearing experiences with my cochlear implants was hearing my daughter’s voice during the first activation appointment.”

— Maria Anderson, implanted at age 52, bilaterally implanted at age 54

What to Expect on Your Big Day

Your journey to hearing will undoubtedly be full of cherished moments, including your activation appointment, which is typically scheduled two to four weeks after your surgery. It may feel like an eternity between the two dates, but this gives you time to heal as you prepare for your new beginning.

What you actually hear once your AB cochlear implant is turned on depends on many factors. The details of your hearing potential depend on:

  • Age when hearing loss began
  • Length of hearing loss
  • Age at implantation
  • The medical health of the inner ear
  • Other medical conditions that could affect hearing

Each person is unique and everyone responds differently to what they hear first. With time and practice, you will hear increasingly more details in the sound around you.

Prepare Yourself and Your Processor

If your audiologist provides you with reading materials and DVDs for your sound processor, be sure to review them before your initial activation. Knowing how to properly operate your processor will give you the confidence and know-how to hear your best every day.

Your audiologist may also give you a Patient Processor Kit before the first appointment. If you have the kit, you need to prepare your processor for initial activation by charging your batteries the day before the appointment.

What Could it Sound Like?

At first, speech and sound can feel like vibrations or sound like clatter or garbled noise. Some people can recognize speech right away, but it might sound mechanical and artificial or high pitched. To others, it may start out sounding natural just like they remember. For people with long-standing hearing loss, the brain may have been deprived of meaningful sound for a very long time, in some cases since birth. It takes the brain time to learn or re-learn how to separate and identify individual sounds in the environment. 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. 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.

Your Map to Better Hearing

Your audiologist will use special software to create a customized set of programs for your sound processor. During this process, you should begin to hear sound. You will need to tell your audiologist what you hear as well as the volume and pitch of sound.

System Set-up

Your audiologist will connect the programming system to your processor and place the headpiece over your implant. The visit may begin with running diagnostics and testing the software to be sure everything is active, including your auditory nerve.

Setting Volume Level

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’s important to remember that it doesn’t matter what you are hearing or whether you recognize the sound. The most important thing is to let your audiologist know when you start to hear or perceive something. 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. For example, 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 will want the volume levels the same, even when the pitch is different. It may sound complicated, but this activity often gets easier with time.


At your first appointment, your audiologist may start with 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 should evaluate the program or programs as instructed and keep your sound processor on during most waking hours. It’s important to keep track of what programs sound like and your successes and difficulties hearing certain sounds or in certain environments.

Who Should Attend the Activation Appointment

Although you can bring people to your 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.

Adult or teen recipients will need to focus on listening and working with your audiologist. It can be tiring and can take an hour or more. It is difficult to predict how much you’ll understand right away. One or two people should be all the support you need.

Learning to Hear with Cochlear Implants

As you adjust to your new cochlear implant, sound will begin to transform over the first days, weeks, and months. This is a natural occurrence that coincides with changes in the auditory system as your nerves and brain acquaint or reacquaint with sound.

It takes time and practice to hear your best with cochlear implants. It’s important to remember that it is a process, not an instant fix. Just as those with normal hearing had to learn to hear, you or your child will need to practice to learn to hear. You can work with your audiologist for a rehabilitation plan and utilize AB’s resources in The Listening Room™.

Things to Know Before You Go

Before you leave your audiologist’s office, be sure you understand how to put on and use your cochlear implant system’s processor and batteries. Your Quick Start Guide and User Guide may be used to review after you’ve had some experience with your system. Remember, sound may or may not be pleasant as you start out with your cochlear implant, but regardless, it is important to keep the sound processor on during most waking hours.

How Hearing Improves



As you embark on your journey to hearing, it’s helpful to know the three aspects that affect hearing development:

  • Time
  • Programming
  • Listening experiences

It’s important to remember to be patient while your auditory system develops. The speed of progress varies from one recipient to the next and depends on practice and repeated experiences for adults. In addition to devising a rehabilitation plan with your audiologist, you can also utilize The Listening RoomTM, an interactive website for parents and professionals that provides free ideas, materials and support to promote active listening and language stimulation. 



Your Next Mapping Appointments

You will have several appointments over the next few months to make adjustments and evaluate your progress. The information you provide about your experiences with sounds and different programs will help the audiologist optimize your hearing.

Contact the AB office in your region or your hearing healthcare professional if you have questions. 

Thank you for contacting us to assist with your hearing solutions. Count on us—a community of hearing health professionals and recipients of cochlear implants—to help you Hear and Be Heard™. A representative from Advanced Bionics will be in touch soon!

If your request needs immediate attention or you have additional questions, please contact

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The Bionic Ear Association (BEA) is comprised of caring professionals and a dedicated team of volunteers who provide you and your loved ones with information, education, and support for choosing, getting, and living with cochlear implants.

Toll Free Phone:  +1.866.844.HEAR (4327) US and Canada

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