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This
is what a typical hook up experience is like
with the Nucleus device:
People have varying experiences in both how their audiologist does their initial mapping, as well as how information from the implant sounds to them on this first day. Some people think the sound is wonderful from the very start, go home and make telephone calls, listen to music, watch TV, etc., claiming it's terrific. They could be exaggerating a bit, but overall probably DID have a good initial hearing experience. The majority, however, are disappointed at how the implant sounds at first, reporting that people sound cartoonish and environmental noise like running water, flushing toilets, birds, etc., are all too loud, irritating and generally unpleasant.
The good news is that this is a temporary reaction, and as the implant "settles in" and the person becomes accustomed to hearing the many pitches (especially high frequencies) that they have often been deprived of for a long time, the sounds get more comfortable and clearer. This is also accomplished with more mappings. Usually a newly hooked up patient will have two appointments close together (a couple days or a week or so apart), with further mappings a month to a few months later. Another mapping session sometimes takes place around the sixth month, and after that, most people have a yearly appointment to make adjustments as needed.
Your audiologist will begin by setting your Threshold or "T" levels. You might think of this as a doorway, with the threshold being at the bottom. T levels are the first, softest sounds you are able to hear. They are the most difficult to set because you want them to be low enough so that you will end up with a wide range of sound, but not so low that you're uncertain you actually can hear them. The audiologist will play a beep that begins from your expected range of hearing and gradually increases in volume. As soon as you hear it, you say so, and the T level will thus be set for that electrode at this point. One at a time, each electrode's T level is set individually in this manner.
Often patients will have problems setting T levels because the sound is so soft and they are unsure if they are really hearing it. Sometimes they experience hearing imaginary beeps after listening to beeping for so long, and sometimes tinnitus is present which interferes with separating the sounds being heard. Many audiologists will initially set the T level or levels and then go back and play anywhere from 2 to 5 beeps in succession for each electrode, asking you to report how many you heard. This is very helpful in assuring you set them correctly. It takes more time to do this, and is often why hook ups can last as long as 3-4 hours on the first day.
Once the T levels are set, the Comfort or "C" levels are made. In our doorway example, think of having entered the room and the C levels are the ceiling, or the top. One electrode at a time, the audiologist will begin increasing the volume from each T level until you report that the sound is comfortably loud. It's okay for it to be LOUD, but it should not make you wince or cause any pain or discomfort. In the beginning, err on the side of it being "under-loud" rather than LOUD, as many people push it too high in the beginning and go home with maps that are intolerably loud. What many of us do is let the loudness go up to a point where it IS uncomfortable, then ask the audiologist to back it down a couple notches or so.
After all the T and C levels are set, the audiologist will usually balance them. Some will play back the louder, C levels 3-4 electrodes at a time, asking you if they sound of equal volume. Other audiologists play the sound of each electrode at a medium loudness. One electrode in a set of 3-4 may be too loud or too soft compared to the others, so the audiologist can change the setting on that electrode to make it "even" with the others. This is done until all electrodes are adjusted if necessary, then the entire array, one electrode at a time, is "swept" from start to finish to ensure that they are all in balance.
Then, FINALLY, your map is "turned on" and you experience the sound that you have mapped. It will certainly not be "perfect" on this first day, but it will be a good introduction to hearing again with a cochlear implant. Your audiologist can continue to make other adjustments after the map is made, including emphasizing the higher frequencies or perhaps putting more low frequency into the map. Remember, if you do not like it at first, there is room for improvement with new mapping sessions and in making personal adjustments as your brain re-trains itself to listen and comprehend auditory input in a different way.
As I said, not all audiologists will do the map exactly this way, but this is a typical example of what a mapping session can be like or be similar to.
Best wishes on YOUR hook up day,
Camille
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