experiences from three cochlear
audiologists-clinicians and a lot of study
taught me a lot about cochlear implants
and audiology doctors.
I am passing it on to you.
is what cochlear clinicians hide from you.
Winfiield Rothlisberger, MM, JD, PhD
based on true events.
a delicate surgery, I got a Cochlear Americas model Nucleus 7
sound processor activated in September 2020 and malfunctioned in
December 2021. After 18 month and 3 dreadful cochlear
audiologists, I gave up trying to use it. It just sucked! And
screeched! The other manufactures are Med-El and Advanced
clinician #1 activated it, i.e. turned it on, I immediately
heard sound and speech clearly. Then Dr. Franken-ear's ten month
horror agenda began. learn more…
clinician #2 to correct the horror. She perfunctorily and
inconsiderately, sett up my sound processor to loudly shriek and
said come back in three months. learn
months, clinician #3 demonstrated poor audio knowledge and
clumsy programming even when guided, then abruptly cut me off with
a curt email. learn more…
has a different experience, they said.
had a different bad experience with each one.
So after 18 months and three clinicians with doctorates in
audiology who couldn't adjust their own radios, I gave up and
stopped. By that time my hope of ever working in music and audio
enginering again was trashed and the prospect of hearing speech
clearly was gone. I determined not to try again until I learned
how the ear anatomy worked, how the cochlear implant technology
worked, how cochlear audiologists work their mapping, and if I
could find a clinician who would actually work WITH me to
help, rather than merely select their favorite software preset,
speak their snake oil shamanism, and say come back in three months
because your brain needs that time to adapt to the raucous noise.
They say it will sound different; it won't sound like natural
speech. But they will not likely say it will SUCK and
with luck, patience, practice, and
good lip-reading, you might be able to understand some
speech from a foot away.
While I personally knew one person who was fine with two implants,
I was made aware of many who had terrible results.
have learned a lot about sound over 50 years.
years of pro music with 20 of them as a digital audio recording
engineer of electronic music and sound design; I knew a lot
about sound and audio before getting the cochlear implant. I did
NOT know much yet about audiology. The nature of my training and
work life gave me a highly developed audio brain beyond that of
most patients. I expected audiologists to know as much about
sound as I did. I discovered that they don't.
is what people, especially musicians/engineers,
should know about cochlear implant hearing devices.
great deal depends on the abilities of the audiologist
They have no means of hearing what the CI (Cochlear
Implant) user hears.
make adjustments by 1) what their textbook shows them, 2)
educated trial-and-error guesswork, and 3) by what you tell
them by reactions or verbal statements (if
they don't ignore you).
Some are brilliant. Most are average. Some are
shockingly ignorant of basic sound and audio.
A detailed chart of these Current Levels in your processor
settings is called a MAP. MAPping is what they call
adjusting or programming.
So, since they cannot hear what a patient hears, MAPping
consists of professionally educated trial-and-error,
guesswork in programming the CI.
Every time a setting is saved, a new MAP is created.
These MAPs are stored in your processor as well as on the
They can be printed.
An audiologist with appropriate software can access most
of the previous MAPs, including MAPs from a previous
to the two theories of CI programming: 1) the brain must
adjust to the way a program is set and that takes many weeks
to re-train the brain to hear with a processor; and 2) the
audiologist should adjust the CI to the patient’s needs in
bringing about intelligible speech perception.
Cochlear clinicians are
NOT all equal!
A few are brilliant. Several are average.
Many couldn't adjust their own radios!
My first three frequency jugglers just SUCKED!
…And in three different ways!
biological cochlea in your inner ear converts natural sound to
electrical signals that your brain interprets as sound and
speech. The cochlear sound processor and implant bypasses your
damaged cochlea and convert natural sound to electrical signals
that your brain interprets as sound and speech. Actually, a
telephone also converts natural speech to electrical signals
that are sent to the listener's receiver. You might hear your
clinician tell you that "it won't sound like natural speech
because it's electrical signals and not your natural ear." Think
about that when your processor sounds terribly distorted and
maladjusted. That's when they tell you your brain must adjust to
that change of sound before they adjust it more.
doctors listen to your description of symptoms and diagnose. I
gave these doctors the finest verbal and written symptom
descriptions of sound that language could provide. It seemed not
told that 'MAPping' (educated guesswork) must be done by a
highly skilled professional clinician adjusting and programming
your sound processor with complex company provided software that
adjusts how the electrical signals activate the array of
electrodes connected to your auditory nerve. This software bears
a strong resemblance to the graphic equalizer screen
on many computer MP3 players.
Note the top and bottom of each range with the
adjustable loudness button within.
Selection at left provide preset settings or one can
adjust each individually.
the red and green (top and bottom) loud/soft
The virtual levers are individually adjustable.
This is what the clinician works with.
is a screen shot of of Cochlear America's Custom
Sound 6.xx software.
clinicians hide this from patients while they try
Be aware that the clinician has NO WAY OF
HEARING what you hear.
may think the clinician uses presets like
those on the left.
The loudness of different frequency
ranges profoundly affects what your
speech perception sounds like. If your
speech/sound processor gives a tinny
high pitched ringing Mickey Mouse
quality to your perceived speech, that
means that some higher frequency
range(s) are too loud. It’s that simple.
My 1st clinician didn’t have a clue to
what sound description symptoms meant
and thus bungled through a variety of
horrid sounding start-over screeches. My
3rd clinician flat out admitted to “not
knowing what to do.” I knew, by that
time,what to do but could not get this
inadequate “doctor” to do it
It took me many months to acquire this
knowledge in bits and pieces because my
1st clinician was very deceptive,
unhelpful, and preferred to keep me in the
dark, and tell me BS and “snake oil
slogans.” I have also heard/read that
audiologists find musician/audio engineers
“troublesome,” “hard to please,” and
“intimidating” because such patients know
what they hear and are less easily
dissuaded by poor audiological
explanations and excuses.
some basics for those new to ear knowledge
and cochlear implants.
The cochlea in your middle
ear consists of thousands of little hair
cells that convert acoustic sound to
electrical signals that your auditory brain
interprets as sound (and speech). When these
hair cells get damaged, you lose some
hearing. The cochlear implant bypasses
the damaged cochlea and sends its electrical
signals to your brain which interprets them
One important difference is
that you now have a hearing range of about
180 to 7960 Hz (Hertz = frequencies) instead
of 20 to 20,000 of the "normal" ear. The
volumes you hear are not measured in
decibels as in other audio fields. The
cochlear jargon calls these “current
levels” or “current units” as they refer to
the amount of electrical current used to
raise or lower the gain (increase) or
attenuation (decrease) of the signal,
perceived volume, on each channel. The
higher the current level, the more intense
the signal, the louder the perceived sound.
My abusive first clinician
never explained or even mentioned "current
units," but relished belittling me by
writing in her Medical Record how she often
"counseled" me that volumes could not be
adjusted in decibels.
info and detail…
many clinicians are little more than frequency
jugglers with a mouth full of snake oil
processor settings (MAPs) are stored in the sound
processor and the audiologist's computer. They can
be printed. My first two clinicians didn't tell me
that. A cochlear implant help source encourages
patients to ask their audiologists for MAPs. Learn
to read them! My first two clinicians evaded and
avoided giving me any! I got many delusions and
deceptions instead. Yet the MAPs I got from my 3rd
clinician were critical to the verification of what
I was hearing. I would now never return to an
audiologist who would not provide me MAPs of every