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Mapping a Cochlear Implant

October 24th, 2011 by | Tags: , , , , , , , , | 27 Comments »

Mapping (or MAPping) is the term for programming a cochlear implant to the specifications and needs of its user.  While any cochlear implant user, or parent, caregiver, or family member of a CI user, has probably attended countless mapping appointments with an audiologist, the process is often confusing or poorly understood.  We go to the audiologist, he or she presses some buttons and adjusts somethings on the computer, a new MAP is made, and we go home, knowing little more about the process than when we entered the appointment room.

Here are some basics to help you understand the mapping process and get more out of your/your child’s next appointment.  If you are not 100% clear on how a cochlear implant works, it might be helpful to review THIS diagram before reading more.

MAPs are programs that help to optimize the cochlear implant user’s access to sound by adjusting the input to the electrodes on the array that is implanted into the cochlea.  While each cochlear implant company has different terminology, different programming strategies, and different capacities for various MAPs on their processors, the basic ideas behind MAPping hold true for all three FDA-approved brands.  The cochlear implant processor is connected to the audiologist’s computer for MAPping.  Using a series of “beeps,” and measuring the CI user’s response (see ways of measuring audiological responses HERE), the audiologist sets T- and C- levels for each electrode.  T-Levels, or Thresholds, are the softest sounds the CI users can detect.  C-Levels (also sometimes called M-Levels), are Comfortable loudness levels that are tolerable for the CI user.  The audiologist might also adjust the stimulation rate or programming strategy used for the MAP — these refer to the various computer algorithms and programs used to translate acoustic sound (what people with typical hearing perceive) into the correct combination of electrode stimulations to give the cochlear implant user that same sensation of sound.

CI user’s processor connected to the audiologist’s computer during a MAPping appointment. Image from “Ellie’s Ears,” a children’s book featuring a pediatric cochlear implant user (written by Elizabeth Boschini, MS CF-SLP, illustrated by Rachel Chaikof). CLICK image for ordering information.

Here are some DOs and DON’Ts to get the most out of your MAPping appointments:

  • DO come well-rested, well-fed, and ready to concentrate.  For young children, it often helps to bring a favorite toy (not one that is too noisy or distracting, though) or snacks.
  • DON’T forget your gear.  Bring your remote, FM system, backup processor(s), music link accessories, etc.  If you’ve got it, bring it!
  • DO prepare notes and observations about your hearing performance to help guide the audiologist to your best program.  What listening situations are difficult for you?  Which are easy?  What sounds good and what doesn’t sound quite right?  What changes have you noticed since your last MAPping appointment?  How has this MAP affected your access to sound or the sound of your speech?  Are you relying more or less on speechreading or visual cues?  How does music sound?  What do your child’s teachers and therapists report?  It is helpful to keep a “hearing diary” continuously between appointments — this is not something to pull together in the car on the way to the audiologists’ office.
  • DO come with questions!  Write them down before the appointment so you don’t forget any crucial information.
  • DON’T rely solely on NRT (Neural Response Telemetry) for your children or CI users who are, for whatever reason, unable to respond.  Put simply, NRT measures the nerves’ responses to the “beeps” stimulating the CI from the audiologist’s computer.  While it can provide valuable information, beeps and neural responses do NOT directly translate to hearing performance.  A skilled audiologist will also use Behavioral Observation Audiometry, Visual Reinforcement Audiometry, Conditioned Play Audiometry, or Conventional Audiometry (depending on the patient’s age and developmental levels) to measure the listener’s response in a more “real” situation.  An NRT sweep is a rough estimate compared to the assessment of a skilled audiologist in a behavioral response situation.
  • DO choose an audiologist who has experience with children.  MAPping children and MAPping adults are completely different ball games.  A good pediatric audiologist, one who can hold the child’s attention while getting high quality MAPs, is worth his or her weight in gold!
  • DON’T forget speech perception testing in the booth.  After a new MAP is made, booth testing, specifically booth testing for speech perception and listening in noise, are not-to-be-missed final steps.  Listening to beeps is fine — but real life is not listening to beeps!  If the MAP does not improve the CI user’s speech perception and/or listening in noise, it’s time to go back to the drawing board (or laptop, as the case may be!).

Frequent, high quality MAPping is key to optimizing performance with a cochlear implant.  Many centers have a set protocol for the initial stimulation and series of follow-up appointments.  Over time, MAPs may stabilize and audiology appointments will become less frequent.  Indicators that you/your child might need a new MAP include:

  • Complaints of things sounding too quiet, distorted, or unclear
  • Changes in listening performance (missing quiet phonemes like s, th, f, etc., difficulty listening in noise)
  • Changes in speech production (sounding slushy, having sloppy speech, changes in sounds previously achieved)
  • Hormonal changes and growth spurts may also necessitate a new MAP
  • As the CI user’s listening skills grow, he/she may be ready for more “power” in a MAP, and might need an adjustment

When in doubt, contact your audiologist!  A good relationship with a skilled professional will have you on the road to your personal best hearing performance.

Written by

Elizabeth Rosenzweig MS CCC-SLP LSLS Cert. AVT is a Listening and Spoken Language Specialist Certified Auditory Verbal Therapist. She provides auditory verbal therapy, aural rehabilitation, IEP advocacy, consultation, and LSLS mentoring for clients around the world via teletherapy. You can learn more about Elizabeth's services on her Website or Facebook.

27 Comments

Samantha

October 24, 2011 at 1:07 am

Thanks for an excellent article. I wish I had had somethin like this when we first started mapping my daughter.

January 26, 2012 at 8:45 am

[...] audiological needs (e.g. if the child is not demonstrating detection of /s/, is it time for a new CI MAP or for a child who is a hearing aid user to consider CI [...]

Julia Hutchison

January 28, 2012 at 4:01 pm

I’m extremely frustrated. I keep asking about the process of Mapping and have gotten only one answer “it takes time”. The noise I hear when the device is connected to the head chip is so awful, I don’t want to wear it. My car motor sounds like a chainsaw (very uncomfortable over extended period of time). When I’m around anything electronic, I get a buzzing sound. When I walk thru a medal detector, the sound is so horrible I want to rip the device off my ear. Background noise becomes warbled when in a restaurant. I’m having a terrible time with no explanations, even though I’ve asked. I was activated in early November 2011.

I’m now experiencing tinnitus!!!

When the implant is adjusted, we’re in a noiseless room, which isn’t very realistic. Therefore, it appears the device is working well when it isn’t. As soon as I step outside, the static and warbling begin.

Can you give me any help understanding what’s happening.

Thanks.
Julia Hutchison

Elizabeth

January 30, 2012 at 2:06 am

Julia — I am sorry to hear that you have been having difficulties getting the most out of your CI. While it is true that adjusting to the CI and hearing well take time, you also have a right to expect reasonable progress. Having been activated for just a few months, you are still in the new phases of listening, so it may well be a matter of time, but here are a few suggestions that might help you:

1. Many CI users to experience a momentary change when “linking up” the processor to their internal device first thing in the morning. It’s just like what we all experience when going from a dark room to opening our eyes in direct sunlight — it takes a while for the body to adjust to the sudden influx of new sensation (be it light or sound).

2. Experiencing some interference from metal detectors (like when walking into a store) is also normal, but it should go away once you are out of range of the scanners.

3. Hearing in background noise is a real challenge. See below for some tips of auditory exercises that might help with this. You also might want to ask your audiologist about special programming changes that can be made to help you focus on your conversation partners and tone down the background noise in these situations.

4. I encourage you to keep good notes of when things sound good and when listening situations are difficult. Share this with your audiologist and ask what changes can be made to help you. If you feel that your audiologist is not able to make the changes you need, ask for a representative from your CI company to come to your next mapping. They are experts and can often partner with your audiologist to get you the best results. If that doesn’t work, you might also seek a second opinion from another CI audiologist in your area. Though audiological testing is done in a sound treated booth, once you gain more listening experience, testing will be done to assess your understanding of speech in noise.

5. Much of success with a cochlear implant depends on the auditory rehabilitation that comes after activation. You need to train your brain to adjust to a whole different kind of sound input. HERE are some resources for listening practice online, but you might also ask your audiologist for a referral to a Speech-Language Pathologist in your area who specializes in aural rehabilitation. HERE is a directory of Listening and Spoken Language Specialists who may be able to help you. The CI does 10% of the work, the other 90% is all about what you make of it.

The first few months of hearing with a cochlear implant can be really tough for adults who are retraining a brain from a lifetime of old habits to a new way of listening. Know that you are a not alone and you will get there! It might help you to check out some of THESE stories from others who have received CIs as adults. Best wishes as you continue to pursue better hearing!

Bambz Irawan

February 14, 2012 at 7:25 am

Anybody can pls give some information what respond normally supposed to be seen from Cochlear Implantation patient within 1st and 2nd week after activated.
My son has undergone for CI surgery on 17 Jan 2012 at his right ear and the CI has been activated on 7 Feb 2012. I am wonder why until now I could not see any respond from him when we give some sound like music, calling his name even clapping the hands.. Up to now we have done 2 session mapping. the 1 st was only with the audiologist. The 2nd was with CI engineer and the audiologist.. We planned to have next appointment next week. Anybody can advise me what should we do…? I am frustrated with this condition..
In other case, it seems very difficult to put the coil and processor into my son’s head. Every time he tried to take it off. Does this because he felt uncomfortable with her ??voice heard? Or because he does not have the benefit of the CI that has been placed in his head?

Thanks,
Bambz

Elizabeth

February 15, 2012 at 3:16 am

Bambz — It does take time for a CI recipient to make sense of the new sounds they are receiving after activation. How is your son responding during booth testing at his mapping appointments? At what decibel level does the audiologist see him responding to sound? If he is responding to sounds appropriately during mapping, then it could just be a matter of time before his behavioral responses in the “real world” catch up to what he is receiving through his CI “on paper” in audiology. The most important thing is to be connected with a good pediatric audiologist and to be receiving therapy from a Listening and Spoken Language Specialist. If you need help locating a professional who is trained in listening and spoken language, you can find a registry HERE. It is very important that your son wears his cochlear implant all waking hours to get maximal benefit from the device. Young children often make a game of pulling off the processor because it gets them attention and a big reaction from parents. Initial mapping sets the CI at low levels, so it is not hurting him. Just calmly replace it each and every time he pulls it off. Once he realizes that it benefits him, he will likely be much more willing to wear it. It’s hard to be patient, but with hard work and good listening and spoken language therapy, your son will get the most from his cochlear implant. Best wishes!

Kristyne

February 23, 2012 at 12:34 pm

Hi, everyone i am a canadate for a CI, but still havent recieved it yet… Ima still wearing bilateralt hearing aids but they are no help anymore, my hearing has been dropping for years,. Now these days my hearing will be completely gone for a couple of hours on one side then comes back then the other does the same thing, i go to the audiology deparment every four months, my speech descrimination in well in the 80% range but my hearing is in the 105 decible range and dropping, im trying to fail tests so i can get it and be able to funtion in school for my senior year.. its so hard, i miss hearing the nature and people talking, i also realy on lip reading thats also hear especially when your completely blind in one eye… any advices?

Ann

April 9, 2012 at 1:43 pm

Hi,
I’ve had the CI for over two years now. With the CI I hear about 25 db, however my speech discrimination is only about 60% without visual cues in quiet and even lower in noise. I’ve been working hard at trying to improve my speech discrimination through various auditory rehab measures on my own for there are currently no programs near me for adults. I’ve also met others with the CI and they’re progressing very well with their CI, even talking on the phone independently. One person shared with me that I should try their mapping to see if it helps to speed up my rehab progress.

Is it possible that there is a mapping that will work for most people? Or is this something I would have to continue to work hard on my own at to achieve? Also are there any other good auditory rehab programs I can purchase to use at home? I have a MAC computer, which isn’t compatible with Cochlear’s program. I’ve tried to contact them about a MAC program, but they’re not very responsive. I also continue to keep a journal and work with my audiologist on mapping every 4 months.

Any thoughts?
Thanks!

Elizabeth

April 11, 2012 at 3:59 am

Thanks for your comment, Ann! There is no one right MAP for all CI users. Each person’s programs will be different due to their own physiology as well as their auditory experience and how their brain deals with sound. The key to getting a good MAP is to make careful observations of your own hearing in between appointments (which situations are easy? which are hard? what sounds are you missing? can you describe how things sound to you? etc.) and share those with your audiologist at your appointments. It may also help to have a representative from your CI company attend your mapping, as they are the experts in that brand. HERE is a link to some online sources of auditory practice that may help you. I also strongly suggest getting in touch with a Listening and Spoken Language Specialist, an aural rehabilitation professional who can tailor a program specifically to your needs. HERE is a directory to find an LSLS near you. Thanks so much for reading Cochlear Implant Online, and best wishes as you pursue success with your CI!

September 2, 2012 at 8:03 pm

[...] was showing my hearing friends what a mapping is when they asked. Go to e link below to find out! Mapping a Cochlear Implant Mapping a cochlear implant can take a while, but in my case if I remember correctly it may only [...]

Tim Kissler

November 5, 2012 at 8:44 pm

I think the best way for people pre-CI, is to read what the digital process is about because, we as humans talk and hear in analog. Find a website that will explain what the Bionary part of the digital technology does. If you talk to those of us that played video games back when they were 32 bit and improved to 64 bit the images had square edges and looked box like figures. If you campare that to Xbox 360 today you will see images that look almost real. This is how I can best describe how someones brain processing the sound input from a CI. Yes’so be patience and allow time to devolope. So over time things will sound very life like again. I recently received my second CI for my right ear in Sept of 2012, and in October of 2007 received my first implant in my left ear. It took months for that sound of Alvin the chipmunk to change, Slowly sounds like my wifes sweet voice, or music to sound pretty good. Now my right ear is also slowly coming around. So be patient, listen to your favorite music, talk show or what ever. You must cause your brain to adjust. Don’t give up.

Tim Kissler

November 5, 2012 at 8:52 pm

Tim K. Biunilatarel CI’s

Don’t let mapping confuse you, and heres why. I think the best way for people pre-CI, is to read what the digital process is about because, we as humans talk and hear in analog. Yes our frenquency range will be less than those of normal hearing, but it’s not bad. Find a website that will explain what the Bionary part of the digital technology does. If you talk to those of us that played video games back when they were 32 bit and improved to 64 bit the images had square edges and looked box like figures. If you campare that to Xbox 360 today you will see images that look almost real. This is how I can best describe how someones brain processing the sound input from a CI. Yes’so be patience and allow time to devolope. So over time things will sound very life like again. I recently received my second CI for my right ear in Sept of 2012, and in October of 2007 received my first implant in my left ear. It took months for that sound of Alvin the chipmunk to change, Slowly sounds like my wifes sweet voice, or music to sound pretty good. Now my right ear is also slowly coming around. So be patient, listen to your favorite music, talk show or what ever. You must cause your brain to adjust. Don’t give up.

March 24, 2013 at 4:55 pm

[...] even hear that well being bimodal with a hearing aid on one side and CI on the other. What was your mapping process like compared to [...]

sherri dougan

April 12, 2013 at 8:54 pm

Julia it may also be that your mapper has set your threshold levels too high. be sure to tell her all this next time you go in! Your brain does get used to it, but it should not be terribly unconfortable!

sherri dougan

April 12, 2013 at 8:54 pm

Julia it may also be that your mapper has set your threshold levels too high. be sure to tell her all this next time you go in! Your brain does get used to it, but it should not be terribly unconfortable!

D

July 25, 2013 at 11:10 pm

HELP- my daughter is bilaterally implanted. She received them at 13 mths. and is now 4.5

She has always needed mapping more often then most. Going at least a month or 2 earlier everytime. Does anyone know why a child would pretty much always need more mapping. That can’t be a growth spurt or she’d be 5’4- ha ha

Also- we are NEVER put in the booth after mapping. That’s typical???

Adil B. Al-Riyami

August 7, 2013 at 10:25 pm

Hi,
My son got his right ear implanted 3 months ago. Since his implant he has had no reaction to loud sounds like clapping or banging doors. When we go for mapping he seems to react to increasing the thresholds.
All the exercises we are given to perform at home require that he responds to sounds, which he doesn’t, and therefore performing these exercises feel useless.
I’m not sure what the problem is. Everybody tells me that it takes time, but all the other children implanted at the same time seem to respond to environmental sounds.
My wife and I are so depressed and frustrated.
Are there situations when cochlear implants just don’t work?

Akaya

August 9, 2013 at 4:03 am

@D

Hi! I have had a CI since 18 months, I’m now 16. Growing up, before I hit 12, I had to get a new map every 6-7 months because otherwise I’d get difficulty understanding others and would act frustrated and annoyed in noisy settings and the likes. When I reached 14-15, my audiologist told me to shoot for a yearly appointment instead, hehe. I had to go back rather early a couple of times though, when my CI was acting stupid and not functioning properly.

I’d imagine she’s similar to me when I was little – her listening skills would progress to the point that she would have to return early in order to adjust her CIs so she could keep progressing. It slows down a lot once you hit the decade mark (so you have 6-7 years until then)!

As for the booth, yes, totally typical. I have never been tested after I got my new map (presumably since they got information about how I heard before the map, they can apply the changes they made to my CI to the chart that was produced from the booth).

Ig van Kraayenburg

November 25, 2013 at 8:18 pm

Hi, my daughter have two implants. I would like to know if there are different mapping systems that are used for Cochlear and Baha implants.

Regards
Ig

Dana

February 8, 2014 at 5:47 pm

My four year old son just had his implant surgery. I am very frustrated with the audiologist we are working with and am requesting someone different.
I’m wondering about the mapping process. We have several appointments ranging from weekly to every other week. Is it okay to activate with the frustrating audiologist and then follow up in eight weeks for another mapping with the new audiologist?
My son was wearing bilateral hearing aids before the surgery with no measurable hearing. He was slightly more vocal w the hear aids so some sound was coming in. I don’t want him to get comfortable with the silence from the surgery and think activating on schedule has some importance. But I do want to limit our exposure to less than quality care with the current audiologist. What are your thoughts on limiting the mapping? Is there any resources that discuss the pros and cons to the frequency of mapping? Thank you for any assistance you can provide me.

February 16, 2014 at 9:55 pm

Dana, I’m sorry to hear about your frustrating experience. A good pediatric audiologist is worth her weight in gold, and it is so crucial for your son’s development that his implant is mapped correctly. I think it is important to change to a better audiologist ASAP. For a new implant user, audiology appointments are usually very frequent (the weekly/every other week schedule you describe sounds about right) because the devices are constantly being turned up and adjusted until your son reaches what we call a “stable map” which means that his hearing levels are within the normal range across all frequencies. It takes time, and a lot of appointments, to get there, but it’s very important to get to that optimal level as soon as possible because that’s where the real development starts (until he’s hearing the sounds of speech clearly, it will be very hard for him to produce them clearly). So, I think if you can change to a new audiologist, you should do so immediately. If not, I still think it’s worthwhile to keep your current appointments, but be very clear to this audiologist what your goals are. You didn’t mention your specific issues with this audiologist. Is it something that perhaps clarifying some information or having more explanations/communication might solve or at least make it better in the meantime while you’re waiting to switch? Best wishes and I hope you’ll get it worked out soon!

TOM L

August 19, 2014 at 9:22 pm

Recently(July 23, 2014),I have cochlear implant done on my right ear.
Activation was done on Aug 14, 2014.
But I still don’t understand speech from my wife even face to face talking quietly at home, why?
Her words and sentences are running together and very confusing.
I never have this problem even without wearing hearing aid at all before cochlear implant. Thank for your help.
Tom L

TOM L

August 19, 2014 at 9:46 pm

I just sent out my messages but I didn’t see it on the board. Should I resend it again?

August 21, 2014 at 4:23 pm

Your CI ear is very, very new, and what you describe (having difficulty understanding speech) is not at all uncommon at just a week post-activation. When cochlear implants are activated, the initial MAP (programming) is set very conservatively. You should have a series of appointments with your audiologist in the first few months to get your MAPs up to a good hearing level. It will also take time and aural rehabilitation to help you make the most of this new sound. It takes patience and practice, but rest assured that you are not unusual for feeling this way just seven days out. If you are still having these concerns several months from now, and your hearing levels with your CI are not within the “speech banana” (allowing you to hear conversational speech), then it’s time for a change of plans (new audiologist, change your rehabilitation program, etc.). For now, just keep wearing your CI and practice, practice, practice! All the best!

August 21, 2014 at 4:24 pm

All comments go through moderation before appearing on the page. There is no need to resend. Comments appear after they have been approved.

Natasha

September 29, 2014 at 1:59 pm

Hi…could u tell me where I can find info/tutorial materials on basic mapping procedure…im an audiology student

October 20, 2014 at 1:27 pm

Each CI company has a section on their website for professionals which includes information on mapping and the company’s specific software and programming features. You might also find the webinar courses from Audiology Online to be helpful. Best wishes for success with your studies!