Rehabilitation and Tuning Following Cochlear Implant Surgery

This page provides information regarding rehabilitation and tuning for children following cochlear implant surgery.

Please use the links below (shown in blue) to navigate to the desired section of the page.

What happens now my child has had their implant operation?

When the new processors arrive in our office, the implant keyworker who you have met during the assessment period will visit you to deliver them. This is so that you can become familiar with the parts and have an idea about the controls before the initial tuning. It is also so that your child can wear the processor(s) in the ‘off’ position for a few days before the initial tuning and get used to how it feels. This means there are not so many new experiences to cope with at the initial tuning.

Soon after the cochlear implant surgery, you will receive the first three tuning or mapping appointments with the audiologist.

In the meantime, it is important the wound and scar are kept clean to avoid infection. You will be given instructions about this when your child is discharged from the hospital after surgery.

Should you notice anything unusual with the wound such as redness, swelling, hot to the touch or discharge, please contact the cochlear implant office immediately for advice during office hours. It may be essential for your child to be checked by one of our ENT surgeons to prevent or treat any infections which could cause further problems or delay your child’s device switch-on.

Out of office hours: James Cook Hospital patients please contact the ward where you stayed (usually ward 22) through the hospital switchboard to ask advice. Freeman / RVI patients please attend local A&E, GP or walk in centre who will contact the Freeman Hospital ENT Registrar through the switchboard.

When will my child’s Cochlear Implant be switched on?

The first tuning appointment is also called switch-on or initial stimulation. This is when the sound processor (worn on the outside) is connected to the internal implant to introduce some stimulation.

In most cases your child’s cochlear implant will be ‘switched on’ three weeks after their surgery. This is to give your child enough time to recover from surgery and for the wound to heal properly. There is also usually some swelling around the implant site which takes a few weeks to gradually settle down. This is important as it could affect the wearing of the coil or headpiece as sometimes even the strongest magnet is not enough to keep it in place. This would make it difficult for the sound processor to send the signals to the internal implant.

What happens in the switch on appointment?

Appointments usually last for 60 to 90 minutes, and sometimes longer when children have two implants. The audiologist will check the implant site. They will also check that the magnet strength for the headpiece or coil is just right. In some cases, a stronger magnet is needed initially, but may be reduced as the scar and swelling settles completely over time.

While the processor and coil are being worn the external sound processor will then be connected to the computer with a wire which allows the audiologist to start tuning. A quick test of the electrodes will be performed first to ensure that these are all working fine. There are occasions, although rare, where electrodes will have to be disabled if they show unusual activity. If this occurs, the audiologist will explain this to you in more detail.

Once this is done, the audiologist will start the mapping or tuning. This is the process of converting acoustical speech signals into electrical stimulation. To measure this, the stimulation will sound like beeps.

Children will be trained to respond in different ways, depending on their age. For example older children will either be asked to count the number and/or rate the loudness of the beeps. Sometimes a different type of measurement will be done where the child is not required to give a response. This is called an objective measurement.

Once these levels are established, the audiologist will then switch the processor on to ‘live’ but at very low levels to begin with. Initially, what your child will hear may just be noises. It will take a while for the brain to adapt to the sound of the cochlear implant.

During the first session, even a small amount of stimulation usually sounds loud. The levels will gradually increase over time as your child gets used to the implant. As the levels increase, the sound quality usually improves. Further testing will be regularly performed by the audiologist to ensure that the levels are set appropriately.

How often does my child need to see the audiologist for tuning?

This varies for every child as it depends on how quickly the levels stabilise but you should expect to have more frequent tunings within the first year especially if your child has bilateral cochlear implants.

The number and frequency of your child’s tuning appointments will depend on clinical need which will be decided by the audiologist. However, the standard guideline we follow is shown below:

1st tuning (switch-on) = three weeks after surgery
2nd tuning = One week after switch-on
3rd tuning = Two weeks after 2nd tuning
4th tuning = One month after 3rd tuning
5th tuning = Five weeks after 4th tuning
6th tuning = Twelve weeks after 5th tuning (six months post switch-on)
7th tuning = Twenty six weeks after 6th tuning (twelve months post switch-on)

Some children may require more tuning appointments than others to ensure that the levels are always set to be as good as possible. Once the audiologist is satisfied with mapping and there are few changes made at an appointment, your child will only be required to attend a tuning appointment once a year provided that there are no other problems with the cochlear implant.

What is involved in the rehabilitation sessions?

What is rehabilitation?

Rehabilitation is the process we use to enable your child to make the most of the new hearing they receive from their cochlear implant. Rehabilitation focuses on specific targets in a hierarchy of learning to listen skills. First we aim for your child to detect sounds, then to begin to discriminate sounds from each other. Then they will begin to recognise and identify sounds and be able to put a name to some of the sounds they hear. Their speech and language will begin to develop once they are able to do these things. Your child’s awareness of sound and the ability to use it to understand speech and other sounds is developed at the child’s own pace. We aim to make our sessions enjoyable and relaxed.

How do we organise rehabilitation?

Your child’s keyworker, who may be a speech and language therapist or a teacher of the deaf, will arrange to visit your child regularly at home or nursery / school. The visits will last approximately an hour and we are very keen that a parent or a staff member will be able to join us during the session. This enables the people who spend the most time with your child during the week to participate in sessions and to develop ideas for more listening games and activities they can do before the next rehabilitation visit.

How long does the keyworker visit?

Intensive rehabilitation like this will continue until your child has made significant progress in their listening. Our visit schedule is determined by our guideline. Children will be given regular rehabilitation visits. We will discuss how and when these visits will take place with parents and local teachers of the deaf and speech and language therapists. The schedule of visits will be reviewed at intervals and continued as necessary up to a maximum of 40 visits over three years. After this local services will continue to visit a child at school or home. The implant team will offer an audiological annual review and will collect information on the progress of your child’s speech and language from local services.

Why does my child need rehabilitation?

When a child has their cochlear implant stimulated for the first time, they are rather like a newborn baby who has just been introduced to the world of sound. Newborn babies spend a lot of time lying in their cot or pram and making sense of sounds around them. Your child is probably far more active than this and their attention is taken up with learning lots of other new skills.

Previously your child gained information about the world around them through other senses, especially sight, but now they need to learn to listen. Being able to hear is not the same as listening to and making sense of sounds. They need to have their attention deliberately drawn to the sounds around them, sounds such as the telephone, the washing machine, the toilet flushing, as well as noises of toys and of voices. After some time they will begin to recognise these and become more interested in speech. They may begin to babble and recognise their name being called and turn to look at you.

How do implant keyworkers work with other teachers and therapists?

We liaise regularly with local teachers of the deaf and speech and language therapists and in some cases make joint visits with them to see your child. Where children have been introduced to signing before they have an implant we will also discuss with parents and local teachers of the deaf how to proceed. It is usual for families to continue to use their signing alongside the child’s growing awareness of sounds and speech.

What can I expect in the future?

Children are individual and their development in listening and speech and language will be individual too. It is impossible to predict how well your child will be able to learn to do these things. We do know, however, that the best chance they have is if they wear their processor all day everyday from as early on after the initial stimulation as possible. We also know that parents spend far more time with their child than we do and so you are the most important person in helping your child learn to use their cochlear implant.

We will help and support you together with the others in our team, and those in the local services and together we can help your child reach their potential.

What do I do if my child has any problems?

For any queries or concerns about your child’s cochlear implant, please contact us in the office and we will try our best to answer your questions.

Please do not just turn up as it is likely that all the audiologists will be busy with other patients and will not be able to see you

Top tips for your child in the first week after switch on

  1. Often the biggest challenge within the first week is asking your child to wear their processors and keep magnets/coils attached to their head. The feeling of the processor and magnets will be a new sensation to your child and it is quite common for them to pull at their equipment. Do not worry! This just takes perseverance and replacing the processors and coils as soon as possible.
  1. Try to keep the processors on from waking up until bedtime each day. Only by wearing the processors as much as possible every day will your child be able to make sense of the sounds they are now exposed to and establish auditory pathways.
  1. If the equipment keeps falling off, you may want to try retention strategies such as earmoulds, huggies, toupee tape, different earhooks, headbands or a different wearing option.
  1. If your child gets very upset when trying to put the processor on, try to distract them by giving them a toy.
  1. It is unusual to see any reaction to sounds within the first week following switch on, your Audiologist and Cochlear Implant Keyworker will have discussed this at length and so try not to be disheartened by this. However, if your child does appear to be upset by certain sounds, it is not because they are too loud, it will just sound very strange and this is something they will learn to aclimatise to. These sounds will eventually make sense to your child!
  1. Always speak to your child in plain view where they can see your face and use your lip patterns to help them make sense of the sound.
  1. Use your child’s name frequently when you are talking to them to help them begin to recognise it.
  1. Try to introduce your child to sounds in their environment by pointing them out and encouraging them to listen.
  1. If the processor does not appear to be working, always change the batteries first. If this does not help, try changing the cable. If this still does not solve the situation, please contact your cochlear implant company or the Cochlear Implant Team for further advice.
  1. Sometimes it helps to sit and look over the equipment and the manual when your child has gone to bed. There is lots of information to take in. Within the first week it is usually most important to charge and change the batteries, use the drybox and change the programmes.
  1. Contact your Cochlear Implant Keyworker if you need any help or advice during the first week, they are there to support you!
  1. DO NOT make sounds behind your child’s back to see if they respond. Sound has no meaning initially and they are also unlikely to have heard it. They need to ‘see’ sound in order to be able to make sense of it. Again, this is something your cochlear implant keyworker will advise you on during rehabilitation sessions and will practice this with your child.

What should I expect from my child’s cochlear implant(s) and what can I do to help them?

The team around your child

Following implantation and subsequent switch on, both you and your child will receive lots of help and support from an array of different people in order for your child to get the most from their cochlear implant. Each team member will play a different role for your child and these professionals usually consist of:

  • Ear nose and throat consultant
  • Audiologist
  • Cochlear implant keyworker
  • Teacher of the deaf
  • Speech and language therapist
  • Technical support from the company whom have provided your child’s cochlear implant

What should you expect your child to hear?

Implant teams routinely counsel parents of children to have ‘realistic expectations’ about what their child may be able to hear with a cochlear implant, particularly in the initial phases of ‘tuning’. People with an implant will hear varying amounts of sound and speech and how much they are able to hear will depend on factors such as length of deafness, cause of deafness, how often the child has worn hearing aids previously and/or how often they wear their cochlear implant processors and whether the child has other additional needs. These factors will have all been discussed prior to implantation.

How much should the implant be used?

We encourage parents to help their children wear their processors all of their waking hours and in as many different listening situations as possible. Gradually, over the first few weeks and months, your child will make steady progress. This may take more or less time than you expected and also the rate of improvement may vary. Sometimes your child may make a lot of progress in a short time and other times you will feel their progress may be slowing down.

How do we monitor your child’s cochlear implant use?

We are able to monitor how often your child is wearing their processor and in what situations and also how many times the magnet may become disconnected from their head through the cochlear implant software in order to support you to maximise their use.

Cochlear implant usage is the most important factor for a child’s progress.

How quickly can you fine tune the processor?

Generally, it takes longer to be able to fine tune a baby’s cochlear implant than an older child as their responses are more difficult to gauge and they have a shorter concentration span for testing. It is common to only be able to programme or test one ear at a time during tuning sessions until we have reached a stable programme or the child has reached an age where they can focus on a task for a longer period of time. Tuning sessions can be very long and so short breaks for your child are often provided in order to maximise the amount of tuning and testing we can achieve in one session. We can also arrange shorter appointments within close succession if this is more appropriate for your child.

For older children, we are usually able to fine tune their programmes more quickly and they can also tell us what it sounds like in order for us to make helpful changes.

What if other people are expecting my child to hear everything clearly and quickly?

Few people understand about cochlear implants. Sometimes, family members and friends may expect that the implant will restore your child’s hearing to normal. Other people may or may not be interested to learn more about the cochlear implant. Either way, it may help if you arrange a meeting to show people the device and discuss how it works and what your child may be able to hear with it. This way, you will be able to educate them about how they can help communication between them and your child.

In addition, your Keyworker and/or Teacher of the Deaf may arrange a visit to your child’s nursery/school in order to show them how your child’s cochlear implant processors work and also basic troubleshooting so they know how to replace batteries and faulty components.

How can I help improve what my child hears with the implant?

Helping your child to learn and understand the sound they hear through the implant takes time, patience and perseverance. Each child will develop their listening skills at their own pace. Over the first few months of implant use, as well as wearing the processors as much as possible and having the implant programmed, your child will have appointments with their Cochlear Implant Keyworker, Teacher of the Deaf and possibly an additional speech and language therapist. These sessions will focus on hearing and listening skills. It is extremely important that both you and your child play an active role in these sessions and practice their techniques in your everyday routines to facilitate your child to become acclimatised to an array of both speech and environmental sounds. This will help to improve their hearing and listening skills in different environments and help them to develop speech and language.

If you are concerned about the progress for your child at any stage, please talk to a member of the implant team

Useful listening tactics

  1. Use your face and eyes

Make sure that your child can see your face when you are talking to them.  Parts of speech may be heard with the cochlear implant and part of it they may be able to lipread or deduce from facial expression.

Try to position yourself so that the light falls on your face. Explain to people who are talking to your child that it helps to be able to see them when they are talking.

  1. The communication environment

The physical environment both at home or when in nursery/school can make a difference to how easy or difficult it is to hear what people are saying to your child.  For example a room with lots of hard surfaces (tiled floor, no soft furnishings) will generally be more challenging to hear in compared to one with carpets, table cloths, soft chairs, curtains etc. This is because sound waves just bounce around on hard surfaces and can give an echo-like sound quality.  This can be made even more difficult if there is also a high ceiling.

Background sound and music can also make a more challenging listening environment as these sounds will mask quieter sounds and speech.

If you notice that communication is better or worse than usual in any situation try looking around to find out why this may be so.

Bimodal hearing

If your child has one cochlear implant, there may be a compatible hearing aid they can use in their other ear. Your audiologist will discuss this with you if it’s appropriate.