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Horrid 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.
Here is what cochlear clinicians hide from you.

by Winfiield Rothlisberger, MM, JD, PhD

Story is based on true events.

1672 words

Following 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 Bionics.

When 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…

I visited 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 more…

Over five months, clinician #3 demonstrated poor audio knowledge and clumsy programming even when guided, then abruptly cut me off with a curt email. learn more…

Everyone has a different experience, they said.
I 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.

 I have learned a lot about sound over 50 years.

From 50 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.

Here is what people, especially musicians/engineers,
should know about cochlear implant hearing devices.

A great deal depends on the abilities of the audiologist clinician

  • They have no means of hearing what the CI (Cochlear Implant) user hears.
  • They 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 clinician's computer.
  • They can be printed.
  • An audiologist with appropriate software can access most of the previous MAPs, including MAPs from a previous clinician.
  • There appear 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

The 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.

Most 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 to matter.

You are 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.

                            graphic equalizer

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.

map image
                            of Custom Sound software screen shot
Note the red and green (top and bottom) loud/soft limits.
The virtual levers are individually adjustable. This is what the clinician works with.
This is a screen shot of of Cochlear America's Custom Sound 6.xx software.
Most clinicians hide this from patients while  they try different settings.

clinician's mapping system?
Be aware that the clinician has NO WAY OF HEARING what you hear.
You 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 satisfactorily.

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.

Now, 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 as sound.

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.

more info and detail…

Too many clinicians are little more than frequency jugglers with a mouth full of snake oil shamanism.

Sound 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 session. 

It took me many months to acquire this knowledge in bits and pieces because my 1st clinician was very deceptive and 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.

This CI info comes from my personal experience, my often erroneous medical records, emails from my  audiologists, technical articles, my knowledge of sound and digital audio, Cochlear Americas’ own 48 page Custom Sound software manual, and other people's good and bad experiences.

Winfiield Rothlisberge  click to email


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Lucy holds
                                                  footbal for Charlie                                                  Brown to kick