Apical region :: The apical region is the tip of the ‘snail shell’ shape of the cochlea. This region is responsible for sensing low-pitched sounds. MED-EL cochlear implants are the only implant systems that reach deep enough into the cochlea to stimulate the apical region and the part of the system that is ‘tuned’ to low pitched sounds.

Audiogram :: The audiologist does an audiogram (sometimes called audiometry) to determine the softest levels that a child can hear across low and high pitches. Often, the audiologist will also assess how well the child perceives speech sounds, which is called speech perception testing. Additionally, the audiologist may measure how softly a child can understand speech.

Audiologist :: An audiologist is a specialist in the diagnosis and non-medical treatment of hearing and balance problems. Audiologists obtain either a Master’s or Doctoral level degree, and then complete a training fellowship prior to entering practice.

Auditory brainstem response testing (ABR) :: An audiologic test that roughly measures hearing acuity without any participation from the child. As the child sleeps, a clicking sound is presented to the ear, and the resulting brain activity is measured. This measure is used extensively for diagnosing hearing problems in infants and young children who are unable to respond behaviorally.

Auditory habilitation specialist :: This term is used in this guide to refer to the wide variety of professionals who become specialists in teaching deaf children to use their residual hearing with hearing aids or cochlear implants. It is well accepted that children with hearing loss need special assistance to develop auditory skills. An auditory habilitation specialist can be a speech-language pathologist, a teacher of the deaf/hard of hearing, a certified auditory-verbal therapist, an audiologist – any one of a variety of related professions – who has specialized in the habilitative aspect of hearing loss.

Automatic gain control (AGC) :: The AGC is a system the speech processor uses to manage sounds of different loudness. The child with a cochlear implant does not have a wide range of sound tolerance, as does a person with hearing. The AGC ensures that very loud and very soft sounds are processed accurately so that they fit into the range of hearing of the implant user.

BabyBTE™ :: A unique wearing option only available with the TEMPO+ system that allows the entire speech processor to be attached to the clothing for security.

Basal region :: The basal region of the cochlea is the high-pitched region. This is the area that would be considered the base of the ‘snail shell’ shape, and is the area closest to where sound first enters the inner ear.

Batteries :: The TEMPO+ is unique in that it has very long battery life. Three of the four battery packs available with the TEMPO+ run on size 675 batteries (for an average battery life of 3-5 days). These batteries can be purchased at many drugstores as well as hearing aid dealers. It is critical that they are labeled as “high power” batteries. Size 675 batteries that are not labeled “high power” will result in very short battery life because their power levels fluctuate enough to signal a dead battery to the processor, even though the batteries may be fully charged. The remote battery pack uses one size AA battery (either rechargeable or alkaline).

Battery door latch :: The battery door latch needs to be moved in the direction of the arrow before it will release the battery door. On the children’s battery pack, the latch is recessed to discourage a child from tampering with the batteries. A small object such as a paper clip is needed to move the latch.
Battery pack :: One of four modular components of the speech processor that houses the batteries that power the system. The four battery packs are: straight, angled, children’s, and remote (rechargeable). The straight battery pack can also be used to configure the BabyBTE™ wearing option.

Channel :: A channel refers to one of the 12 electrode pairs that are arranged along the array. The channels are numbered consecutively, with channel 1 being the lowest in pitch, and channel 12 being the highest in pitch. Not all children use all available channels, however. Channels can be deactivated for various reasons without any negative overall effect.

Coding strategy :: A coding strategy is a series of calculations used by the cochlear implant system to measure the sound that is presented to the microphone, analyze its components, and then determine which electrodes should be stimulated and how they should be stimulated to best represent the original sound. Next, it generates a code that is sent to the implanted portion of the system. This code tells the implant which channel address to stimulate within the cochlea, when to stimulate it, and how loud that stimulation should be to accurately represent the sound at the microphone. In MED-EL cochlear implants, this entire process happens many thousands of times per second.

Coil :: Also sometimes called a transmitter. The coil sends the coded information from the speech processor to the internal implant. It uses radio signals to send this message across the skin. The radio signals produced by the coil are a special frequency that is the only frequency understood by the implant receiver. The coil also contains a magnet that holds it against correct area of the head so that it is aligned properly with the implanted portion.

Coil cable :: The cable that connects the coil to the speech processor.

Control unit :: The computerized part of the speech processor. Most of the controls, such as program, volume and sensitivity, are located on the control unit.
Communication methodology :: The form that communication (and education) takes. Speaking, listening, using a signed or cueing system, or a complete signed language are all various communication methodologies.

Decibels (dB) :: The decibel is the measure of a sound’s loudness. The range of normal human hearing is typically 0-120 dB, with 0 dB being barely audible and 120 dB being barely tolerable. Conversational speech is fairly loud, at around 50 dB.

Detection :: An auditory response that indicates a sound was heard. A child might indicate he or she detects a sound with a head turn, nodding, raising a hand, putting a toy in a container, etc. The fact that a child detects a sound does not necessarily mean he or she can discriminate it from other sounds – detection is simply an indication of the presence or absence of a sound.

Diagnostic therapy :: Diagnostic therapy refers to the process of using the therapy environment to gain an understanding of a child’s level of speech, language or auditory development. Through a series of fun activities, the auditory habilitation specialist may attempt to determine how well the child is making use of hearing through a hearing aid or an implant, without the use of formal test measures.

Direct input :: Direct input refers to plugging an external sound source directly into the speech processor using a patch cable. Any battery-operated device can be connected to the TEMPO+.
Discrimination :: The ability of a child to understand a sound, word, or sentence. Usually speech discrimination is measured by asking the child to point to various objects or repeat various words or sentences.

Dynamic range :: A term used to define the loudness difference between the softest sound a person can hear, and the loudest sound they can still comfortably tolerate. The dynamic range of hearing is about 120 dB for most people with typical hearing. The dynamic range of the implant user is about 30 dB. The AGC system of the TEMPO+ allows a sound range of 25-100 dB to be represented accurately by the speech processor, giving the implant user an expanded dynamic range of 75 dB.

Earhook :: The earhook has a dual purpose: it holds the speech processor on the ear, and it connects the battery pack (or battery pack cable) to the speech processor. The earhook can be ordered in a locking configuration to keep a child from removing it. The fit of the earhook can be customized by warming it slightly and then bending the earhook material as desired. The angled battery pack uses a special earhook that fits securely in the area between the bend of the battery pack and the processor.

Educational specialist :: In this guide, the term refers to a professional who specializes in educating children with cochlear implants in a wide variety of educational settings. This professional may provide advice and support to a child’s educational team, or evaluate a child’s readiness for a certain type of educational approach. The educational specialist could be a teacher of the deaf/hard of hearing, an educational audiologist, or other related professional.

Electrical auditory brainstem response testing (EABR) :: This is a method of obtaining an ABR but using the sound generated by the implant. Because head movement can obscure the response, children are often lightly sedated for the test. This test assists in determining how well the auditory system is responding to the stimulation generated by the implant.

Electrical stapedius reflex test (ESRT) :: An objective measure that can be useful in establishing an MCL measurement in children who are unable to provide feedback to the audiologist about the loudness of sound. A small probe is placed in the opposite ear. The stimulation level of the implant is increased until a small muscle reflex is seen in the opposite ear. This muscle reflex is present in most people, and occurs at a level that is loud, but still comfortable. The level at which this reflex occurs correlates well with the MCL level of the map.

Electrode array :: The implanted device has a long, flexible portion that is inserted into the cochlea through a small opening. This portion of the device is called the electrode array.

Electrode contacts :: Electrode contacts are small oval-shaped disks made of platinum that are arranged along the electrode array. In MED-EL implants, they are arranged in 12 pairs. Each pair stimulates a different frequency region in the cochlea.

Electrostatic discharge (ESD) or static electricity :: A build-up of charge difference between a person and an object, often caused by friction between synthetic materials, or electronic equipment (such as TV screens), usually felt as a “shock” when the statically charged person touches a grounded object. The cochlear implant user does not feel the “shock” any differently from a non-user. A good example is the shock that occurs when touching a light switch after walking on the carpet. ESD tends to be worse in a dry environment. ESD can cause damage to electronic equipment of all kinds. The TEMPO+ has built-in safeguards to protect the processor from program loss due to ESD. Please refer to the Equipment Guide for more discussion on ESD.

Expressive language :: The ability of the child to produce language to communicate with others.
Fixation device :: A small accessory that is attached to the battery pack that allows it to be connected to the clothing. One fixation device can accommodate a small safety pin or diaper pin.
FM system :: An assistive device that consists of a microphone and transmitter worn by the speaker, and a receiver worn by the listener. In the case of the implant, the receiver must somehow connect to the speech processor, usually with a patch cable. An FM system sends the speaker’s voice to the listener using FM radio waves to help overcome the problems of distance and background noise.

Hair cells :: The hair cells in the inner ear sense the pitch and intensity of sound waves that travel through the fluid of the inner ear. In most instances of deafness, the hair cells or some part of the anatomy associated with them do not function properly and cannot send signals accurately to the brain. The cochlear implant attempts to mimic the function of the hair cells by generating a signal similar to what the brain might normally receive from the inner ear.

Hertz (Hz) :: A unit of measurement for pitch that describes the number of cycles per second in a sound vibration. The range of human hearing is 20 Hz – about 20,000 Hz. Speech information falls roughly in the frequency range 200 Hz – 6000 Hz. “Middle C” on the piano falls at 262 Hz.

Implant :: The implanted portion of the system. The implant contains the receiver circuitry that decodes the signal from the coil, and also generates the tiny electrical pulses that travel down the electrode array and stimulate the cochlea. This receiver and stimulation circuitry is encased in a thin, and very strong, ceramic package that sits just under the skin. The electrode array carries the electrical impulse from the implant case to the cochlea. The implant also contains a reference electrode that is placed under the muscle of the scalp. The reference electrode ensures that all electrical current is managed appropriately. A magnet is fixed inside the implant case to supply the magnetic attraction to the coil.

Implant case :: The implanted electronics are hermetically sealed inside a strong ceramic case, which is placed in the mastoid bone. MED-EL implants are only 4mm in thickness, which quite often allows them to be fully recessed into the bone behind the ear.

Individualized education plan (IEP) :: Although the IEP has a different name in some states, the term refers to the formal educational plan that is developed for each child who receives special services through a local school district. Federal law requires that schools provide a “free and appropriate” education to all children, including those with special needs. The IEP is a document that defines the services that will be provided to meet that law. The IEP is developed with input from the child’s parents, the child (when appropriate), teachers, school administrators and special service providers.

Inner ear :: The anatomical portion of the hearing system that triggers nerve impulses that travel to the brain. Both the hearing and balance systems are found in the inner ear. The cochlea is a small snail-shaped structure that contains the tiny hair cells that sense sound and send signals to the auditory nerve. The semicircular canals sense balance and position changes and report these changes to the brain.

Input dynamic range (IDR) :: See Dynamic Range. The IDR a measure of the implant system’s ability to handle a wide range of sound inputs accurately. The IDR of the MED-EL system is 75 dB.
LED indicator :: The small red light on the front of the processor will flash in a variety of blinking patterns to indicate different error conditions of the processor or batteries.

Localize :: The act of locating the source of a sound.

Magnet :: There are two magnets in the system: one in the coil and the other in the implant case. Together the two hold the coil in place on the head. The implant center audiologist can adjust the magnetic strength of the coil.

Map :: The program stored in the speech processor that tells the system how to process sound on each channel so that it is most audible and comfortable for the individual user. Each implant user’s map varies considerably from every other user. Maps also change over time, as the human body also fluctuates slightly in its sensitivity to electrical stimulation over time.

Mapping sessions :: A visit to the implant center where the individual’s speech processor program is evaluated and changed if necessary

Mastoid bone :: The area of bone directly behind the ear where the implanted portion of the system is placed.

Microphone port :: The tiny opening on the front corner of the processor is the microphone port.

Microphone test device (MTD) :: An optional TEMPO+ accessory that allows a hearing person to listen to the microphone of the TEMPO+ processor to determine whether it is functioning adequately.

Middle ear :: The anatomical portion of the ear just beyond the eardrum. The middle ear consists of a small air space that holds the three small bones of hearing (malleus, incus and stapes). The Eustachian tube allows air exchange between the middle ear air space and the outside; when the ears ‘pop’ during a change in altitude, this is actually the pressure equalizing between the middle ear and the outside. The middle ear is the most common site of an ear infection.

Mixing cables :: “Mixing” refers to a feature of certain assistive listening devices (such as FM systems) that allows the user to combine the signal from the speaker with the signal from the TEMPO+ microphone. The TEMPO+ supports this mixing feature, but it is necessary to ensure that a mixing patch cable is in use.

Most comfortable loudness (MCL) :: MCL refers to a loudness level that is loud, but still comfortable, to the listener. This is an important measurement made on each channel during a mapping session. The final MCL setting of the map sets an upper limit for loudness, and stimulation will never exceed that limit. MCL levels are different for each user; therefore it is important that speech processors are never traded between users.

MRI scan :: Magnetic Resonance Imaging is a medical diagnostic procedure. At this time, MED-EL cochlear implants are FDA approved for 0.2T (Tesla) MRI scanners without the removal of the implant’s internal magnet. Only machines of 0.2T strength should be utilized with MED-EL at this time. Additional factors, such as head placement, make it important for the scanning radiologist to contact MED-EL Corporation prior to scheduling the MRI scan. MED-EL can provide a list of approved scanners and their locations upon request.

Newborn hearing screening :: A program in place in many hospitals that allows a child’s hearing to be evaluated immediately after the baby is born.

ON/OFF switch :: The ON/OFF switch is located on each of the battery packs.

Otologist/Neurotologist :: An otologist is a physician who first became an ear, nose and throat specialist, and then went on to specialize in just the ears and the area of the head surrounding the ear. An otologist completes over 10 years of medical training and a specialized otology training fellowship prior to entering practice.

Outer ear :: The anatomical portion of the hearing system that includes the pinna (the visible “ear” on the outside of the head), the ear canal, and the eardrum (tympanic membrane).

Phoneme :: The smallest unit in a language that is capable of conveying a change in meaning. For example, the m in mat and the b in bat. There are 41 phonemes in the English language
Phonemic repertoire :: The range of various phonemes (speech sounds) that a child is able to produce. Generally, certain speech sounds seem to develop earlier than others over a period of several years.

Play audiometry :: An audiometric technique that teaches a young child to complete an activity when a sound is heard (such as dropping a block into a container or putting a piece in a puzzle). This facilitates testing the hearing of preschoolers and toddlers.

Program switch (1-2-3) :: The program switch on the speech processor allows the user to select different programs, or maps. Please refer to the implant center audiologist or parent to determine which program should be used most of the time.

Receptive language :: The ability of the child to understand language that is presented to him/her.

Residual hearing :: This is the term used to describe the hearing that remains after a hearing loss occurs. Most people with significant hearing loss still have some residual hearing that can be stimulated by amplifying sound using a hearing aid. However, the remaining hearing often does not provide enough clarity for a hearing aid to be of much benefit. These are the individuals who are candidates for cochlear implantation.

Sensitivity control :: The sensitivity control determines how sensitive the microphone is. High sensitivity settings cause the microphone gain to be increased. This can be good in a quiet environment, but in a noisy environment, it results in poor loudness relationships between soft and loud sounds. The general “rule of thumb” is to keep the sensitivity setting at about halfway on, which equates to 2 or 3 o’clock on the dial.

Sound field FM system :: An FM system that does not plug into the speech processor. Instead, a small speaker near the listener amplifies the speaker’s voice. A sound field system is a good alternative to regular FM if the child is unable to provide feedback on the quality of a direct FM connection.

Speech awareness threshold (SAT) :: The softest level at which a child can detect a spoken word. However, the child is not required to be able to understand the spoken word.
Speech processor :: A tiny wearable computer that transforms sound into the coding understood by the implant. The TEMPO+ contains a microphone, a sensitivity control, a program switch, and a volume switch. It connects to different battery packs. The term “speech processor” is often used to refer to the entire external part of the system (processor control unit, battery pack, coil and cable).

Speech reception threshold (SRT) :: The softest level at which a child can hear a spoken word well enough to repeat it back correctly.

Speech-language pathologist :: A speech language pathologist is a specialist in the diagnosis and non-medical treatment of speech and language disorders. An SLP obtains either a Master’s or Doctoral level degree, and then completes a training fellowship prior to entering practice.

Steady state evoked potentials :: An objective measure of hearing that requires no participation from the child. SSEP’s provide detailed information about the child’s hearing acuity. This is a very new measure that does not yet have widespread availability.

Suprasegmental :: The cues of language that come from pitch, intensity and durational differences in the pattern of speech. Suprasegmentals are what allow an English speaker to recognize the inflection of a question, even though the question is asked in another language.

Telemetry :: A feature built into the implant system that allows the audiologist to test the function of the implanted portion of the system. This is a quick test that requires no input from the child, and provides valuable information about how well the electrodes are functioning.

Telemic :: An optional accessory to the TEMPO+ that allow the user to take advantage of two features: a built-in telecoil for accessing certain assistive listening devices, or an external microphone.

Threshold :: Hearing threshold is defined as the level at which a person hears a sound 50% of the time. This means, it is so soft, that the listener isn’t even sure the sound is really there. When the audiologist performs an audiogram, he or she is trying to find the child’s threshold of hearing at different pitches across a spectrum from low to high pitch. Threshold can also refer to the softest level of electrical stimulation a child can perceive. In the MED-EL mapping software, the threshold setting of the map is abbreviated as “THR”. However, with MED-EL cochlear implants, threshold measures do not significantly impact the quality of the resulting map, and often are not measured.

Tonotopic organization :: The inner ear and the auditory area of the brain and central nervous system are arranged in pitch order, from low to high. Sounds of different pitches are processed by different hair cells, nerve fibers, or brain synapses. The cochlear implant, therefore, is designed to present pitch information to the areas of the cochlea that are “tuned” to be sensitive to those pitches.

U-pin :: A connection accessory that allows a battery pack to be connected to the speech processor without using an earhook. It is most commonly used in the BabyBTE™ configuration. The u-pin can also be ordered in a “locking” configuration, which keeps a small child from removing it from the processor.

Visually reinforced audiometry (VRA) :: This is a technique for obtaining responses to sounds from children who are not yet able to report what they hear. The child is presented with a sound, and when they respond, they are rewarded with something they can see, such as a puppet or an animated toy. The audiologist attempts to condition the child to look for the toy when a sound is heard, thus providing a method for testing the hearing of small children.

Vocal play :: The act of experimenting with the voice. Babies go through various stages of playing with their voices. This play becomes more and more speech-like until true words emerge. When a young child with a cochlear implant begins experimenting with his or her own voice, it is a good indicator that the child is hearing sound through the implant and is beginning to make the connection between hearing and the voice. With more time and practice, these vocalizations should begin to approximate words or phrases.

Volume switch (x-y-z) :: The volume switch allows the user to choose different volume levels for each program. The audiologist sets the volume levels, so it is best to consult the child’s parent or implant center for guidance on the correct volume setting for the child.