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I owe a post that discusses EAS (electrical acoustic stimulation) and my CI journey so far.  When I discussed my reasons for visiting UNC Chapel Hill (almost 4 hours from home) with the surgeon there we agreed that since I came that far seeking information about “hearing preservation” that we should go that route.  By that point I wasn’t sure I really cared much about preserving hearing in my worse (right) ear, I just knew I wanted to benefit from a CI.  I was surprised that the fact that I did not qualify for the MedEl hybrid CI trial didn’t mean we couldn’t try for hearing preservation and electric-acoustic stimulation as the end result.

How does that work?  Well aparently MedEl has another electrode that is already FDA approved that allows a chance for hearing to be preserved.  I’d get that electrode with their normal CI implant and normal processor.  Then if a new hearing test showed that I still had usable low-frequency hearing I could wear a hearing aid too.  So if that happens I may be in the market for an in the ear hearing aid.  In the mean time I think I can wear the MedEl ’sports’ processor that pins to your shoulder along with my current BTE.

This article has a good summary of EAS. http://www.asha.org/about/publications/leader-online/archives/2007/071016/f071016c.htm

So is this other electrode going to prohibit from full use of the CI?  Probably not really.  It just isn’t the extra long electrode that MedEl normally uses.

Hearing preservation with a cochlear implant is also possible with a conventional long electrode array. It had been assumed that any residual hearing in the implanted ear would be sacrificed due to surgical trauma; however, in some instances, this is no longer the case. Increasingly skilled surgeons employing soft surgical techniques—which may include a smaller cochleostomy or round window insertion and more careful electrode insertion—with thinner electrode arrays and/or perimodiolar electrodes (which also may allow for a relatively atraumatic cochlear insertion) have all helped contribute to hearing preservation with standard cochlear implants.

That article also mentions using a BAHA type hearing aid after a CI. Interesting.  Not sure my better ear is good enough to bother with that.  There’s an article about that here.

Time to get back to work.  Playing catch up on everything after a week out of town.

Originally published at Sarasera. You can comment here or there.

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It was only a few weeks ago that my boss at work asked me what frequency an octave is.  We were planning to do an acoustical test for some fire insulation and it came up in the discussion.  He figured as a musician I would know.  Never having studied acoustics, I didn’t, but Google did of course.  An octave is a doubling in frequency.

Right after I looked this up I received a package from UNC with all the different CI literature in it.  It talked about frequencies and the piano keyboard and frequencies and the cochlea.  So interesting.

In all these years I hadn’t really thought about my audiogram and a piano keyboard.  Looking at my audiogram it looks like my hearing vanishes somewhere between 1000 and 2000 Hz.  1000 Hz is C6 - 2 octaves above Middle C.  Yeah, that sounds about right from my memory of playing with a keyboard.

This page has a list of all the notes and their frequency and wavelength: Frequencies of Musical Notes

And this page has a Flash keyboard to play with: Flash Piano - the Method Behind the Music

Edited to Add: Here’s an even better piano to play with that goes from C2 to C7. Virtual Piano: Online music innovation at its best

I was looking for a piano online that went above C6 but haven’t found one yet.  In Garage Band on my Mac however there is one that goes from C2 to C8 (except it has middle C as C3?! let’s ignore that).  Above C6 (1000 Hz) notes do not sound distinctly different to me, and above C7 (2000 Hz) I can’t hear much beyond the F (2800 Hz).

What does all that mean to a non-musician, or non-piano player? Well Middle C is an easy note for men and women to sing. High for men, low for women, but not a stretch for either gender.  C6 is a very high note for a woman to try to sing, I think A5 was the highest note I ever saw as a soprano in choir.

What does all this mean to me in my cochlear implant journey?  Well it means that the human singing voice, and I suppose the frequency range of most instruments in a band (minus piccolo!) are less than 1000 Hz and thus in the range of what I can hear with my hearing aids.  Wait, really?  So why get a cochlear implant if you can already hear everything?  It all comes back to understanding speech.

Here’s the speech banana:

graph known as the speech banana

If you look at the line from 1000 Hz at the top down - anything to the right is what I can’t hear, even with a hearing aid. I’m deaf in those frequencies.  A CI helps a lot with those frequencies, but can often make the frequencies below 1000 Hz sound strange or at least different. How strange and different? I can’t tell you that as I haven’t experienced it.

Traditionally a cochlear implant meant that you would lose all hearing that you had left.  It would be replaced by hearing through the implant.  The new technology known as the hybrid implant, or electric-acoustic stimulation (EAS) tries to preserve residual hearing so that you can continue to use a hearing aid for the low frequencies and add the high frequencies through the CI.  I promise I’ll write more about this next time.

Originally published at Sarasera. You can comment here or there.

sajego: (Default)

I liked this post a lot:

http://bionic-kate.livejournal.com/10614.html

Originally published at Sarasera. You can comment here or there.

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I’ve been reading a lot of new blogs lately, a lot of them written by other people about their cochlear implant experiences.  I love random web surfing so I don’t remember how I found most things.  When I end up with a couple dozen tabs open in Firefox I try to add blogs to Google Reader and sites to Delicious so I can find things again.

I’ve been looking at a couple of sites this evening that are interesting enough to share.

http://www.esl-lab.com/ is a site with many recordings and quizes.  I’ve found that with the “Easy” listening exercises if I read the questions first I can score pretty well on the tests.  I’m definitely not understanding more than 20-30% though.  Just listing for the answers to the questions.  It’s amazing how easy it is to understand when I go back and read the transcript.  The harder exercises left me completely lost.

I was reading another site and wanted to share their sound file examples here.

If you have ever wondered what having a hearing loss is like for me, listen to the first two sound files:

Sound #1

Sound #2

The first represents normal hearing (for those of you who need help, the sentence is “She’s drinking from her own cup.”) the second represents a severe/profound hearing loss similar to mine that is amplified with hearing aids.

To me, the second one sounds almost identical to the first one (I can tell there is a P sound missing from the end of CUP on the second).  I’ve experienced this before.  Back in high school we would request a meeting at the beginning of the year with all my teacher to talk to them about my hearing loss.  My audiologist came to one or two of these and she brought a cassette tape that had examples like this on it.  I remember my French teacher, Mrs. Anderson, thought that a recording like the second one was how I hear without hearing aids, she couldn’t believe that no, that is what I hear WITH hearing aids.  Without hearing aids I don’t hear much of anything.

The other three sound clips on that site have to do with hearing with a CI. All the sound clips are here: http://www.cochlear-implants.net/cochlear_implants/ci_soundfiles.htm

I can tell that the quacky voice one is indeed quacky.  The last one sounds a bit off to me, but I can’t tell you why.  Don says it sounds perfectly clear, and if that’s how I can hear with a CI, compared to the second clip, then that’s an amazing improvement.  We shall see.  It is hard to trust any of these sites completely because everyone’s experiences are different. Not to mention changes to technology.

Originally published at Sarasera. You can comment here or there.

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Originally published at Sarasera. Please leave any comments there.

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I’ve started this post twice now and it has morphed into something else… Let’s try again.

There are lots of reasons to get a cochlear implant. There are also many people who will be happy to go on and on about the reasons not to get one, or more specifically why you shouldn’t get one for your 12 month old child. I’m not getting into that.  This is about My reasons.

As I said in the last post, I had a CI evaluation done about two years ago and decided not to do it.  Why?

Well, I am getting by quite well just as things are now thank you very much.

Big reason number one has to do with that too. A cochlear implant will destroy any residual hearing you have left.  If I’m getting by fine now, why would I make such a permanent change?

Reason number two goes like this:

“I have but a mere ten electrons that replace the 180,000 some hair cells that at one time did the job of firing sound at my auditory nerves.” - David at Five String Guitar (but not the first time I’ve seen that thought expressed)

Research is slowly unraveling how the ears work.  Hearing aids are no where near as effective as glasses are. Cochlear implants are even more mysterious.

Another reason, that middle-ear-implant I wrote about before. It doesn’t use a microphone, it is totally implantable.  I don’t care about invisible, but waterproof sure is nice!  They are trying to get it to work with a cochlear implant eventually.

Another reason, stem cell research. They should have a cure for deafness in the next 15-20 years or so.  What if getting a CI damages your ear so much that you can’t benefit from this?

My biggest reason though is that I’m a musician.  I started playing alto saxophone in 5th grade and played for four years before I lost my hearing.  I am still playing now.  I play in a band weekly and for the last year I’ve also been playing in a saxophone septet. It’s a hobby that requires a commitment so I try to go to rehearsals whenever I can.  I listen to music in the car on the way to and from work. I truly enjoy music. What if a CI makes it sound awful? I’ve heard that it’s hard to even recognize different notes on a piano, how would I ever be able to tune?

Just recently I was looking into new technology known as a Hybrid Cochlear Implant.  The technical name is “Acoustic-Electrical Stimulation”.  The idea is that a short electrode is used for the CI that doesn’t damage low frequency hearing. Thus you can use the CI for the high frequencies and use the hearing aid for the low frequencies.  The benefit may be a more natural sound.  It’s still in FDA trials.

I sent an email to the company, Med-El, to ask about their trials.  One more surprise waited for me in their answer.  They told me that my hearing loss was too profound for even a hybrid CI.

Wow.

Once again I’m wondering, am I really That deaf?

Originally published at Sarasera. Please leave any comments there.

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It has been over 15 years since I lost my hearing. In 1993 I was told that a CI would not help me. That they didn’t produce very good sound and that speech comprehension with one was lower than I was getting with my hearing aids. I wasn’t that deaf.

Honestly, I didn’t really think about it again after that until 2006. I got new hearing aids twice while I was a student at RIT and things were pretty good with them. Put me in a group and I’m definitely hard of hearing, try to get me to use the phone and I will make a mess of it, but talk to me one-on-one in a fairly quiet space and you will soon forget.

In 2006 I read about a new type of hearing aid, hearing implant really, that promised a totally implantable solution that used your ear and ear drum instead of a microphone. I was, and still am, intrigued. I think microphones are a very poor substitute for our ear drums and outer ears. I think hearing aids should at least be waterproof so that I can kayak and swim and kiteboard without damaging the electronics. A device that solves both of those problems had me calling them up to get them to provide more information.

Well the response from them was kind of a shock to me.

Hi Sara-
Thank you for sending your audiogram. Unfortunately, your hearing loss is too profound to be a candidate for our clinical trial. Candidates have to show a mild to severe hearing loss in both ears (nothing over 85dbHL) to be considered.

Thank you for your interest in our program.

I thanked them for the quick reply and was surprised to get an email back “have you ever thought about a cochlear implant? Just a thought…..”

Really? Me? A CI? Am I really That deaf? I don’t feel like I’m that deaf. I told her I had not seriously considered it. I didn’t want to give up my residual hearing. I didn’t think a CI had much benefit to my quality of life over hearing aids. I didn’t give it much thought.

Fast forward to 2007, I wanted to get new hearing aids. So I put $2500 into a flexible spending plan at work and had to spend it that year. I didn’t have a local audiologist, so I set up appointments at the UVA Medical Center. I figured they’d like it if I saw their ENT too since I was a new patient.

Well that visit was also a surprise. My hearing was still stable but my speech comprehension on a CNC test was really low in my right ear. I definitely had recruitment during that test but didn’t ask the audiologist to set the volume lower. Both ears were tested separately at 105 dB and the right ear was really feeling the recruitment. I think it was a recording I was listening to for the test, but I can’t remember for sure. The CNC test has always been hard. CNC stands for consonant-nucleus-consonant so is a list of one syllable words that I have to listen to and repeat back. I can’t even tell you what the words are because I have no idea (though that link explains the test and has a sample list, maybe if I study I’ll do better! or is that cheating?). They all sound like “Blah”. I make myself try and usually score higher than expected, but obviously guessing since I don’t know any of the words at all. Not like the compound words like ice cream, rainbow, firetruck, baseball, railroad, hot dog, etc. Those are used to determine the speech threshold.

Anyway, the audiologist didn’t seem that interested in selling me hearing aids for some reason. I saw the ENT and he talked to me for about 30 seconds and recommended I be evaluated for a cochlear implant. Still in shock but trying to keep an open mind, I agreed and set up an appointment.

The CI audiologist was very sweet. She did more hearing tests, just with my hearing aids, both ears at the same time. Words, and then sentences, something I’d never been tested on before. I scored 60% on sentences - for those of you unfamiliar with hearing tests - this means in a sound booth with no visual cues, i.e. no lipreading. I guess I’m just a good guesser. I even got 10% of sentences in noise.

We finished the tests and the CI audiologist said I do qualify for a cochlear implant and then she actually asked me if thought I wanted to peruse getting one! Finally. Someone who actually cares what I think about it. I told her, no I didn’t so, not yet anyway. She said that she understood, that she thought I was doing very well with my hearing aids, and that since I had had hearing aids so long I was obviously very used to them and that I might really dislike how a CI sounded. This echoed my own thoughts very closely. It was so nice to have my cautiousness reaffirmed by someone.

And so we left it at that and I ended up going back to NTID again to get new hearing aids that fall.

But the few weeks between appointments at UVA was the first time I had seriously thought about a CI. I knew I wasn’t ready. My boyfriend, Don, told me that I didn’t have to worry about it. For everything in my life, when I’m ready to do something I just go ahead and do it. Boy was he right, because that’s where I am now.

Originally published at Sarasera. Please leave any comments there.

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