Practicing with the radio

During my commutes, I listen to NPR ripped to my iPod, and use a patch-cord to jack directly into the BTE. I'm following 90 percent of shows and even higher when I re-listen to difficult passages with foreign accents or noisy recording; after a second passage, comprehension goes to the max. When jacked in via the patch cord, and the sensitivity set to 0, there is no interference from noises around me. To teach myself to listen in noisy surroundings, I'm slowly increasing the sensitivity wheel, thus increasing ambient sound.

Happy Birthdy to Mark

The Borg are linking!

Happy Birthday to Mark Stern, a fine man, a leader, amd a fellow CIer.

Mark was in my thoughts today. His courage, insights, and support motivated me to pursue one, then bilateral implants. He shared wholeheartedly his personal cochlear implant research, listing the pros and cons of each device. He introduced me to Dr. Joe Roberson and Becky Highlander, such passionate care providers. I am ever so grateful that he came into my life, and to have shown me to way to a world where sounds have meanings without limit. They form the rainbows of my ear.

I went to a fundraising event for the AIDS and Breast Cancer Fund (http://www.aidsemergencyfund.org/body_events.html), and I was able to follow so much of the speakers so well, with only an glance at the interpreter for names and occasional missed words. I was touched by the speakers points and in their own words, I laughed at their jokes, even when the lips were not in my line of sight.

Dame Edna at the Curran theater!

We've gone to see Dame Edna at the Curran Theater in San Francisco. I'm using the theater's Sennheiser IR assistive listening device: with 2 stereo cables with a stereo splitter, I'm jacking the theater's sound system directly into the CI. The sound quality is superb! I'm following all the monologues and most of the songs and dialogues. I'm laughing so hard, I'm crying. This is the first time I've gone to live comedy and been able it so much.

Sounds are not the same at different spaces.

Tonight I went dancing at Mass party at 1015 Folsom. I hadn't been in that club since January for the New Years Day party. The entry space is much bigger now, and there is easier access to the floor. I wanted to see if the stereo effect at the last party on July 15 in a different dance space would be mirrored here. While the volume was loud, I didn't get the sensation of my brain creating a spatial analysis of the sound. Alfie explained that the music was muddled there tonight. That's effectively a good way to describe it! It's nice that I can tell the difference now in sound quality from one dance space to the next.

T-levels go down in the older ear

Went in today for a remapping for the new implant, and my audiologist also did a new mapping for the older implant. Surprisingly, even almost two years after the receiving the first one, my T-levels are still going down. T-levels --where T is for "threshold" measure the amount of electrical stimulation required to hear softest sounds at each electrode.

Can't stop the music, in stereo!

We were out dancing for the first time since getting the second implant. Hearing in stereo gave a new dimension to the music! I could tell how each side picked up the sound differently. Every now and then, the streams would deliciously meld together in my head, sending me into orbit. I've always loved to jump and spin with the beat, and it's definitely easier now. Occasionally I would test turning one or the other side off, and I'd be struck with how much flatter the music seemed.

One downside was the cables are twice as easy to accidently knock off. I could tell that freaked out some people; they could deal with remembering to leave the right side of my head alone, but now they have to keep their hands lower than my face.

Quality of sound progressing

This afternoon at a garden party, I chatted with many hearing friends. Despite the background chatter, I had no problems following conversations. Bilateral definitely helps with screening out unwanted sounds. I'm please that 2.5 weeks after activation, I'm already noticing a clear benefit. I'm already using the highest program and wanting more input, so I've made an appointment for a new mapping ahead of schedule.

Who is master now?

In Spiderman-2 movie, Doc Ock uses 4 snake-like protheses as extra arms, and these are directed with an artificial intelligence (AI) chip. In the course of an experience gone haywire, the arms fuse permanently to his body, and the AI takes over his brain, changing his relationship with the prostheis to one of slave/servant. I can't help but draw parallels.

The dividing line between human and machine is still clear with the cochlear implants, but for how long? It was still a struggle for me to go ahead with getting them, knowing that I would -- for all practical purposes -- be integrated with and dependent on the devices for the rest of my life.

Activation, take two!

My second implant was activated today! After surgery on my left side a month ago, and the slow (much slower this time around) healing process, I was "turned on." I was pleasantly surprised that as bad as everything sounds with the new implant, it's not been disruptive. After the mapping, Becky turned on all circuits, and did a few simple tests. I could recognize the difference between number of syllables ("Hello", "How are you" and "Let's go eat dinner"), but attempting to understand even the simplest sentences was beyond me. We agreed to stick with the BTE (G3) and skip the BWP (body worn processor), using sensitivity with one program louder than the other. Within minutes of setting up the programs, I wanted more umph, so Becky replaced both programs with new ones with more volume.

On the drive home, it seems listening to talk radio KCBS and KGO was easier. The new ear really picks up on high pitched sounds, and glosses over lower frequency ones, which is not surprising, since it took a couple days with the first implant before I got the full spectrum of sound.

So far, I'm pleased; I was expecting to get the "Minnie Mouse on speed" effect and to be bewildered by the difference in input, but I only notice the effect when I turn off my left (older) implant. With both on, the squeakiness is masked, and I'm just more aware of high pitched sounds. Boy, some sounds like keyboard clicking and rustling paper, are just eeeeeech!

I go in for the second mapping in two days.

3 month followup

Today my audiologist made slight adjustment to the mappings, but nothing significant worth reporting; things are very stable. My speech comprehension is up to 73%. I'm at 30% sound recognition, while the average for CI recipients is 40%. I'm so thrilled with the progress to date and look forward to continued improvement.

Dropping the 1800 Hz

The BTE has been changed to have 900 Hz, one program with low frequency emphasis and one without (neutral). The latter sounded soft so the volume was increased compared to the program with low frequency emphasis.

A couple days of observations of new settings

[Warning: heavy technical jargon follows. For more information about the various programs and settings, check out Cochlear Corporation's website]

Body Pack:

1) 900 Hz with low emphasis and ADRO
2) 1800 Hz with low emphasis and ADRO
3) 900 Hz with neutral emphasis and ADRO
4) 1800 Hz with neutral emphasis and ADRO

[Adaptive Dynamic Range Optimization (ADRO) is a pre-processing algorithm designed to improve access to low-level sounds to increase the salience of the softer phonemes of speech, while keeping louder sounds comfortable. ADRO is only available with the SPrint (body worn) processor.]

BTE:

1) 900 Hz with low emphasis
2) 1800 Hz with low emphasis

Low frequency emphasis works great :

I used the body pack all day Friday (office) and most of Saturday (morning doctor's appointment, afternoon at a picnic). I experimented with programs 2 (1800 Hz with low frequency emphasis) and 4 (1800 Hz neutral). In all situations, both programs resulted in similar speech comprehension, though in outdoor settings and with program 2 I had to concentrate more to pick up voices over the environmental sounds.

The real benefit for speech comprehension from low frequency emphasis surfaced while listening the computer CD player and using the AV patch cord with sensitivity set to 0 (I have the book and CD set of the Night Listener by Armistead Maupin):
• I tracked easily
• I could start the CD at an arbitrary point in a chapter and find the location in the book
• I could take my eyes off the page and get the gist of what was being read to me, sometimes to the extent of understanding full paragraphs
• With the neutral setting I could only track, and even then sometimes lost my place.

Low frequency emphasis and the joy of music:

For listening to music -- with and without singing -- I love the low frequency emphasis. This morning I listened (and sang) along to my favorite songs from Les Miserables. With one in particular, the mix of voices and music was so beautiful, I cried. Without the low emphasis, I'm able to better separate the lyrics from the music, but everything sounds tinny, and the the voices mask the music, making the listening experience incomplete.

900 Hz is enough (compared to 1800 Hz):

I've come to the conclusion that 1800 Hz does not offer better information than 900, either for speech comprehension or music. I did notice that at 1800 Hz:
overall sounds are shifted toward higher pitches; this is not a desired effect.
less volume; e.g., 1800 Hz at volume 9 is roughly equivalent to 900 Hz at volume 6.

Discomfort with 900 Hz programs on the body pack:

I started out with volume 7 on all programs on the body pack. I quickly shifted to volume 9 on all 4 programs, and that turned out to be a mistake. I related in a subsequent email that pain started in the back of my head; it only surfaced with the 900 Hz programs and spiked with certain sounds like "sh."

I realize now I was trying to get the sound input with the 1800 Hz that I was receiving with the 900 Hz. I had erroneously assumed that I was building up tolerance and I would want the same volume across the board. With the 1800 Hz rates, my brain can handle the extra volume - and likes it! On the 900 Hz programs I'm now keeping the volume between 5 and 7; the discomfort is still present but tolerable.

The puzzling thing is that on the BTE I don't have any pain with the 900 Hz program, and in fact can tolerate loud volume without discomfort. In fact, using the computer CD player and AV patch cord jacked into external speakers, everything set to maximum was comfortably loud. The only sounds that are annoying with the BTE are the crinkling of paper.

With the body pack, focusing on low frequency emphasis programs:

I'm staying mostly on the low frequency emphasis programs to see how well I do with it in noisy surroundings. So far, while voices are not as easily distinguishable from ambient noise as without the low frequency emphasis, I still appear to be understanding people well, especially when I reduce sensitivity. The biggest problem is being out in the street; god, do environmental noises sound loud! Next week at the office, I will explore more how much low frequency emphasis provides better speech discrimination in noisy environments.

With the BTE, focusing on program 1:

Thus the rest of Saturday and Sunday I went around with the BTE using the low frequency emphasis program at 900 Hz, especially since it conserve battery compared to the 1800 Hz. I would like to try something else in the other slot, perhaps a program without low frequency emphasis?

One month adjustment: introduction of low frequency emphasis and using ADRO

After the mappings, I was tested on speech comprehension and I'm up to 30%, as compared with 18% with the hearing aid. Granted that these are simple sentences in a controlled setting, but it's a great sign of how much more I'm understanding speech.

I've now switched to the body pack and will be testing out the various settings for the next few days. A few observations I wanted to note for future reference:

• I'm using volume 7 for all 4 programs. It's great to have such high sound input with no facial twitching.
• Music sounds wonderful now!!!
• With either low emphasis setting, whistling high notes sound strange; they sound very breathy and too much of the high pitch is lost. • On the other hand, music sounds richer and more full with the low emphasis settings.
• With either low emphasis setting, the computer fan is once again noticeable and somewhat distracting. I assume I will get used to it with time.

I haven't had a chance yet to experiment with listening to books on CD, and I will do so in the next few days.

Longer period of observations

Thursday and Friday with SPrint: I was mostly at home experiencing the SPrint. I have also done some listening to the CD on the computer using the TV/HiFi cable. On the other hand, with the Personal Audio Cable connected to my Walkman CD, the sound is still too soft. I also was able to follow the news and talk shows with the combination of lipreading; that was something I could not do with hearing aids! I had music playing in the background while at home, and over time it sounded better. Ambient noise was bothersome, but by end of day Friday I was able to "tune it out" and focus on the sounds I wanted to hear.

Saturday through Monday with the BTE: Over the weekend I was mostly outside and around lots of people in noisy situations. Today I worked at home. Since I didn't need to use any of the features only present in the SPrint, I switched to the BTE. The convenience over the SPrint is considerable; no wires dangling around or the bulk of it against my side. I was amazed at how well I could understand people in noisy environments! Even on the dance floor, I could distinctly hear the voices of people over the loud background music, sometimes even more than my hearing friends. :-) The one drawback of the BTE was the noise of air against the microphone; it's really noticeable even walking in a quiet street with no breeze. Today when alone in the house I would switch occasionally to the higher mapping to build up my tolerance for the increased volume. With both programs, I no longer notice the computer fan noises.

With both the SPrint and BTE I do find that reducing the sensitivity to minimum helps with listening to the radio in the car and minimizes outside noise. I can enjoy music, but don't understand much when listening to talk radio.

Second Day

The mappings were significantly boosted upward. I also received the BTE (behind the ear) unit to try out.

First day hearing with the cochlear implant

This morning, after the initial mapping (calibration of each channel/frequency for minimum and maximum volume) the CI was turned on with all channels. At first everything sounded very high pitched and monotone; voices sounded like Minnie Mouse on amphetamines. My audiologist said I was the first to describe the initial impression as such; others have used cartoon characters like Porky Pig and Mickey Mouse.

Toward the end of activation, the audiologist had me use the phone plug accessory (directly connects the CI to the phone) and dialed up her voicemail. I could hear the dial tone, the individual keypad tones and even grasp a few words like “you have reached the “voicemail” and “thank you.” I was able to do this with the hearing aid, so it wasn't a new experience for me. She was floored, explaining that most CI recipients don't gain that kind of discrimination so soon after activation, so I'm pretty excited by the potential.

Now a more full range is coming in, but still biased toward high frequencies. This effect is normal and will fade over the next few days as my brain adjusts. I was given the SPrint, the body processor to take home.

I've been experimenting with watching TV: I'm able to understand newscasters by lip reading and the CI, whereas I couldn't do that with hearing aids. I also listened to a couple of songs from Les Miserables. I am able to track along with the lyrics more easily even now, than before. The voices come through more distinctly than with hearing aids, but I don’t hear the music as much yet. Listening to classical music is a disturbing experience: it sounds like gurgling and trilling, not relaxing at all.

I go back tomorrow for modifications.