A couple of days ago I had my 4th mapping appointment, 5 weeks to the day after activation. In the 2 weeks since my last appointment I had steadily increased the volume level to nearly the 3 o'clock position on the dial, so it was time for more adjustments.
The first thing my audiologist did was stick me in the booth for some sentence and tone tests. The last time I had that done was for my CI candidacy screening back in October. For many years the sentence test has been a futile and mildly frustrating event. If you are normal hearing and want a simulation, try stuffing some good ear plugs in your ears, set your clock radio to a talk program, put a pillow over it and try to repeat what you hear. The sentence test is a pre-recorded male voice, calibrated to a normal conversational level, speaking random sentences such as, "the two boys played in the rain," or "she put her purse on the table." Sitting in the booth waiting for the test to start, I was subconsciously gearing up for the usual strain when a man said quite clearly something like, "the boy threw the baseball through the window." I easily repeated it. This went on for several minutes. I guessed on a couple of words, and only missed one sentence completely (in which, as my audiologist explained later, the speaker had practically yelled something about "the angry man..."). Four separate tests were run. My scores ranged from 93% to 100%. Amazing. And that was with my old map. Sure, it was in a quiet setting with no background noise to interfere, but I only scored 13% before my CI!
Next up was a tone test. I didn't get a hard copy of the test results but I took a quick look at it. At the lower frequencies, which we kept lower at my last mapping, my threshold was in the 40 dB to 35 dB range. Then it dropped to 20 dB at 2 kHz before climbing a bit to 25 dB at 4 kHz. A 20 dB or lower threshold is considered normal hearing, so I'm doing great. And, again, that was with my old map.
A quick shuffling of cables and I was connected to the Advanced Bionics laptop for a mapping. We decided to keep the same 3 program strategies and just crank the levels. We ended up boosting the low frequencies a bit more relative to the highs on my HiRes-S programs, so I think my tone test would be flatter now. One thing I noticed more than during previous mappings was the distinct difference in the quality of sound when Fidelity-120 is ON or OFF (F-120 is AB's new feature that increases the number of spectral bands dramatically). When F-120 is OFF, my audiologist's voice has a slight "buzziness" to it; when ON it is smoother, more natural.
We finished up the session with a discussion about my right ear hearing-aid and HiRes-P vs. HiRes-S (two different electrode stimulation strategies). She gave me the green light to use the hearing-aid as often as I want. So far I've been liking HiRes-S better, for speech especially, but I still want to spend some time testing HiRes-P. I was listening to some music a few days ago, switching between P and S, and I think P might be better. Also, there is the chance that, once I get more accustomed to the CI, P might be better for everything -- so I don't want to discard it from my available programs.
The number I mentioned in my prior post was... hold on to your hat, or grab your underwear, or something... the total billed cost of my CI, surgery and activation. Sobering, huh? It deserves to be on a t-shirt, or a tattoo. I keep getting things in the mail detailing the breakdowns of all this and each time I hold my breath because they look like bills. Though I was covered under a top-tier HMO and I'm quite sure we only pay a small co-pay, it's still enough to give one the willies. I feel fortunate to have received this magnificent technology, but I also feel very fortunate that I didn't need to take out a second mortgage to pay for it.
Thursday, January 17, 2008
Wednesday, January 16, 2008
1 Month Post Activation
A few weeks ago, on Jan 2nd, I had my 3rd mapping appointment. It wasn't really a "mapping" since we didn't adjust anything. I had gone a bit overboard on the levels at mapping #2 and had only just reached the point of running the volume at normal. My audiologist used the time to run the NRI (Neural Response Imaging), which I described in my "Mapping No. 2" post. During the NRI the software sent pulses to various electrodes in a rhythmic pattern. It sounded like wooden blocks clacking together, almost musical. I enjoyed it. She said the results were good and she would use them as a reference at my next mapping. She also removed the extra half-strength magnet from the head-piece because she felt it was grabbing on a little too strongly. It seemed to adhere fine with just the normal magnet.
Unfortunately, in the following days it became clear I wasn't quite ready for the reduced magnet strength. The head-piece would fall off too easy, just by sitting down or doing anything that slightly jarred my head. Worse, it would constantly lose the communication connection and have to re-sync -- several times per hour at least. It started to drive me nuts! My CI has a very distinctive sound when it re-syncs. First it goes instantly dead. Then, upon reconnecting after about a half second, it makes a deep, metallic, watery, reverberating "PINNNNGGGGGG" that sounds exactly like a sonar ping in an old World War II movie! Finally after another half-second the sound of the world comes rushing back. Normally it's not bothersome at all, but having it happen every 10 minutes or so I felt like I was under attack!
The following week, on Jan 8th, I had my 5 week checkup with my surgeon. He checked my scar, the site over my implant, and took a quick peek in my ear. All looked good. I told him about the head-piece. He checked it and said there would be no problem putting the additional half-strength magnet back in for awhile, as long as we keep an eye on it. It is very important to use as little magnet strength as possible. There is the potential to irritate the skin over the implant if it squeezes too tightly. If allowed to go on too long it can lead to an ulcer, which would mean not wearing the CI for the time it takes to heal, or worse it could become infected which puts the implant at risk. There have been cases in which the implant must be temporarily removed to allow an infection to clear up. He said the skin over the over the magnet toughens up with time and becomes less prone to problems.
Next we had a good little discussion about the pitch perception I have described in prior posts -- in brief, everything sounds deeper in pitch then I expect and in relation to my right ear. He was intrigued by my tests that showed about a half-octave difference the week after activation. I wondered if it had to do with insertion depth and he said it was quite likely related. He confirmed my suspicion that they have no way to precisely position the electrode array to match frequency location, adding that there is evidence pitch perception is not necessarily "hard-wired" to locations in the cochlea and that the brain may compensate over time. I think I might already be experiencing some re-wiring, since some sounds don't seem as deep as they did a month ago.
Finally we discussed my right ear hearing aid. He asked if I had been using it at all. I told him my audiologist had recommended I not use it very much during the first month or so, but that I had tried it for short periods of time on occasion. He explained that in the past they (CI surgeons) had found most users didn't want to bother with a hearing aid in the other ear because the CI sounded better by itself, or the two didn't sound good together. So they didn't encourage continued usage. But now they have made a one-eighty since there have been findings that using a hearing-aid along with a CI has several advantages if the unimplanted ear still has usable hearing. It helps with spatial location, speech discrimination, and pulling sounds from noise. And by keeping the ear functioning as much as possible it can improve the result of a future bilateral implant. I had intended to work at using my hearing-aid again, so it was great to get encouragement from my surgeon.
I like movies. Who doesn't? For the past 5 years, I have always gone to a theater with closed-captions. This severely limits one's options since there are only a couple of captioned screens locally. Once or twice during that time I went to a non-captioned theater and I couldn't understand a word. Last week my wife and I went to see "The Golden Compass" in a theater without closed-captions. Even though I've been doing really well with speech, I had no idea what to expect with a loud movie soundtrack. By the end of the endless previews my hopes were rising. Ten minutes into the movie I practically had to scrape my jaw off the floor. I was getting nearly every word, without straining. I even did some little tests switching between hearing-aid only (loud, noisy, english-as-a-foreign-language), CI only (great!), and both (slightly better!!). My best guess is that I caught about 80% of the dialog, if not more. I never felt like I missed anything crucial. The special effects and music sounded good too. Even though the movie was disappointing I was pretty thrilled.
I was in the shower the other day, cleaning my ears, and I noticed a sound when I wiggled my wet finger in my implanted ear! What? More wiggling and sure enough I heard a deep sounding flutter in my left ear. So I seem to have a little residual low frequency hearing. I will have to run some tests on that in the near future.
I have a big project going on in our little (tiny) front yard. I started it many, many months ago and had to take about 2 months off because of my medical adventures. I am finally back to work on it! It feels really good to be physically active -- and sore in the morning -- again. The sound of a shovel digging into wet decomposed granite is just lovely, "Crrrruuuuuunchhhhhh!"
As a parting gift -- ponder this number: 134861.10
Unfortunately, in the following days it became clear I wasn't quite ready for the reduced magnet strength. The head-piece would fall off too easy, just by sitting down or doing anything that slightly jarred my head. Worse, it would constantly lose the communication connection and have to re-sync -- several times per hour at least. It started to drive me nuts! My CI has a very distinctive sound when it re-syncs. First it goes instantly dead. Then, upon reconnecting after about a half second, it makes a deep, metallic, watery, reverberating "PINNNNGGGGGG" that sounds exactly like a sonar ping in an old World War II movie! Finally after another half-second the sound of the world comes rushing back. Normally it's not bothersome at all, but having it happen every 10 minutes or so I felt like I was under attack!
The following week, on Jan 8th, I had my 5 week checkup with my surgeon. He checked my scar, the site over my implant, and took a quick peek in my ear. All looked good. I told him about the head-piece. He checked it and said there would be no problem putting the additional half-strength magnet back in for awhile, as long as we keep an eye on it. It is very important to use as little magnet strength as possible. There is the potential to irritate the skin over the implant if it squeezes too tightly. If allowed to go on too long it can lead to an ulcer, which would mean not wearing the CI for the time it takes to heal, or worse it could become infected which puts the implant at risk. There have been cases in which the implant must be temporarily removed to allow an infection to clear up. He said the skin over the over the magnet toughens up with time and becomes less prone to problems.
Next we had a good little discussion about the pitch perception I have described in prior posts -- in brief, everything sounds deeper in pitch then I expect and in relation to my right ear. He was intrigued by my tests that showed about a half-octave difference the week after activation. I wondered if it had to do with insertion depth and he said it was quite likely related. He confirmed my suspicion that they have no way to precisely position the electrode array to match frequency location, adding that there is evidence pitch perception is not necessarily "hard-wired" to locations in the cochlea and that the brain may compensate over time. I think I might already be experiencing some re-wiring, since some sounds don't seem as deep as they did a month ago.
Finally we discussed my right ear hearing aid. He asked if I had been using it at all. I told him my audiologist had recommended I not use it very much during the first month or so, but that I had tried it for short periods of time on occasion. He explained that in the past they (CI surgeons) had found most users didn't want to bother with a hearing aid in the other ear because the CI sounded better by itself, or the two didn't sound good together. So they didn't encourage continued usage. But now they have made a one-eighty since there have been findings that using a hearing-aid along with a CI has several advantages if the unimplanted ear still has usable hearing. It helps with spatial location, speech discrimination, and pulling sounds from noise. And by keeping the ear functioning as much as possible it can improve the result of a future bilateral implant. I had intended to work at using my hearing-aid again, so it was great to get encouragement from my surgeon.
I like movies. Who doesn't? For the past 5 years, I have always gone to a theater with closed-captions. This severely limits one's options since there are only a couple of captioned screens locally. Once or twice during that time I went to a non-captioned theater and I couldn't understand a word. Last week my wife and I went to see "The Golden Compass" in a theater without closed-captions. Even though I've been doing really well with speech, I had no idea what to expect with a loud movie soundtrack. By the end of the endless previews my hopes were rising. Ten minutes into the movie I practically had to scrape my jaw off the floor. I was getting nearly every word, without straining. I even did some little tests switching between hearing-aid only (loud, noisy, english-as-a-foreign-language), CI only (great!), and both (slightly better!!). My best guess is that I caught about 80% of the dialog, if not more. I never felt like I missed anything crucial. The special effects and music sounded good too. Even though the movie was disappointing I was pretty thrilled.
I was in the shower the other day, cleaning my ears, and I noticed a sound when I wiggled my wet finger in my implanted ear! What? More wiggling and sure enough I heard a deep sounding flutter in my left ear. So I seem to have a little residual low frequency hearing. I will have to run some tests on that in the near future.
I have a big project going on in our little (tiny) front yard. I started it many, many months ago and had to take about 2 months off because of my medical adventures. I am finally back to work on it! It feels really good to be physically active -- and sore in the morning -- again. The sound of a shovel digging into wet decomposed granite is just lovely, "Crrrruuuuuunchhhhhh!"
As a parting gift -- ponder this number: 134861.10
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