Imagine you were born with no legs. Years later, you are given an artificial leg. It works perfectly, but you have to learn how to walk with it. When you’ve never had a leg before, you’ll struggle to learn how to walk. You have spent a year learning how to walk with the first leg. It’s not perfect – but with a crutch, it is so much better than having no legs at all. Then you’re given a second leg. The first leg helps the second leg to learn the movements necessary for walking, so the newer leg learns at a much faster rate and helps to improve the ability of the first. Each leg helps each other. The combined input of two legs is greater than one leg alone. Two legs are much easier to walk with, requiring less effort and being less tiring than managing on just one leg.
So it is with bilateral cochlear implants.
My ability to understand speech has changed significantly in the four weeks since activation of my sequential cochlear implant. It’s been a very different experience from my first cochlear implant, with a very different outcome.
Within two weeks, voices shifted to a lower tone and Donald Duck left the house very quickly. He took eight months to leave last year! I reached full volume after three weeks. My tinnitus has disappeared from my newly implanted ear, buzzing in my first implanted ear only when I’m tired. I can detect environmental sounds but not always recognise them …. yesterday, I got confused between a crow and a reversing truck! I’ve been so busy since activation that I have not done very much specific rehabilitation work.
+ Summative effect
The learning curve of the sequential cochlear implant has been much quicker than the first, as my brain already knows cochlear implant sound. The older cochlear implant is helping the newer implant as it learns, and the newer implant is helping the older implant by giving it a boost with more sound. The summative effect has reduced the effort it takes for me to listen, and makes speech comprehension easier.
+ Localisation of sounds
Two weeks after activation, I was in a lift (elevator) exiting the underground, and it was packed full of people. A man was talking to his son in a loud voice, and I was able to detect where he was – behind me and to my left. HA HA – brilliant! That was the first time in my life I was able to localise a sound. Since then, I have enjoyed being able to work out whether sounds are coming from my left, right, or are in front of me. If a sound is coming from the side, it sounds louder on that side. If it is in front of me, it sounds the same in both ears. Recently, I went to a cafe and sat there nursing a coffee, listening to the sounds around me and working out where they were coming from. I got annoyed when two women sat near me as they had such loud voices – all very definitely in my right ear! The chef was definitely chucking pans around in my left ear – peaceful it wasn’t!
+ Speech in noise
I have noticed an improved ability to hear speech in noise. However, I’m still lipreading full time! It’s now easier to concentrate on a speaker in a noisy environment but this is still pretty difficult.
+ Head shadow effect
With one cochlear implant, I was unable to hear sounds on my opposing side as my head acted as a barrier. It was weird to have excellent hearing on one side and nothing on the other.
+ Binaural hearing
Unilateral hearing was such hard work. I could understand the odd few words here and there, but never enough to pull a string of sentences together. I feel that the past year has been such a struggle. It was worth it, but it’s been a struggle nonetheless. My remaining ear was very poor and deteriorated further over the last year. I felt as if I was about to fall over into the abyss, I was walking on a knife edge with white light on one side and darkness on the other, my world was so unbalanced. Now, everything feels right again. I say ‘again’, because I always wore hearing aids in both ears, even though my left aided ear didn’t help me at all, it just gave me a little bit of balance to my world. Wearing a hearing aid on my second ear made me feel ill, as the sound signals were so different, and competed against each other for attention. Having two good ears feels natural and although one cochlear implant on its own sounds flat and odd, the two together give me sound that is somehow ‘whole’. I am already ‘centering’ sound, it doesn’t feel like I am wearing two separate hearing devices. It feels like I am wearing one device somewhere in my head. Two implants make the world seem whole and solid, I feel as if I am ‘centred’ within my sound environment, and everything sounds much more natural. One cochlear implant on its own sounds wrong and skewed, whereas two together sound balanced and … just right. Whooo. I am just LOVING stereo sound!
I wondered whether the outcome would have been different, had I chosen to implant my better ear first. My audiologist says it wouldn’t have mattered. Hearing is a brain thing. Once the brain knows cochlear implant sound, the second implant is clued in much more quickly.
+ FM system
I tried an FM system last week. I had used one at school until my hearing deteriorated too much to hear with it. I remember it giving me a clear voice, directly into my ears. If the teacher forgot to take off the transmitter microphone and wandered to the other side of the school, I would clearly hear every word until I found her! Every September, I would hear unintelligible mush until suddenly one day I would wake up, my brain had ‘sorted it all out’ and I would understand every word for the rest of the academic year. The long summer holidays were always my downfall, and in September I would have to learn to hear all over again. With excitement, I charged up each piece, connected the system, and prepared to listen. Complete stone-dead silence. I checked all the pieces were switched on and set correctly. Still nothing. I thought my cochlear implant batteries must have died, so I switched them for a fully charged pair. Still nothing. I checked all the settings again. I plugged into my iPhone’s radio …. silence. I couldn’t understand it. I was getting really frustrated and starting to panic. Then I had a lightbulb moment. I switched the processors from one ear to the other, and hey presto! there was sound. I almost hit the ceiling with how loud it was, with the volume at the lowest setting possible.
Remember to wear the correct processor on each ear! I now colour code my (L)eft magnet with a b(L)ue cap.
+ Hearing test (October 2011)
A hearing test was carried out on my right cochlear implant only (red line), and then with both cochlear implants together (blue line). My audiogram proves that my hearing with two cochlear implants is better than with just one!
+ Speech comprehension scores
Speech was immediately easier to understand with two implants. On my way to my first mapping session after activation, two days after switch-on, I was listening to Stephen Fry talking on my iPod – using only the new ear. I didn’t have time to look for the correlating printed book so thought ‘Ahhhh I’ll just do without’. I was able to understand bits of sentences …. amazing. Just amazing. In the speech discrimination tests, I scored 85% with single words and 100% on sentences. I got most word pairs and discriminations right (e.g. nip/lip : distinguish which one is being said).
We compared the second implant at one month old against the first implant at one month old. In the testing booth I scored 19% in word and sentence tests, which was much better than my first implant which scored pretty much zero! We then tested my speech perception in a more realistic setting as my speech therapist read a story to me, The Emperor’s New Clothes. Last year, with one implant, I scored 83%. This year, with two implants, I scored 93% – against the background noise of road works in the street outside.
I’ve been having conversations with people I know well – ENTIRE conversations. !!! No lipreading! Both on Skype and in real life. It’s not easy and I don’t get every single word, but it’s certainly much easier with two implants. *screams in delight*
+ Music
I was tested on Cochlear’s Sound and Way Beyond software and scored 97% in music and melody perception on my new ear alone. Already, music sounds quite good, and I have only listened to around six hours of music since activation. Advanced Bionics don’t offer a binaural direct connect lead so I bought a splitter from an electronics store to enable me to listen to my iPod with both ears. (More on this in another post.) Bilateral music is just …….. awesome. *sobs*
The only hitch I’ve had is feeling as if sound was quieter and less complete with my new implant, in comparison to my older implant. We eventually realised the implants had different IDRs (Input Dynamic Range). The older implant is set at IDR 70 and the newer implant was set at IDR 60 – once the IDRs were set to the same level, the world sounded much better. I tried them both at IDR 60 for a few days, then both at IDR 70 for a few days, and couldn’t really tell the difference. Two implants are giving me so much more hearing that I am happy enough with a lower IDR – but I just decided to stick with IDR 70 for both. Both implants have IDR 80 for music. – I’m a sound junkie!
I’d recommend Arlene Romoff’s book, Listening Closely: A Journey to Bilateral Hearing. She offers a lot of great insights into what it’s like to have two cochlear implants. My cochlear implant team have seen very few bilateral adult recipients. The evidence of the benefits of going bilateral is thin on the ground in the UK, particularly for those who, like me, were born profoundly deaf.
Here is a comparison of my hearing before I started my cochlear implant journey, and now, with bilateral implants. Amazing, isn’t it?
Going bilateral has been absolutely incredible. It’s been better than I’ve dreamed and hoped. I didn’t even need all my mapping sessions as I progressed so fast. I’ve never been able to hear well with two ears nor benefited from bilateral hearing, but wearing two hearing aids all of my life, lots of rehabilitation work, Auditory Verbal Therapy sessions, and the cross-over training of the sequential implants have really set the scene for my success. If you’re thinking of going bilateral and you’re hesitating … don’t wait one second longer! Go for it and grab it with both hands! You’ll LOVE it!
*Crying buckets of happiness while doing the longest Snoopy dance ever*
I look so I can hear.... 
Wow that must have taken ages to write all that up!
By the way you don’t need to colour code your processors because they have been designed not to work with ears that haven’t been programmed. They have the software to make sure of this. I learnt loads at my recent test recently and did really well in SNR – that’s the toughest test!
Yeah after 4 years I’m still doing well – I was impressed! I never set high expectations but am always proud what I can hear with them and that I can talk to anybody on the phone these days – strangers, etc.
Elaine
That’s very encouraging Elaine, talking to anybody on the phone! I always say, aim for the stars, as you just might catch one. I haven’t had a SNR (signal-to-noise ratio) test yet… I wonder if they’ll ever give me one!
I like to colour-code as at least I don’t panic when I’m being a numpty and put them on the wrong ears and think the batteries have died on me!
Tina, Sam is going to come running over with his crying buckets! Your report sounds such a persuasive argument for bilateral hearing, and it’s only been one month! Just one month! Fantastic! I am so glad you are bilateral!!!!!!
PS I would like seeing your ‘starting’ line on your audiogram. It’s really very dramatic!
I’ve added a separate audiogram in the post to show this. It certainly is a dramatic improvement, not forgetting that hearing is measured on a logarithmic scale, and not mathematically! It’s a huge, huge increase, and potentially life-changing.
I was hoping to see three graphs, the starting line, the unilateral line and the bilateral line. The starting line is for drama, and the bilateral line would present an argument for bilateral hearing over the unilateral. I am so excited by your report!
The unilateral and bilateral are on the same graph! 🙂
oooooop!
Tina, your detailed description is absolutely brilliant!
I read and read and while reading, I think, “Well, maybe I should reconsider sequential hearing.”
Congratulations, Tina!
Now, you too, will be able, while watching the ballet La Sylphide, to hear the soft fluttering of the sylph’s wings as played by violins. I have never heard it before. When I could hear, I didn’t attend the ballet and when I couldn’t, my HA’s didn’t pick up such soft sounds. I was as enchanted as James, who fell in love with the sylph.
Wow…u’ve practically got me convinced to go bilateral. I just dont know if i have the courage to – i have been implanted in one ear for 12 yrs now…to go thru another operation and have processors sittin on BOTH ears… :-S Silly i know, so superficial compared to the benefits you have mentioned…and to be able to comprehend more speech – that is a dream!
*sigh* Maybe they will develop bilateral implants with just one processor sitting on one ear…here’s hoping! 😦
Thanks a lot for this…i’ll keep reading experiences with bilateral implants until one day i am fully convinced lol…
When I felt exactly like you when I had a simultaneous operation (my first implant failed and had a new implant in the other ear).
It’s great now to have processors on my ears cos at the time I trained my the new implanted ear with lots of auditory rehabilitation. It’ll never be the same but they work nicely together especially where my kids are concerned cos with being bilateral the sound from further afield reaches me whereas with a single implant it didn’t reach me and I can tell where sounds are coming from.
You’re welcome to read my blog as well if you like….http://elaineci2007.blogspot.com/2007/11/my-belated-switch-on-experiences-and_27.html
Its so good you have heard more and benefitted ore with 2 CI’s. And I love the way you have wrote this post. I can tell your heart has certainly gone into this post, and i am so happy to hear you are doing well.
We were born with 2 ears. So 2 CI’s must definitly work better than one too. You have proved that, and many more who have 2 as well.
Wow, you really put your heart into this post. I can feel your emotions through your words and I’m transported way beyond happiness for you!
Look at that audiogram, I really can’t imagine what’s it like to be up there in the chart! I’m proud of you!
😀
It’s LOUD, Rashed! 🙂
Then I definitely should try out my singing skills when you’re around! 😉
Me too! 😀
Tina, it isn’t fair to make me cry first thing in the morning at work!
While we have different hearing histories (I’m late-deafened) we are both sequential bilateral implant users. Your impressions are very close to mine, although you express them much more eloquently.
Have you tried comparing the loudness of each implant individually with that of the two together? When you use both, the loudness should seem to be more than you would expect. Audiologists call this the summation effect. It is a big part of the feeling of being immersed in the world.
Congratulations on being able to localize sounds – for the first time in your life! Although I was able to do that growing up, it took me several months to be able to do it with my implants. And the accuracy isn’t as with normal hearing.
Everybody else, if you are on the fence about getting a second implant, or more importantly, if you have decided against it, please do read Arlene’s book!
Congratulations, Tina. It is only going to get better from here.
Yes, thanks, Howard. I am not too enthusiastic, but after reading Tina’s account….
I had such a dreadful time with the anesthetic and the surgery for the ‘first’ CI. Not only did they shave half my hair off (no, I am not exaggerating), but I puked my guts out for three days while my body went into a tail spin requiring all sorts of inventions. I was dead tired and ‘a whiter shade of pale’. For months, I looked like Dracula’s wife and when the shaved off hair started growing in the other half got thinner and thinner. It looks great now, all grown in and full of gloss and life.
Nanna, have you had such a strong reaction to other surgeries? If I may be so forward, have you had other surgeries?
I’m glad that your hair is back to its usual elegant self.
Yes, Howard, I have had several other surgeries with full anesthesia. Except for one, I’ve done the hanging over the railing for a few hours, so I expected that, but it was nothing compared to the CI surgery. The subsequent interventions to stabilize my body were not painful just unpleasant.
Not until a few weeks later, did I discover that the anesthetic used was new and in a let-us-try-it-out stage.
I would still have had the sugery had I known about the pre-shave and the post-surgical effects, for I totally enjoy my CI ear and the lovely things I can hear, but when I think of going through it again, my courage falters. So sue me 🙂
It’s a strange thing, Howard. Each implant on its own is loud enough but together they seem to produce almost a different kind of sound, a little louder but much richer and fuller, and I can pick up more sounds. It’s really very difficult to explain, hence my legs analogy. Both implants work well on their own (but for me personally, not quite giving me enough to work with to understand speech easily) but together, they merge seamlessly and my brain really likes it. It’s a lot easier – sounds are just ‘there’ rather than all this business of straining to detect them.
I had the same thing happen when I purchased my first pair of BTE’s 30 years ago. The quality of the sound with both is different from the sound coming from either BTE alone. It is richer, infinitely more pleasant to hear. I always call it the difference between black-and- white and color. And the summation is 1 + 1 = 3!
@Howard: Part of what you’re experiencing with the altered binaural localization is a function of wide dynamic range compression (WDRC), and is present in digital hearing aids as well.
In the old days with analog non-compressing hearing aids (or ones that only had output stage compression (soft clipping) to limit maximum output SPL), localization was preserved. However, with WDRC, which by necessity CI’s have to compress >100dB of input SPL into less-than 20dB of electrical dynamic range between T & C levels [Actually, the compression for CI’s is much more complicated as the the IDR window is sliding around inside the 100+ dB SPL range, further complicating localization issues.]
What the hearing aid manufacturers have done is go to wireless communication between the instruments to dynamically coordinate the compression to maintain relative loudness balance between the output to both ears,preserving directionality. For example, the Widex Clear 440 Fusion instruments I wear update settings 21 times per second, with compression, speech spectral analysis for their Speech Enhancer which optimizes the response to the Articulation Index (Speech Intelligibility Index, SII), zoom mic directionality, and anti-feedback coordination. To read more about it, click here. (Also, bear in mind that when you see “wireless” hearing aids, that can also refer to Bluetooth A2DP or other similar streaming of an external audio source into the instruments, which is separate from ear-to-ear coordination.)
In a CI speech processor, there are two main parts to the puzzle: The front end, which is the analog input stage, the dynamic control of the directional mics, and noise reduction strategies; and the back end, where the speech and other audio signals are converted into a format suitable for electrical stimulation. One of the reasons that AB was such an attractive purchase by Sonova (Phonak) is that as great as the back end and stim software is for the Harmony, the front end is as terrible, with the only saving grace the T-mic. We already know Phonak engineers are looking to graft the wireless SPICE DSP platform onto a speech processor, which will vastly improve the product. [As a side note, although the Nucleus 5 has a much better front end than the Harmony, we all know how lousy their back end is, due to the severe limitations of the CI512 implant circuitry and it’s inability to deliver current steering; which is why I don’t recommend the N5 system.]
In summary, once inter-ear coordination features are integrated into the front end of CI speech processors, binaural localization and all of the benefits it brings will accrue.
Dan Schwartz,
Editor, The Hearing Blog
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Related links on the Widex inter-ear technology:
Wireless technology
Speech Enhancer
Digital Pinna
3D Trusound
Dan, differences between hearing instruments aside, I thought that most people with hearing loss (and reduced dynamic range) also have a decreased ability to localize sounds.
Fellow Engineer Howard Samuels wrote,
It depends on where the hearing loss is in the frequency spectrum, how severe it is, and how the hearing aids compensate for it. Binaural localization occurs in the low frequencies (long wavelengths) by analysis of the phase difference; while in the higher frequencies it occurs via time delay, augmented by amplitude differences caused by single-slit diffraction around the head, the so-called “head shadow effect.”
Once CI processors start coordinating inputs & outputs on both sides, users will go from “bilateral” to true binaural… And the effects will be much greater than what Tina and Arlene have described.
[As a side note, I’m disappointed that all three major CI manufacturers have not implemented a binaural body-worn processor, which would be a quick workaround to any kind of wireless inter-ear processor communications. Too bad Mike Marzalek only has one CI: He could home-brew the appropriate processor!]
Dan Schwartz,
Editor, The Hearing Blog
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I am reconsidering sequential as well after reading this. 🙂 I hope that the insurance is still in network when AB gets back on the market.
Xantha, AB is available globally now!
Tina, Thanks for writing this! It’s a wonderful and exciting thing to read. Like Howard I woke up and went on HJ to read the updates and saw your link to this and wanted to catch up on how bilateral hearing was treating you! Good stuff!
Deb
Tina, this post can be a tremendous help for anybody who would like a second implant, but doesn’t have coverage by an insurance company or national health care system. Thank you for sharing your experiences, and at the same time, potentially helping lots of people get a second implant.
Hi Tina,
I love this update – both your obvious delight in your new hearing and the way you describe it. Great stuff – and onwards and upwards! I’m really looking forward to seeing where you go next with your implants.
Thank you for your wonderful Blog. I have had hearing loss most of my life, but have gone from moderate to profound in the last ten years. My doctor told me last Thursday that I am a candidate for 2 cochlear implants. He said that I must be a strong lip reader to have made it this long. Losing the ability to use the phone is what made me go in. I cannot do 2 at one time, because I have 2 young kids that I have to hear. The 2/3 week waiting period for activation would do me in. Now, I have the decision of which manufacturer to go with. Is there a good blog to hear pros and cons for the different cochlear? I am hoping to have a wonderful experience like you! 2 implants does make sense, I have always worn 2 hearing aids.
Hi Karen
You have so much to look forward to! I actually put my research on this page https://funnyoldlife.wordpress.com/cochlear-implants/ – just scroll down to ‘Choosing a brand’. I will be updating this section soon so check back!
@Karen: Since you were offered simultaneous implants, can I assume you’re here in the US?
In any case, several important things:
1) Go to Tinas’ blog entry on CHOOSING A BRAND — It is the most comprehensive guide available;
2) Your choice of CI center is vitally important, as they vary widely in quality of both surgeons (the “hardware”) and follow-up services (the “software”). E-mail me at Dan@Snip.Net with the city you’re in-near & I’ll find out who is good — and not-so-good — for your area;
3) If you go with Advanced Bionics, make sure you get the HiRes 90k Helix implant, which has a perimodiolar electrode placement, and not the older HiRes 90k 1j version, which has a lateral placement: This will give you a cleaner, clearer stim and also use lesspower;
4) Simultaneous may not be so bad if your surgeon is decent in preserving residual hearing (at least for the first couple months), so you can still hear your kids before your CI’s go hot. Alternately, you can ask that you be switched on sooner, at 3-5 days;
5) Whether you go simultaneous or not, alwaysapply to your insurance carrier for two CI’s: Most likely, they will come back and offer you one, and you’ll have to appeal to get the second one anyway — You can take the approval for the one and get it now, while fighting for the second one… And if you get lucky and be approved for two, you can postpone the second one if you so choose. However, if you apply for just one, most likely you’ll be turned down at first, and you’ll have to appeal to get even that one;
6) Please read Auditory Therapy: The Missing Ingredient in The Hearing Blog… And be sure to order the Hear and Now DVD, for the reasons I state in the article.
Good luck!
Dan Schwartz,
Editor, The Hearing Blog
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That’s great! wish u all the best..I’m learning a lot from you, love your blog and keep it up! God bless u 🙂
Congrats Tina . I am so so happy for you.
@Dan we need to clarify the Helix array vs the 1J because there’s a lot of misunderstanding and inaccuracies.
AB claim that most surgeons prefer the 1j as it’s easier to implant and they say its SOP to have the1j available when the surgeon is attempting a helix implant as a back up. My AB territory don’t stock the helix – it has to be special ordered.
If you maintain the Helix is superior to the 1j (and I believe it does reach deeper into the cochlea and stims the low freq? am I right?) but in the wrong hands (ie inexperienced ) the helix will do more damage?
Where can we get the facts?
Great post Tina. Very encouraging results going bilateral. I am curious. Did you wear a hearing aid prior to the second implant?
Thank you Peter. I tried the hearing aid after activation and it just confused my brain. I preferred to concentrate on improving the good hearing with the CI than to give my brain mixed signals to cope with.
Peter,
I have a 1J electrode and my hearing is so good that the researchers at AB have to double the noise ratios in HINT tests for me, otherwise there is a “ceiling effect” with the test scores. My test scores are in the top 10% of CI users world wide. I had no hearing at all for 31 years (did not use a hearing aid all that time) before getting the CI.
My impression on the electrodes is that it’s a surgeons call on which to use. I can definitely recommend the 1J electrode. I am sure the Helix is also a great electrode, but if your surgeon is more familiar and comfortable with the 1J, and has more experience with it, I guarantee the 1J will give you access to next generation software programs.
I am one of the “in-house” testers at AB in Valencia, California. I was one of the first to try HiRes and F120, one of the first to try ClearVoice and I am one of the first to try “something else that is coming”…and all with the 1J electrode.
I would stick with professional opinion on this and not worry about it too much.
Just my two cents!
Deb
Thank You Deb. Great information and so glad that you are doing so well. The only thing is that some of us actually can choose a surgeon based on surgeons experience and some of us are not limited to use our closest implant center where the surgeon one sees gets to make the call. I am just exploring the technical merits and differences of the two electrodes in sofar as one might possibly benefit me better over the other and I would go with whichever surgeon had the most experience with the electrode I wanted–not what the surgeon wanted. From what I can see so far is that many people have one of each (if they are bilateral) or have one or the other. In most cases I have read, the differences to the recipients are inconsequential but in some they are noticable. ie someone might report that one of the electrodes sounds “bassier” than the other but they won’t be able to tell which one it is. The only selection criteria I have seen is “the surgeons perogative” and while this might be applicable for certain anatomical structures and the ease of insertion…there has to be more to the issue as there are a couple of studies out there showing differences in performance. At the risk of sounding like a nit picker, it’s not easy weighing the pros and cons but no surgeon so far can do it for me.
Cochlear implants are pretty amazing, one thing worth noting is that you are not able to enter an MRI scanner once you have had one of these implants.
Mia, that is not true: In fact, both AB and Cochlear have removable magnets; and even if the magnets are left in place, Dr John Niparko published this clinical trial late last year on using compression bandages to hold the implant in place while performing 1.5T scans. [But then,, if you came to his annual “Ask The Doctor” workshop at the HLAA Convention, you’d know this!]
By the way, Dr Niparko at Johns Hopkins in Baltimore is one of the top 3 CI surgeons in the world; and I know a number of people (including my former girlfriend) who were implanted by him.
Dan Schwartz,
Editor, The Hearing Blog
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[…] certainly noticed a difference when I went bilateral. With my second cochlear implant, my speech perception improved by 20% and I found listening […]
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