It was time for my one year annual review of my cochlear implant. I was so excited. I was so hungry for improvements in my hearing. I have been so delighted every time I heard a new sound, understood it, and passed another milestone. It had been 9 months since my last assessment, and I was hoping to come out with good results this time.
I saw my speech therapist and we talked about my new hearing in general. She took me to the soundproof booth and tested my hearing. Mid-way through testing, I had to ask her to shut both doors to the soundproof booth (there are two in one doorway) as I could hear people talking. It turned out that my hearing had, yet again, improved overall, with a dip at the high frequency end. The blue line shows my current hearing level compared to my hearing before I received my cochlear implant.
Then we carried out some speech perception tests;
1. City University of New York (CUNY) sentences which is a list of simple sentences such as ‘The dog bit the postman’. Guessing from context and rhythm, or top-down processing, means I can gain more marks. The first time I took this test, a year ago, I scored 40%. I took it again 3 months after activation, and scored 48%.
2. A much harder test, the monosyllabic consonant-nucleus-consonant (CNC) test which is a list of single words. There is no context so I can’t guess, although marks are given for getting bits of words right. My score on this test, after activation, was 33%.
I had to sit at a measured distance in front of a speaker and listen to a recorded voice at 70 dB. This time, I’d had 3 hours sleep the night before, I was numb with tiredness, and I was totally thrown by how loud and deep the speaker’s voice was. BOOM-BOOM-BOOM. Whoa. I almost fell off my chair.
This time, I was hugely disappointed to score 40% on listening to sentences and 33% on listening to phonemes, although I scored 98% on lipreading with sound. I had put sooo much rehabilitation work in over the past year and I felt so deflated. I felt as if I had gone back to square one. This cochlear implant thing sure is hard work.
I then met with my audiologist to have an adjustment made to my cochlear implant settings (often called a ‘mapping’).
Each electrode was tested for comfort. I heard tones ranging from very low to very high. The audiologist increased the volume of each tone (electrode) until I was comfortable with the level of loudness for each one.
Listen up ladies and gentlemen! The operative word here, the key word, is COMFORTABLE.
Not … ‘As loud as you can stand it’.
Not … ‘As loud as you would like it to be’.
Not … ‘Louder is better, just like the hearing aid’.
It turned out that my cochlear implant had been too loud – for a year! Waaay too loud. She gave me a new setting with the volume turned way down, and another setting with the volume a little louder, just in case I found the quietest setting too quiet. This makes me wonder about the efficacy of cochlear implant adjustments / mappings. I would like to see NRI (Neural Response Imaging) used more, or a better way of testing comfort and maximum threshold levels. I find it very difficult to tell the difference between loud and louder.
Myles de Bastion wrote an excellent essay explaining the problems with Bamford-Kowal-Bench testing for cochlear implant candidacy.
The balance of the frequencies on my cochlear implant was also adjusted, so the lower frequencies are now boosted and the higher frequencies are now lowered quite a lot. I can happily listen to crinkly plastic bags and screaming children now. My audie used the Harmony listening check to test my T-mic (microphone) to ensure it was fully functioning and enabling me to hear as well as I could. That got the all-clear.
Onto my rehabilitation ….
I’ve been pushing the auditory verbal therapy as I feel this is the golden key that will unlock my mind to understanding what I’m hearing. I had popped in to see my audie for an adjustment a few weeks ago, and after that, I was able to tell the difference between the Ling sounds OO and EE. The Ling 6 sounds are the sounds that lie within the speech spectrum of hearing, and they are M, OO, AH, EE, SH, S. I had persuaded my speech therapist to give me some free auditory verbal therapy and a week after my annual review, she gave me an AVT session (this is my second AVT session) and tested me on my listening skills, reading 3 passages from ‘The Emperor’s New Clothes’. I scored 82.5%, 83%, and 85%. HOWZAT! Much, much better than in the soundproof booth with that godawful speaker!
I’m happy with my new volume setting. I’ve been cringing so much lately that my shoulders are around my ears and I’ve been ratty with the over stimulation or ‘sound hangover’, snapping at people when they clatter cutlery, unpack a bag, or just generally make too much noise for my liking. Nothing makes me cringe any more. I’m now listening to talking books every chance I get – at work (tee hee), when shopping, walking the dog – not just on my commute. I figure that if I push the speech just like I did with the music, it will drive the momentum forward and get me there quicker. My interpreter is reading to me daily from a children’s book, Billionaire Boy by David Walliams – it’s quite funny and a challenging listen, as I can’t guess as much as I would with a conventional story….
‘The carpets were made from mink fur, he and his dad drank orange squash from priceless antique medieval goblets, and for a while they had a butler called Otis who was also an orang-utan.’
I’ve also lined up more from David Walliams, The Boy in the Dress and Mr Stink, and more of Harry Potter has gone onto my poor iPod, which is working over time. Jacqueline, my auditory verbal therapist, recommended a book, Bounce by Matthew Syed, a three-time Commonwealth table-tennis champion. The book explains the rationale behind success, how the key to achieving greatness lies in hard work, the right attitude, and training. This book is now on my reading list.
I’m also taking part in a clinical study at my hospital, which is looking at factors affecting audio-perception with cochlear implants. The purpose of this study is to determine if cochlear implant sound processors can be adapted to improve speech perception. The team will make changes to my programme that are intended to improve pitch discrimination based on my discrimination ability and evaluate this with speech perception. I went in to do the first round of tests yesterday. They hooked me up to their computer and asked me to carry out a pitch discrimination task, listening to pairs of sounds – the same sounds used in mapping. I had to say which sound was higher in pitch. Each sound is a separate electrode on my implant being stimulated and this was done for all the electrodes, to work out which ones give the clearest pitch and if there are electrodes which sound the same. Then I was asked to do the same task again, but this time with volume, guessing which sounds are louder, softer, or the same. These tests were incredibly difficult. I scored 100% in some areas, and fairly badly in others. So the team have now set a baseline of my discrimination ability to work from, and will be able to evaluate how much benefit my auditory verbal therapy will give me. In July I will return for another set of tests and will be given a program on my processor to try out. So I’m really trying to push the boundaries of my brain’s ability to hear, to make this cochlear implant as successful as it can be for me.
And … now for the best news of all. I’ve been given all my birthday presents at once. My cochlear implant team informed me that I’ve been approved to go bilateral. As the HiRes 90k implant is now back in production and available in the UK, I’m in the queue and hope to get my second bionic ear this summer. Two ears, even if one is very new and not performing as well as the older implant, will give me better hearing overall due to the concept of synergy. So I will benefit from two ears fairly quickly, I won’t have to wait for a year or so to benefit from the newer one. With two good ears, I will be able to detect direction of sound, hear in noise, eliminate the head shadow effect, and hopefully do a pretty good fake of a hearing person.
I CAN’T WAIT, CAN’T WAIT, CAN’T WAIT!