I am delighted to welcome a guest blogger this week – Peter Stelmacovich, the FM and SoundField Product Manager for Phonak Canada. Peter is a late-deafened audiologist and a CI user whose expertise and advocacy have supported people across the continent (and probably around the world). He is also a fellow Canadian, as well as my colleague at the Canadian Hearing Report where he writes a column called – what else? – The Deafened Audiologist. Read Peter’s personal and professional opinions on some issues frequently faced by CI users.
By Peter Stelmacovich
It has been about seven years since I received my Cochlear Implant (CI). As a late-deafened adult and an audiologist, I frequently get asked many questions such as:
What does the Cochlear Implant sound like? How does it compare to a hearing aid?
What does music sound like through a CI?
Why do you wear a hearing aid on the other side?
What can an FM system do for a CI user?
Right now, the Cochlear Implant sounds fairly “normal” to me, but it did not start out this way. When I was first hooked up to the external components, the CI sounded only like beeps and chirps. The best analogy would be that it was like listening to R2D2 from Star Wars. I was completely unprepared for this. I had watched some videos sent to me from various Cochlear Implant manufacturers, some of which had CI recipients describing how they “heard their granddaughter” on the first day. Turns out that being able to understand speech on the first day of CI use is the exception and not the norm. Kudos need to be given to Suzanne Stewart and the Cochlear Implant Team at Sunnybrook Hospital for working very hard at keep my expectations realistic.
Following a week or two of R2D- like sounds, the CI began to sound like Sammy the Snake hissing words into my head. Still unpleasant, but it was starting to sound like actual words. This was encouraging.
Over the next six to eight weeks, the sound continued to improve. Words were starting to emerge, although they all still sounded very cartoon-like. For a while, it sounded like Alvin from the Chipmunks had inhaled a helium balloon, then later like Alvin had ditched the helium. I began to feel more at ease as I could clearly see that we were on the right track. I even found it in me to laugh at the weird way things sounded. I recall listening to Elton John’s classic “Your Song” and wondering when Elton turned into Daffy Duck.
Running parallel to improvements in sound quality were improvements in word identification. This was also very encouraging. About six months’ post-implantation, I felt I had received my money’s worth for going through with this. I was clearly hearing and communicating better than I did prior to implantation.
Two areas remained problematic: music perception and hearing in noise.
I was trying, as much as I could, not to use the hearing aid in my non-implanted ear. However, when I listened to music with just my CI, it sounded tinny. Furthermore, I’m a bass guitar player, and the instrument sounded completely wrong. Every low-pitched note sounded almost the same.
To resolve this, I reprogrammed my hearing aid to pick up low pitches only. I have little, if any, high-pitched hearing left in my non-implanted ear. Even the low-pitched hearing is not great: 90 dB at 250, dropping down to 120 dB at 1500 Hz. It’s practically a left corner audiogram. When I listen to sounds with just a hearing aid, everything sounds really bad, including music. Yet when I combine this little bit of acoustic hearing from the hearing aid with the electrical stimulation from the CI, I get what I like to call Gestalt Hearing in which the whole is greater than the sum of the parts.
Thus a hearing aid in a non-implanted ear provides additional low-frequency cues that significantly enhance music perception. It turns out I am not alone. A study by El Fata et al. (Audiol Neurootol 2009;14 Suppl 1:14-21. Epub 2009 April 22) looked at 14 adults who continued to use a hearing aid in the non-implanted ear after getting a CI. Subjects were given a music perception task in three conditions: CI only, HA only, and Bimodally CI + HA. Subjects with sufficient low-frequency hearing did better in the Bimodal condition. Another study by Gfeller et al. in 2007 (Ear & Hearing: June 2007 – Volume 28 – Issue 3 – pp 412-423) compared CI users with electrical-only stimulation compared to hybrid CI users, who get both electrical stimulation for the high frequencies and acoustic stimulation for the low pitches. The hybrid CI users clearly outperformed the traditional CI users on pitch-perception tasks. Note that not everyone has sufficient low-frequency hearing for a hybrid implant, so this is not an option available to all.
The hearing-in-noise issue was more easily addressed. All the CI companies seem to claim good hearing in noise with their respective devices. However, the studies clearly show that using an FM with a CI significantly improves speech understanding in noise. Jace Wolfe at Hearts for Hearing in Oklahoma has done some great work demonstrating this. I very quickly added FM to both my CI and HA and have been enjoying the many benefits from combining these three technologies.
These benefits include:
1. Improved speech understanding in noisy restaurants, bars and cafes.
2. Improved speech understanding on trains, automobiles and other forms of transportation.
3. Listening to music with an iPod. Note the FM system sends a wireless signal to both the CI and the HA.
4. Wireless monitoring for live music when playing bass in my band.
5. Better understanding of coaching during archery, kayaking, skiing and other sports lessons.
6. Better understanding in meetings.
7. Better understanding of tour guides in art galleries and museums.
8. Connecting to laptop computer for Internet-based learning and meetings.
9. Connectivity to mobile phone.
10. Better enjoyment of television.