this one's for Sherwood

First things first:  I had my three-month post activation (second CI) check today.  This involves a 90-minute appointment with my audiologist and a battery of hearing tests in addition to the usual mapping of my processors.

The results of the hearing test were great - and a good reminder to me that even though it's probably good for me to keep on moving the goalposts - to increase my own expectations - that the progress made so far is (according to my audiologist) better than average CI recipient results, and in comparison to what I was hearing this time last year, an order of magnitude better.

And that's the main thing.  Will I ever be able to hear what people with normal hearing do?  Probably not.  But the improvement over what I was hearing (or more to the point, what I wasn't hearing) prior to implantation is astounding.  The fact that this is my new normal and I want more, more, more?  Well, that's okay, and I'll be working on it.  But it's already incredibly successful.

So:  the test is for speech - words and sentences - without context, which is harder than hearing people in real life, where there generally is context.

Prior to implantation, with two hearing aids:          19% comprehension

Three months after right side implanted:               89% with CI only
                                                                          92% with CI and HA

Three months after left side implanted:                 87% with right CI only
(today!)                                                              84% with left CI only
                                                                          93% with both CIs

You can see that my score on the first CI went down a little bit.  That's because I've been focusing my efforts on the newer one, and once I get past the initial phase of rehab (I have just a bit of high frequency tinniness when I listen with my left CI) then I'll probably do some rehab on each of them individually to get the right one back up to speed, but then will be able to work on them together.

According to my audiologist, the average level of comprehension for CI recipients is between 60% - 70%, so you can see this is really good.  Seriously?  It's great.  The impact on my ability to function at work and in general is worlds better.  

Fifty years ago someone like me wouldn't be employable.  The impact of these devices really can't be understated.

So after my last post I was asked if I took requests.  An inquiring mind among my friends wants to know what CI rehab consists of, and I'm more than glad to describe it - at least, I can describe what I've done.  Others differ.

Mostly it's just using the thing.  After I had my first CI activated, I used the hearing aid in my left ear for two or three weeks and then just abandoned it as not bringing much to the table.  At that point everything I listened to became rehab - because part of this is just listening.  Listening to family members, listening to coworkers.  

CI rehab is all about training the brain so that it learns how to process sounds that the auditory nerve receives as electronic impulses rather than as physical sound waves.  In my case, because I could hear at least fairly well for quite a lot of my life, I can wear my CI and listen to things that I know what they should sound like, and my brain makes the connection.

It's not at all like normal hearing.  For most people, the sound waves enter the ear and cause the eardrum to vibrate, which essentially repeats the sound and send it on to the ossicles, three little bones in the ear which in turn vibrate and send the sound wave on into the cochlea.  The cochlea is lined with cilia, or hair cells, which also vibrate and send the sound through the coils of the cochlea, which is surrounded by nerve endings that carry the sound to the auditory nerve and to the brain.

For people like me with sensorineural hearing loss, the hair cells in the cochlea are damaged, absent or just nonfunctional, so no matter how loud the sound is, it pretty much dies in the cochlea.

The implant bypasses all that.  It has microphones which hear the sound and pass it up a cable to the external magnet, through that to the internal magnet and then through the electronics in the implant and to the electrodes that were implanted in the cochlea.  I have eleven functional electrodes on the right (one apparently dangles outside the cochlea where there are no nerve endings, so no matter how much volume my audiologist sent, I didn't hear anything, so it's turned off.  On the left I have all twelve.  Each of them is assigned a range of frequencies, from low-pitched to high-pitched, and when we map the processors what we're doing is trying to get all the electrodes at more or less the same volume - from my own subjective point of view.  And from there we make adjustments based on what I hear.

After that, I have to teach my brain, as I mentioned above.  There are a number of things that help with this:

• aural rehab apps.  I have several on my phone but there's really just one that I found really helpful.  It offers several types of practice, and the exercises are individually focused on specific parts of speech.  Some will help the user learn to differentiate between consonants - n and m, for example, or p and t.  Some exercises focus on initial consonants and others on those at the end of words.  Some focus on vowel sounds.  Some let you practice with background noise.  This is all extremely helpful in the early stages of rehab, when the CI is sending your brain beeps and Mickey Mouse tones and all sorts of odd unintegrated sounds.  Right after activation, I spent hours and hours with my aural rehab apps, and it does help a lot.
• There's a point at which they're less productive, though.  Then I started doing things that were more like real life.  I watch videos with both the sound and the captioning, so I can tell my brain what the sounds mean (via captioning) and hear it at the same time.
• I also like audiobooks for that.  I can listen to an audiobook and read along with the actual book.  It slows me down considerably, but it does help with getting the brain to hear what it should.
• I listen to music.  Most music is far too complex for the early weeks after activation, but slowly it gets better and I'm optimistic that at some point it's going to sound good again.  Right now I can listen to some songs and they sound like what I remember (like "Centerfield" - hi, Lisa!) but many just don't, yet.  Orchestral music I haven't even tried yet, but I will.
• I listen to people.  I go to meetings, and talk to coworkers.  I talk to, and listen to, my husband.  I tell my cat to shut up.  I go to lunch with friends and we talk in background noise.

Slowly but surely it all gets better.  For me it's taking a bit longer than it might have because I decided to do the two sides separately, so that at six months, right when my first CI was starting to sound really good, I started all over with the second.  But over the coming months as they both start sounding good individually, and together - there's a thing the audiologists call summation, when they work together like a person's two ears do, and then, as you can see in my test results up top, the two of them together are better than either of them individually.  

That's already true for me, and if I keep on working both sides, I may be able to improve even from where I am.

But it's already such an improvement that I can hardly describe it.  This is truly amazing technology.