17 ALMOST ONE YEAR GONE

I didn't want to keep blogging when there was little new to say which is why there has been quite a gap since my last blog. However, it's almost a year since I was switched on so I thought I'd give an update.

I've completely given up using an hearing aid in my left ear. That ear is now beyond help with hearing aids and although there is till some residual hearing left it is too distorted for me to cope with speech using an aid and without it there is very little sound at all.  However the cochlear implant more than makes up for this and I'm now totally dependent on it. So every morning I switch on, attach it to my head and ease the processor behind my ear and then from total silence crystal clear sound awaits. I've mentioned before the circumstances when I still find things less than perfect but I think that many people my age would find some difficulty in the same situation.  Yesterday I attended a large meeting of around fifty people. I switched the processor to the Super Zoom mode and even those from twenty feet away were clear. And then the person sitting beside me stood up to speak and as he did so turned away from me and became too quiet for me to hear. I can now listen to Radio 4 easily and also use my iPhone without too much anxiety. I also find myself able to engage in casual conversations with people when previously I would have avoided that situation. All told I regard myself as having normal hearing. Originally sounds were shrill and mechanical in nature but now they are much more natural.  I can even enjoy regional accents. My own voice sounds a bit harsh but that's not a problem.  The implant is designed to improve speech so music was never a priority. However I do enjoy music, especially familiar music when I can remember the tunes. There's no bass though and I have difficulty in picking out the melodies but perhaps that will improve as everything else has done.

So I continue to be a a very contented and grateful recipient of a cochlear implant.  Thank you Advanced Bionics for the Naida Q70 electronics and thank you to Mr Robinson my surgeon and all the superb people on the West of England Cochlear Implant team at Bristol.

16. Mapping and assessment.

I’ve just returned from the audiology department at Bristol.  This session was with Sarah the senior audiologist and was for checking progress as well as  mapping the processor. As usual we began with a sound check where Sarah turned up the volume for each frequency to a point where I thought it loud but comfortable. She then created and installed four programmes.

Programme 1 is the default programme, which uses two microphones, one on top of the processor and the T mic, which sits near the ear canal. Clear Voice was also switched on.

Programme 2 is similar to programme one but with the T mic only which allows me to focus the sound from my mobile phone onto that microphone exclusively.

Programme 3 Uses Clear voice but with Super Zoom.  Here the processor picks up sound directly in front of me so I can turn towards a speaker to hear more effectively.

Programme 4 is a Telecoil programme for use with loop systems where it is available.

 I will need to experiment with the programmes over the next six weeks but what about progress so far?

I was presented with a TV screen from which the totally impassive face of a man spoke sentences on a stated topic. I was asked to repeat the sentence.  Then he spoke without the topic prompt and finally the image was removed and it was sound only. The results?  Well you may recall I am a good lip reader so my score on the visible man was good just as it was during those initial tests. But during those initial tests I scored zero when it was sound only.  Today, on that test, I recorded a score of 77%, which is a massive improvement. There were smiles all round not least from Marjorie, my wife and Sarah who said that I was bang on target.  Next I was presented with a variety of sounds and asked to identify them. The final test was the traditional press the button when you hear the sound test but using only the implant. Prior to the implant my score for my right ear was zilch, well into the profoundly deaf area with over 90db of hearing loss but today the hearing loss was around 40bd, a massive improvement.

So I’ve returned home with a few things to play with and the proof of what I knew already, that the implant has restored significant hearing to my defunct right ear.  That formal assessment is great news and, I am told, there is scope for further progress.  So where am I now from a personal point of view?

I often use only the implant for whole days and manage quite well. When I do use my hearing aid I turn it down so that it provides a background sound only and the implant picks up the details.  There is no doubt, in my mind, which produces the better result. After a temporary battery failure left me with the hearing aid only I couldn’t believe how I managed before.  There are issues of course.  Background noise and distracting sounds make it difficult to hear without intense concentration but when my wife whispered to avoid waking grandchildren, in the absence of no other sounds, I heard her clearly.  The shrill voices of Annie and George my grandchildren come over much better and I feel that they are a bit more confident that I will hear them so our conversations are longer. If I use earphones with my iPhone I can hear Radio 4 in my implanted ear very well in most cases and quite often I can hear the spoken word directly from the phone. I can hear my mobile phone quite well but after years of not using the phone I’m a bit short of contacts. The only downside I can think of is the effect on my sense of taste, which still persists. All told, seven weeks after switch on, I’m a very happy man.

15. Back to work.

The rain has passed and on a bright but chilly morning I was off to join one of the Cotswold Voluntary Wardens work parties I mentioned in my last blog. I really enjoy being a Warden and not only because of the activities or the satisfaction of helping maintain our rural landscape but also because of the excellent company of fellow wardens. I haven’t missed the fact that my deafness doesn’t seem to bother anyone and that people do keep an eye out for me and don’t seem to mind repeating a few things when I ask.  The fact that I turned up mistakenly thinking I was going on a postponed activity was down to daftness not deafness on my part. The task involved coppicing and bonfires on Crickley Hill for the National Trust, an activity that I’ve done many times before but not with a transmitter on the side of my head.  The hard hat was the first problem because the headband of the hat passed right over the transmitter and the internal receiver making it unusable.  Still, there was always the fire to tend where a hard hat was not essential.   Later I tried a brush cutting hard hat, which had a large adjusting knob at the back, which allowed the headband to expand and contract easily.  With a beanie to cover the electronics I could expand the headband so that it went over my head without knocking the transmitter off and then tighten it until it was secure.  Problem solved!

I felt more confident talking to others and although the shrillness has diminished a little I still have to tell myself to concentrate on the chipmunks!  Lunchtime banter provided me with snippets of conversation, which had been beyond me previously, but I realise that I’m some distance from being able to comfortably engage and eavesdrop in that situation. However, talking in smallish groups was better than before.  The wind doesn’t help either as it whistles across the microphone so I’m going to look out for a furry cover like those used by sound recordists.

14. First Mapping Session.

First mapping session.

After ten days I returned to Bristol for the first mapping session.  It would have been a week but the Christmas festivities intervened.  I shared all of my observations with the audiologist and she told me that they were common experiences and that there was no reason for concern.  The loudness of the implant had reduced which was normal but adjustable.  So, wired up to the computer, I was presented with the sounds produced by the sixteen electrodes in the cochlear array and each one was turned up to the point that it was loud but comfortable.  It was good to see that all of the electrodes were working and amazing to hear those very high frequencies, which I feel I have never been able to hear at any time before.  The volume on all of the frequencies was similar which interested me because my hearing aid was set to boost high frequencies most.  The audiologist then saved the new settings as the default programme in the processor.  A second programme was also created with a further boost to volume should I need it.  I had no difficulty in hearing the audiologist; she came over loud and clear yet my wife told me on departure that she had spoken softly throughout.  Constant deterioration of natural hearing is unavoidable and inevitable but, I am reassured, the implant should remain stable without deterioration.  This is one of he reasons why I wanted the operation. So I returned home with a renewed hearing experience.  I tried the TV news without subtitles and got most of it but will still use the subtitles for a while yet. 

Today is New Year’s Day and it is pouring with rain. I’ve not mentioned this before but I am a Cotswolds Voluntary Warden and in that capacity I join my fellow wardens in keeping our beautiful part of the world in good order.  I’ve helped clear paths, installed bridges, stiles and gates and I look after a section of the Cotswold Way which runs through Crickley Hill overlooking Cheltenham.  But on this rainy day I’ve been one of four leaders guiding a walk for the general public.  I appreciated the interest shown by my colleagues this morning, which is the first time we’ve met since the switch on.  It will be interesting to re-join the work parties after the holiday to see if I can pick up more of the banter.  As I waited in the car for the intrepid walkers to arrive I tuned into Radio 4 and was able to enjoy a discussion about pantomimes.

13. A Few Days Later.

I’ve spent a lot of time just using the CI with no hearing aid. With background noise it is difficult but without things are not too bad. I’m beginning to feel that my own voice is less shrill especially when I speak quietly and that’s true for my wife’s voice also.  However there is a lack of consistency and at times the chipmunks are out again.  When I use my hearing aid I obviously hear sounds in both ears but there is a huge difference between the two.  Because the hearing aid produces a more natural sound, even if it is distorted to some extent my brain tends to focus on that sound.  I have to force myself to listen to the shrill, squeaky sound in my CI ear where voices are actually clearer.  I’ve tried turning down the hearing aid and that seems to help.  When I use the CI alone it can be difficult to determine where sound is coming from in part because all sounds are similar. Is it my wife or the TV? If my ability to distinguish different sounds improves then that should assist in direction finding.

I used to be an avid listener of the radio so I’ve been experimenting to see if I can return to all those wonderful programmes on Radio 4.  There’s a brilliant BBC app, which provides all the stations including Radio 4 so I’ve tuned in on my iphone. It’s early days but I was able to hear some of the content especially where there is a single speaker talking on a given theme. The comedy shows are a bit beyond me at the moment but one day, who knows.  As I write this I have music in my implant ear courtesy of my wife. I can just about hear the lyrics but disappointingly the music sounds very flat so my ability to hear pitch is still not there.

The processor rests on the top of my ear and the only physical attachment to me is the magnetic link to the internal receiver. It is very light and I am unaware of its physical presence. So I worry that it will drop off or I will catch it on some object, which will dislodge it. As the audiologist said, I should soon know it was gone by the lack of sound. However, yesterday the rechargeable battery ran out and I did not have a replacement with me. I was leaving my daughter’s house and five minutes from home so simply left the processor in place thinking it was safe there.  As I put on my coat I must have knocked the processor off my head but was totally unaware of this until my wife noticed it at my feet. I’m going to ask for the magnet to be strengthened and will have to come up with some strategies to protect this expensive piece of kit.

12. Switch on Day

Switch on day.

 I was advised that when the processor is first switched on the results can be disappointing and not to expect too much on the first day. There is a lot of sense in that advice which will be obvious later but first something which was astounding.

Sarah, the audiologist activated the external processor and then placed it on my ear locating the transmitter magnetically over the internal receiver. My hearing aid was removed. She then activated the device by sending sounds at various frequencies to adjust the volume.  It started with mid-range frequencies and went up to sounds so high I can’t recall ever having heard them before.  It was then that the processor was switched on to its’ normal mode and in my right ear, which had been dead to almost all sound, I could hear Sarah’s voice. That was astounding!  

However there was a huge mismatch between what I could see and what I could hear because if I say the very pleasant Sarah sounded like a chipmunk I would be understating the case. In an odd way I felt I could hear her better if I closed my eyes and concentrated on the sound alone.  When I spoke I sounded just like Sarah except louder and oddly my voice seemed to have a delay in it.  I was invited to take a walk outside to see what I could make of the world so off I went making a first stop at the toilet where the sound of running water was all too apparent and stunning in the high frequency detail. The nearby pelican crossing beeped out an invitation to walk loud and clear and I was now asking my wife to walk on my right where the microphone could pick up her voice better.  I couldn’t hear the car engine but all the switches happily clicked and clattered.  All this with just the cochlear implant.  But now I’m at home and realising that there will be a lot of adjusting to do. TV is not clear and small clashes and bangs are disproportionately loud. I need my hearing aid to provide the lower frequencies and get a more natural sound. I return for further adjustments in a week and in the meanwhile will use the implant as much as I can, some of the time exclusively. So, it’s not really been a disappointing day but one of great promise.  The fact that this electronic device can send signals directly to my auditory nerve, which can then be recognised as a person’s voice is truly astounding.

It’s not yet twenty-four hours since the turn on and my new hearing fascinates me. What seems to me to be happening is that the CI processor converts all sounds to a much higher frequency, which is why people sound like chipmunks. The lack of high frequency sound is a major factor in deafness so it’s understandable that the focus is on rectifying that situation.  But the new sound is far from natural, being very synthetic as if generated by a computerised voice synthesiser.  It requires a lot of concentration to mentally focus on the new sounds, partly because they also sound detached and distanced but when you do there is clarity.  I started the day using the CI only and managed to say good morning to my wife and return from the kitchen with a cup of tea.  I’ve woken to a completely artificial world of sound and it is quite unnerving. Putting in my hearing aid brings back natural sounds and its clear that I will need to use both for a while.