With only a day for the audio connection, I wait obviously excited to get the sound on the new CI’s on Thursday, November 3rd. It will be interesting – not least to get hearing to my hitherto deaf right ear. It will probably be a very special experience!
But otherwise the most exciting about the audio connection, is how much I will be able to hear and how it will sound, and how much talk I will be able to understand from the start. It is very different from person to person how much you can hear and how the connection is experienced. Someone hears only the sounds and find it difficult to get a consistency of sounds, while others are able to understand speech from the start. I expect however that I have the advantage that I after all have had some hearing, and has had a good discernment, which will hopefully make connection easier for me. It is generally said that if person has been totally deaf for a long time before the surgery, you need more time to learn the subtleties.
There are many Youtube videos with people who get connected to sound for the first time. Some of them are a bit dull, but are good because they show in some detail how the connection is progressing. Other video clips are obese because people really view the feelings associated with suddenly being able to hear more than they ever did before.
But I will talk about the audio connection in a later blog post. Here I turn to tell a little more about the background to the selection of equipment I will have tomorrow, and that I very briefly told about in the blog post “The third feasibility study in Odense”.
A significant part of a CI process is that you must decide which CI manufacturer you want to get an implant from. This is a difficult decision, since this is also a decision for life – it requires a second surgery if to switch manufacturer – so you don’t do that. There are three manufacturers to choose between:
Generally, most CI users are happy with their choice regardless of which manufacturer they chose. You can not get a definite answer on what manufacturer that is exactly right. peoples personal sound histories, that is how well they were able to hear before, also come into play. The hospitals will be neutral, and they can not just suggest which manufacturer you choose. Thus, one has to explore solutions yourself from the three manufacturers, and familiarize themselves with the differences there are when you make that choice.
I have chosen Cochlear’s Nucleus processor. There are several things that were decisive for my choice that I will here tell you about.
To help choose CI and CI equipment is to read other users experiences. Here I have read several blogs on the web – including this, that has been a really great read for me: Sound – A journey to Cochlear Implants. But also the Danish CI-corporation, which has a website at www.cochlearimplant.dk and a Facebook group has been a help to choose.
I first read about the solutions at the manufacturer’s websites, but since all the producers obviously trying to get their solution to emerge as the best, so you also have to use other sources. This includes a comparison schematic where some users have collected facts from the three manufacturers, so you can see the actual specifications side by side. Comparison sheet is admittedly aimed at parents with children, but since it is the same equipment, I could still use it – and used it a lot to figure out the differences. Comparison worksheet can be found here:
http://www.cochlearimplantcomparison.com/comparisonchart
One of the things I’ve been very unsure of was how simple the sound will be with CI, compared to a hearing aid – especially in relation to music listening.
A CI would replace the natural way to hear sound with an electronic device that communicates directly to the auditory nerve. Specifically, you insert a wire into the cochlea, which sends electrical impulses directly into the nerve from a plurality of electrodes. One can very roughly say that each electrode corresponds to a particular tone. The length of this wire is not particularly long, and therefore, it is limited how many electrodes may be on the cable itself. Therefore, it is necessary to do so that each electrode is about to send out a certain number of frequencies in the sound spectrum. They thus share the sound image up into chunks, where the notes of a piece is to be played through a given electrode also called “channel”. Most CI solutions today have somewhere between 16 and 24 electrodes.
It is nicely hard to imagine hearing the sound through as few divisions of the sound!
I realized, however, that it probably is not as bad as I did it, when I was searching for specifications on the Phonak Naída hearing aid I last used. It was found that depending on the particular variant, this device has 16 or 20 channels. Thus, it dawned on me that if this device could give me the good music experience I know, so it can hardly be quite uncomfortable with the Cochlear CI’s 22 channels. Or said in another way, I think now that the CI actually is a hearing instrument with electronic output directly to the auditory nerve, instead of hearing aid’s “speaker” into the ear.
The two manufacturers Advanced Bionics (AB) and Cochlear, was like my choice came to stand between. Here I think it may be an advantage to have Cochlear’s 22 rather than AB’s 16 electrodes, since the inner part can not be changed after surgery. AB implant may indeed energize the two electrodes, and thus use this to physical stimulation to the auditory nerve frame between the two electrodes. This should provide 120 virtual audio channels instead of only 16. Although the information has been harder to find, I believe that Cochlear’s implant also to some extent are able to mix between the individual electrodes. So I think there are several factors that come into play, and that it is more about the processor technology is able to process sound in a sensible manner. Therefore, I believe in a development potential of Cochlear’s processors, which is the interchangeable outer part.
One of these other factors is what the auditory nerve is capable at all. There I find the following quote very likely – it is taken from a Cochlear-employee blog comments to the author of this blog, I found on the net. According to him, there are limits to how many impulses can be transmitted to the head:
”… did you realize that the speed limitation is not with the technology but with the hearing nerve itself. Once the nerve fires, there is a recovery period before that area of the nerve can fire again, so even if you stimulate a million times a second, the nerve won’t send information to the brain at that rate. Cochlear has done extensive research to maximize the correlation of electrode pulse to the nerves ability to send information. If you like fast cars, a good analogy would be having a super fast Ferrari in a stand still traffic jam. The other cars limit the speed of how fast your Ferrari can go. In fact, a bicycle will actually get you where you need to go faster and more efficiently than the Ferrari. You are right that technology is important, but remember if that technology doesn’t accurately match the need then it isn’t going to be as helpful. In Cochlear implants the need is hearing performance and Cochlear has proven that people will have equal or better hearing performance as every other company…not only that, they can do so using significantly less power. Meaning you’ll hear well and your batteries last much longer.”
That sounds of course like the comment have got a trip with advertising violin, but I think nonetheless that there probably should be a little truth.
But as to the choice of the producer, then one of the differences is that Advanced Bionics (AB) has one microphone in front of your ear on their processor. I was I told, this would mean less. I see the idea of it, but the disadvantage is that AB’s processor can not be maintained with an earplug. I tried a demo model of AB and Cochlear’s models for the feasibility study in Odense. I do think it was too little movements until the processor falls off the ear – that required only relatively small head movements. It is possible this is related to my ear shape? But here Cochlear’s processor can be fitted with an earplug like with a hearing aid, and thereby maintained better (and in a way I’m used to). It was also instrumental in my choice – and the consequence was, moreover, that I immediately got taken images used for these plugs – which are of a type that does not go so far into the ear like a hearing aid plug.
One last but important thing is that waterproof equipment is something I also need very much, as I am dinghy sailor. In fact, it is a requirement on my part that I get something waterproof equipment too. The positive is indeed that both AB and Cochlear are equipment that would be more waterproof at sea than my changing hearing aids ever been. My choice of Cochlear is also reasoned that I thus can avoid a long wire from the spool to the body-worn processor, as in the case of AB’s Neptune processor. It may be impractical to have fluttering. As a sailor I do not have swimming goggles on which Neptune possibly could be mounted to. However, with Cochlear’s Aqua+ equipment I could add some fixture to the body with a hat, headband or baklava (the latter probably best in the cold time) at the head.
I will be excited to try out swimming and sailing in practice and see if there are problems with water intrusion in this regard? Problems with water intrusion into the hearing aids I have used during sailing through time, makes me have a good deal of skepticism in advance. May I jump in the water with CI-processor, and while bathing? It will undoubtedly require a bit overcome, believing it IS waterproof.
A final and more secondary thing that also affected the choice of Cochlear, is that it is easier to get support at Cochlear, as they have an office in Birkerød, where AB’s equipment is to be sent to England in event of a fault. I think this must also be an advantage.
Regardless of the manufacturer, you should probably still think of CI as a hearing aid – a different and advanced one at that is. So yes, there will probably still be situations where I am more challenged than a normal hearing. My hope is that with the new bilateral hearing, it will be at least on par with what I experienced in these situations before my discernment and hearing went downhill.
I hope now that I made the right choice – a choice that I have to live with for many years.