Friday, May 1, 2009

Red Letter Day

Today is a Red Letter Day of sorts. It's 3 months since my cochlear implant was activated and 3.5 months since the operation. And, coincidentally, two other things happened today:

The Sound of ... something

Ever since the operation, I have heard nothing in my right ear except via the cochlear implant. And when I say nothing, I do mean nothing. No airplanes, buses, trucks, subway wheels screeching - not even that harbinger of spring, the muffler-deficient Harley (although the sound of them in my left ear is enough to send me scurrying for the nearest bomb shelter). I've pretty much resigned myself to having no residual hearing whatsoever in my right ear. Yet this morning, while in the shower, I could hear something! A kind of scraping sound when I rubbed my wet outer ear with my hand. Not very useful so far but it may improve further as the middle ear continues to heal.

Locked out

I made my first 'cold' telephone call in quite a while. This was due to sheer frustration on finding I could no longer use my online brokerage account to trade shares. I haven't done this for a while, partly because I've been busy but also out of a kind of stunned inertia following the big meltdown of the stock market last October.

I use TD Waterhouse's Webbroker service. Mostly, it's been problem free for me but, when there are problems, you need to call a help line or 800 number. They do have a TTY number but it's a single number for the whole company and I suspect that it's not too effective at getting you connected to the right expert. I don't have a TTY and I'm not sure there's much point in getting one now as it's very much yesterday's technology (circa 1950). There's no other way to communicate with TD Waterhouse as far as I can tell - no e-mail, no IM, not even a tin can with wires!

So I connected up my expensive Phonak gadgetry to my work phone and tested it out. It allows me to hear with both my hearing aid and CI processor at the same time while speaking into the standard phone handset.

I worked my way through TD's voice-mail maze until a live person became available. I expected to have to explain that I was deaf and that she might have to repeat things a few times. But no - I could hear her perfectly. I understood all her questions and was able to understand the instructions she gave me on how to restore my password, etc. (It turns out that the second-level password is disabled if not used in over 6 months ... it must have expired a few days ago!).

So this is all quite encouraging. I can make noises in the shower, navigate voice-mail and play the stock market; not necessarily all at once but I'll work on that.

Saturday, March 7, 2009

Gender Shift

Gender
I think I mentioned earlier that all voices seem to sound alike through the CI. Whether male or female, young or old, they sound essentially like the voice of a woman or perhaps that of a youth. This is likely because the CI doesn't pick up the lower notes well and that's where people's voices differ most.

When there are no other cues, as when listening to an audio-book, I can understand what is being said but don't have much sense of who is saying it. Add in some other cue and it becomes much more apparent. In my case, that means listening in with my left ear via a hearing aid. So:
  • listen with the right ear only (CI) and the voice sounds like a woman's voice
  • listen with both ears and I can affirm that it's definitely a male voice
  • turn off the left ear (hearing aid) and the voice gradually drifts away and starts to sound like a woman again over the space of a few minutes
  • turn on the left ear and it immediately returns to be a male voice
  • turn off the left ear again and after a few minutes it again starts to sound like a woman.
Very strange!

Clocks
Last Saturday, I spent the morning doing housework including a thorough dusting of my office which seems to get dusty very quickly. I don't wear my hearing aid and CI while using the vacuum-cleaner, since the noise is quite loud. I can see why dogs are so afraid of vacs!

I found my small battery operated clock was no longer working as the battery had died. It's the old-fashioned type with hands. So I replaced the battery with a fresh one and went on vacuuming.

Later in the day, I went back to my office to do some things on the computer. I became aware of a new rhythmic noise. Tick-tock, tick-tock, etc. What was that? The disk drive about to die? Some sort of beetle that comes to life in mid-winter? No ... it's the clock! Now this may sound strange but it's a few years since I've heard a clock ticking. Mostly because clocks these days don't tick but also because I've simply lost the ability to hear it.

Green Lights
My CI comes with three programs: one for 'normal' hearing, another that's optimized for music and a third that's the same as the first but uses a microphone that's in a different position. I haven't used the last program much as it's somewhat redundant. While looking in a mirror yesterday, I discovered that this program has an interesting feature: a green LED on top of the CI flashes in sync with any sounds that are being picked up!

I guess it's a diagnostic feature for use by audiologists or parents whose kids have CI's. I wonder what other uses it might have?!

Saturday, February 28, 2009

Two plus two equals ... five?

The last few days, the cochlear implant has come to seem more natural and less, well, freaky. It's less distracting; instead of thinking about it constantly, I'm simply using it. I even forgot to plug in its charger one night. Fortunately, I had three more cells on standby.

Bananas
I'm also starting to hear more low frequencies. Not very low frequencies but the ones centred around, say, 500Hz which is where many of the speech sounds occur. I'm still having trouble distinguishing between m, b, v but I'm getting there. No trouble at all with the sounds above 1,000Hz which is where I was having difficulty before the CI operation. Here's a diagram called the "speech banana" showing where the main speech sounds are centred and at approximately the volume level in normal speech:

Speech Banana (borrowed from http://quietsong.net)

If you read the previous post, I mentioned that I was able to understand an audio book recording by listening to it with both ears via my FM transmitter. Now the odd thing is this:
  • if I listen to it with just my left ear (hearing aid), I can't understand it at all. It sounds like the teacher in the Charlie Brown cartoons (blah blah blah-blah blah);
  • if I listen to it with just my right ear (CI), I can understand it quite well but something is missing;
  • but if I listen to it with both ears, I can understand it almost perfectly!
This is strange. Somehow, the brain picks up bits from both ears, adds them together and ends up with a bit more than the sum of the parts. Thus 2+2 =5!

Telephone
For the past year, I've pretty much stopped using the telephone except for brief conversations with people I know well. For example, asking Barb what things I should pick up from No Frills on the way home from work. Sometimes, I'd get it wrong and we'd end up with, say, two jars of marmalade but no margarine!

Early phone use

Since getting the CI, I haven't been too optimistic about the telephone. At first, I was unable to even hear the dial tone using the CI. But now, the dial tone is starting to come through. Not loudly but it is there. I played around a bit with various configurations of headphones and listened to a few recorded phone messages. I found I could understand what was being said even if it sounded a bit unnatural.

I took the plunge and called Clare who is usually happy to have a chat on the phone at the end of the day! We talked for about 15 minutes and I could understand most of what she said. Not 100% but enough to follow the conversation and fill in some of the gaps from the context. So that's encouraging. I'll have to keep working at this and try some more formal exercises with her and some other willing victims - lists of words and phrases from the workbook, etc.

The telephone obviously conveys a lot less sound information than other sources such as FM radio or cassette tapes. From what I've read, it's limited to frequencies between about 300Hz and 3,000Hz. Looking at the speech banana above, that band encompasses most of the speech sounds but j, f, s, th and ch fall outside its range. Is it possible to really hear the word this on the phone? Does it sound any different from fith or do we just know that fith isn't a word in English?

Friday, February 20, 2009

The Gadgeteer

I think most hard of hearing people have a collection of gadgets to use for hearing assistance in various situations. One of my gadgets is made by Phonak and is called a Smartlink. I've used this with my hearing aids for a few years now and, for the most part, it does what Phonak claims it can do.

It's a small handheld microphone with a built-in radio transmitter and antenna. Depending on switch settings, the microphone can be directional or omnidirectional. For example, at a dinner party, that means you can focus its attention on a particular speaker or have it pick up all the speakers around the table.

The radio transmitter + antenna beams a signal up to a small sugar-cube sized receiver that attaches to the hearing aid. I have two receivers, one for each hearing aid so I pick up the same signal in each ear (at least, I did before the CI was installed).

It can also be connected by a jack for sound source such as a laptop, TV or telephone. This is great as it means I can walk around the room or even the house while listening to "Jeopardy" and miss very little. Or, if it's "Friday Night Smackdown", nothing at all.

That said, it's obscenely expensive and somewhat over engineered. For example, it has tiny switches that are difficult to see, much less to press. In dim light, you just squeeze away and hope that you have selected the right thing. Other features are a little too 'automagical' for my taste - e.g. a power-saving feature that causes it to shut off after one minute of silence. It's not easy to get it to turn on again. That's very annoying if you are using it with the phone and have been put on hold.

This week, I received an attachment that allows me to connect one of the sugar-cube things to my cochlear implant processor. This attachment is quite easy to use but it does require an tiny battery to power the receiver; presumably, it would put a bit too much of a load on the cochlear implant's built-in battery.

Anyway, I set everything up, connected the transmitter to my computer earphone jack and tried it out. The first selection was from the aforementioned On the Origin of Species.

Absolutely amazing! I could clearly understand every single word of the passage without having to follow the written text at all. I haven't been able to do this with hearing aids alone for years; even if I could 'hear' it in the sense that it was loud enough there was just too much distortion and garbling of speech for it to be understood.

This is encouraging in more than one way. I had not been using the Smartlink as much lately because it became less useful as my hearing deteriorated. So it looks like it will become more useful instead of being an expensive paperweight. And it may provide a way to understand the telephone. There's a big advantage in being able to hear the phone in both ears rather than just one. At this point, I really can't understand the phone.

It's something to work at.

Wednesday, February 18, 2009

Ear Exercises

I haven't posted for a whole week and a half. Not because nothing has been happening but because I've been a bit busy with one thing or another. Now it's the end of our winter long weekend and I have a bit of time to catch up.

Exercises
One of the things that has kept me busy is doing 'Ear Exercises'. These are of two kinds. One is simply listening to audio-books and following the printed text word for word. For this, I downloaded Charles Darwin's On the Origin of Species. Now you might think that's rather dry but it's actually very interesting. The chapters are read by various people. Mostly, they are easy to understand but Chapter 5 is read by someone with a distinct Irish accent. That makes it a bit more challenging!

The other exercises are from a set of listening exercises in a workbook/CD loaned to me by the audiologist. These are graduated exercises centred around closed or limited sets of words. I listen to spoken words, write down what I hear then later check the workbook to verify that what I thought I heard was actually what was said. Simple and quite effective. I stumbled on some things:
  • one exercise is based on time. The reader uses some odd expressions such as "twenty five of three" and "ten of twelve". I don't think I've ever heard or read this expression in Canada or UK. Perhaps it's an Americanism?
  • for numbers, the words "five" and "nine" are difficult to distinguish; also "fifteen" versus "fifty". And, often, I can't distinguish between "fifteen" and "thirteen"
  • another exercise is centred around letters of the alphabet. These are actually quite difficult because there is no context. And, of course, many letters sound alike: "m" versus "n" or "b" versus "p" versus "v".

Maps
Yesterday, I went off to Sunnybrook for another 'tweak'. This one did not take very long and I now have an alternate map (or program) to try. I can switch between the new program and the previous program within a couple of seconds.

So far, the new program isn't working too well for me and I realized by about 3 o'clock this afternoon that it was making me irritable and crabby. So I switched back to the former map and -presto- I was instantly much more cheerful! I may just have to give the new map more time or it may be that it's a step backwards rather than forwards.

That's part of the point of all the mapping sessions: to find the "sweet spot" where things sound good and, more importantly, I'm understanding people.

Music
Music is also starting to sound better. Matthew sent me a CD of the Goldberg Variations played by Glenn Gould (thanks Matthew!). I haven't heard this for a while but I remember it quite well. It sounds pretty good as I listen to it right now even with just the CI. Not too much dynamic range (i.e. no very loud or very soft passages) and mostly just one instrument. Occasional cymbals, though.

Tim's
On the long weekend, we drove up to the cottage. I found I could understand Barb talking quite well in the car. Previously, I had to rely on lipreading, either directly or via a mirror mounted on the inside of the windshield.

We stopped at Tim Horton's in Orangeville for lunch. Like most such places, it's fairly noisy. I can't honestly say that I could understand what other people were saying but I did catch phrases or snatches of other conversations. But it's hard to determine where they are coming from or even how far away they are. Similarly on the subway - I can hear someone talking but I can't tell if the speaker is a person sitting close to me or a group of people half way down the car. They just seem to be disembodied voices.

Saturday, February 7, 2009

EEEs and MMMs

It's now the end of Week 1 with the CI. And I've survived my first week back at work without getting too stressed out.

I really did not have very high expectations for the short term. I was prepared to hear bleeps, pips and hoots but not to be able to make much sense out of it. That, apparently, is the experience of a lot of people for the first while.

In fact, the CI has exceeded expectations even within this first week. I'm hearing things but I'm also understanding people better. That's in combination with lip-reading and a hearing aid in my left hear - these seem to fill in the gaps that the CI is not, so far, able to comprehend.

Yesterday, I returned to Sunnybrook for a 'tune-up' session with the audiologist, Amy. I had a number of questions for her, one of which was whether all the electrodes in the implant were working correctly. For some recipients, not all electrodes are functional and not always for any identifiable reason. But Amy assured me that all the electrodes are working for me. That's a relief - it may not be too important in the end; all that matters is how much hearing and comprehension I'm getting out of the electrodes that are there. But it does mean that there's more of a reserve in case anything goes wrong with one or more of the electrodes in the future.

Initially, I had been set to a rather low level such that even with the volume control turned up to the max, it still was not very loud. Training wheels if you like. This time, Amy took me through a number of simple tests to find my comfort and tolerance level for individual pitches of sound. We then went through some listening exercises for various phonemes and I was able to distinguish most of them. The exception was /eee/ versus /mmm/. She says that a lot of CI users have trouble with this and nobody seems to know quite why. Fortunately, these two sounds are easily distinguished by lip-reading and are usually identifiable by context, in English at least.

The end result is that I now have a wider range of sounds: there's more mid-range so voices sound less thin and hissy than before. There's also a lot more volume so I'll have to be careful with the volume control! Even though it's tolerable at each separate pitch, when they are all put together the combination is going to be intolerable if the volume is set too high.

She also loaned me a workbook/CD set of listening exercises to do. This looks quite comprehensive and well thought out. I've never actually had anything like this before. It's too bad that hearing aid vendors don't provide something similar with their products. I'm sure it would help a lot of people adapt to hearing aids and (perhaps) prevent the aids from being relegated to the drawer.

So lots to work on. But I'm going X-C skiing tomorrow even though I'm not supposed to exercise for a month or so after the operation. I'll just take it very easy, not do anything that could be considered strenuous and listen for chickadees.

Tuesday, February 3, 2009

Hear and There

Today, I've discovered a few new things in the sound landscape, not all of which I really want to hear:
  • Subway: between St George and Museum, the wheels go SHRIIIIIIIIEEEEK as the subway takes a sharp corner. I thought they had fixed that problem years ago. Nope, it just seems I became deaf to that particular sound.
  • Muzak: on a walk in the underground mall at lunchtime, it seems that nearly every store has some kind of muzak going. Does anyone actually LIKE that stuff? Are they trying to drive customers away?! Well, it will drive me away which may not be so bad.
  • White noise: at work, I realize that the building ventilation noise is quite loud and obtrusive. Before the CI, I couldn't exactly hear it but I was aware of it because, when it shut off at the end of the day, there was some sense of release or quiet. With the CI, I can hear it all the time. Perhaps I'll get used to it.
On a more positive note:
  • While putting ingredients in the bread machine, I poured out some flax seed into a measuring cup. It makes a soft noise - a sort of piiish. Nice
  • I'm hearing more low frequency sound now. Not deep bass notes or anything but deeper than before. For example, the noise of the keyboard clicking away sounds more natural now whereas, a couple of days ago, it sounded thin and high-pitched. Strange.
  • I tried listening to various bits of music from the web. On Monica's suggestion, simpler pieces or with just one or two instruments. Harp music sounds quite good, but more crisp and precise than before, especially the very high notes. Clarinet isn't bad. But I can barely hear the cello - it's too low and deep.

Monday, February 2, 2009

Syllables, Sybillants and Cymbals

Phew, I've survived the first day back at work.

Mostly, it wasn't too bad. Several co-workers asked how the operation went and how I was doing. Interestingly, I found I could understand some of them better than before. It's hard to say how but I could pick up more of the consonants, especially the 'sybillants' (s and sh sounds).

Walking to the subway, I heard a flock of starlings overhead. A different sound from sparrows, for sure.

I hadn't realized before how many electronic gadgets make noises when you push their buttons. The bread-maker beeps. My digital camera beeps. The uninterruptible power supply for the computer beeps ... well, OK, I remember that one. It means that it's time to replace the battery. It needed replacing, oh, about 8 years ago and still needs replacing so I can only presume it has been beeping away for all those years and I haven't known!

Some things are NOT working. When I listen to the phone handset I can't hear a thing, not even the dial tone. I'm not sure what's wrong there but it will likely take some time.

Also, music. I tried listening to a bit of Mozart. For example Eine Kleine Nachtmusik the tempo and beat are just right but the whole piece sounds like it's being played not by an orchestra but by a lone and hyperactive percussionist on the cymbals. Monica suggests trying something simpler for starts; a piece with just one or two instruments. She's probably right. I'll have to pull down my rather ancient collection of cassetts tapes as I don't really have much music on CD.

Sunday, February 1, 2009

Heard a Bird

Yesterday, I was off to the dump. No, not to toss out my collection of old hearing aids but to get rid of various bits of defunct computer equipment that have been piling up in my office.

This was also my first time driving since getting the CI. Usually, I have to turn my hearing aids down or even off while driving on the highway because the noise is so loud I can hardly hear myself think. I expected it to seem noisy in the car with all sort of rattles and squeaks.

But no, the CI hardly seems to notice the engine, road noise or wind noise. Instead, it picks up sounds like the turn indicators, the whoosh of the tires going through a puddle, the squeak of my boot against the clutch pedal. Much better. At one time, I could hear the turn indicators but it's been a few years since I've been able to hear them while the car is moving.

I tried listening to the radio - CBC Radio 2. It was evidently Vinyl Cafe. Now, I wouldn't say that I could understand it at all but I was able to distinctly pick out quite a few words. That's something.

I haven't heard any birds for a year or two now. And the last time I heard one, it was more of a click than a cheep or chirp. So I was interested to see if the CI would pick up birds. Not many birds around right now even though there were a bunch a few days ago. So I stood on the back steps waiting. Eventually, a lone sparrow turns up and starts pecking away at the bird feeder. But it's too busy scarfing down sunflowers seeds to chirp. After a while, it flies off into the neighbour's rose bush to digest. And then - cheep, cheep! YESSS!!

I'm noticing various other sounds around the house: the beep when you push the buttons on the oven is different from the beep that the microwave oven makes. Before, it all sounded the same - a sort of croak, if that.

What I hear in my left ear (hearing aid) sounds quite different from what I hear in my right ear (CI). At first, the two sides seemed somehow disconnected as if the sound was coming from two completely different sources. But already, after only 48 hours or so, the two sides are starting to sound a bit more connected or integrated.

Tomorrow, I'm back to work. I'm a bit nervous about that. Partly because I look a bit, well, different:I'm sure the bald patch over the ear will grow back in a while but right now it looks a bit naked.

There will be two and a half week's backlog of work to catch up on and lots of 'new' sounds and voices to get used to.

Friday, January 30, 2009

All Fired Up

A lot of changes in a few hours!

From the start of the appointment, it was right down to business. The audiologist, Amy, had a blue and green box about the size of two shoe boxes. It contained the external processor and all its supporting paraphanalia such as batteries, recharger, gadgets for connecting to MP3 players, etc.

(And, of course, literature including an instructional DVD complete with Closed Captions. This is ironic because I've been fretting lately over the fact that our Toshiba DVD player will not pass Closed Caption information to our TV even though the TV is quite capable of displaying Closed Captions. This was my main excuse for buying a new TV. But I digress ... )

Amy then showed us how to attach the processor, how to recharge the batteries correctly, etc. It took some time to get the processor magnet to stick to my head properly. Either I'm thick skinned or there is still some post-operation swelling under the skin. For now, there's an extra strong magnet to ensure that it doesn't fall off. I may have to be careful when walking close to large metal objects.

She fired up the processor and asked me if I could hear anything. At first, I could not so she turned it up a little. Then, sure enough, I could hear something. 'Hear' isn't quite the right word ... it's more a sort of buzz in the head, something like tinnitus. Or perhaps like the sound one hears at the dentist when he drills a little too deeply and hits a nerve.

Weird at first, but within a few minutes it starts to sound a bit more natural. Amy read through some text which I followed on a sheet of paper. No lip-reading allowed! It was about Salem and witches. I could hear all sorts of 's', 'shh' and 'ch' sounds - something I haven't heard in my right ear for some years. This alone was an improvement on any hearing aid I've tried!

Amy then read through a list of basic sounds or phonemes to ensure that I was able to perceive each one. Some I could understand better than others; certainly no difficulty with the 'sh' sound but more difficulty with the lower sounds like 'm', 'b' and vowels. She said that this was really just a starting point and more precise tuning would happen at the session next week by which time my ear/brain would have sorted things out a bit.

By 10:30, we were finished as Amy had another appointment. Barb and I went for coffee at the Sunnybrook Second Cup. This is a 'buzzing' kind of place and I was expecting it to seem very noisy. But I was pleasantly surprised to find that it was not overwhelming at all. I had no difficulty understanding Barb, though I rarely do anyway.

On the bus back to Davisville, I heard a number of interesting sounds:
* a 'ping' when tokens fall into the fare-box
* the hiss of brakes being released
* the stop announcements. I could clearly hear the word 'station' and some street names; others not so easy to make out. (Similarly, the station announcements on the subway)

I dropped in to the bulk food store on the way home to scoop up some oat bran and other things. I was amazed that I could hear the 'swish' sound of the scoop in the bin. I didn't even know it made a sound!!

And at home, I can hear all sorts of things I either haven't heard for a while or have never heard at all:
* the beep of the microwave oven control
* a crunching noise when Barb eats an apple
* the click of the computer mouse button (I always thought clicking and double-clicking was a concept, not a sound!)
* even the scroll-wheel of the mouse has its own sound!

That said, things do NOT yet sound natural in any sense of the word. So far, things sound tinny and mechanical. There's just no bass sound on the cochlear implant side. I've tried listening to a couple of bits of music that I know well - and they sound like they are being produced by a tiny calliope rather than a chamber orchestra. There's little variation in tone or volume.

But it has only been a few hours. I'm told that it will take a lot of time, practice and adaptation before the full potential of the CI can be realized.

So far, I'm feeling encouraged. It's far from perfect but a whole lot better than having no hearing in my right ear.

Wednesday, January 28, 2009

Post-op followup

Back to Sunnybrook early today for a post-op checkup. It's a snowy day now but not much had fallen by the time of the appointment so there was no problem getting there.

The nurse removed the staples from the incision. Mercifully, they have a special tool for this, something like tiny retaining-ring pliers. So it's looking a lot less grotty now:



Dr Chen said it may take 2-3 months before my taste and feeling in the tip of the ear is fully normal. He emphasized the importance of active listening with the cochlear implant - e.g. listening to familiar spoken or music recordings over and over or reading things out loud to improve my voice modulation.

On Friday, I go back to Sunnybrook for activation! Barb will likely come with me. Whatever happens, it would be good for her to understand how it works and what sort of experience I will likely have with the cochlear implant. It will be interesting to see how it goes!

I understand that a few CI recipients find that they are able to comprehend speech almost as soon as the device is turned on. A revelation, in effect. But for most people, there's a learning curve of 3 to 6 months before they are fully functional. And for some unfortunate people, it doesn't work at all and they revert to other means of communication.

Why different people have such different experiences isn't well understood. It seems to have more to do with hearing history and motivation than anything else.

People who have lived a normal hearing life only to suffer sudden deafness seem to do best. Though traumatized by their loss of hearing, they are likely to be highly motivated to adapt to the cochlear implant as they have no 'fallback' means by which to hear. They are unlikely to have developed speech/lip reading skills and it can take years to develop fluency in ASL (american sign language).

Those who have lived for a long period of time with no sound at all seem to find it hardest. Their auditory nerve may have atrophied from lack of stimulation. They may have forgotten how things really sound or what they hear is just a small part of the full sound spectrum of each word or syllable.

You might think that children would have the easiest time adapting to their CI. Curiously, that doesn't seem to be the case. They do not seem to have to depth of experience of sound that older people may have. And, of course, if a child has not learned language during a critical period of early life, he or she may never to ever learn to understand words through a CI.

Wednesday, January 21, 2009

Tiny Pianos

Most of our senses are ‘mapped’. That is, a particular location in a sense organ stimulates a corresponding point in our brain and adjacent sense locations stimulate somewhat adjacent points in the brain. For example: sight, taste, touch.

Hearing is similar in that each location in the cochlea maps to a particular frequency or pitch. The base of the cochlea is mapped to low frequencies and the tip or apex maps to high frequencies. Something like a tiny piano keyboard rolled up into the size of a pea. This ‘piano’ normally has about 1,500 different ‘keys’.

The cochlear implant, by comparison, has a mere 16 keys. Ideally, those 16 keys would take the place of the normal 1,500 keys. In fact, that isn’t going to happen. The external electronics will be programmed to squeeze the incoming sounds into 16 bands. My brain will have to figure the rest out. It won’t be perfect but, chances are, it will be better than what I have today.

In addition, the electronics will also have to be programmed to accept sounds at all sorts of intensities and convert them in to electrical impulses that are somewhere between barely detectable and fuse-blowingly loud. Again, my mind will have to figure out just what that means. Is that noise a mosquito or a helicopter?

This learning process will begin at the ‘turn on’ date which is next Friday (Jan 30th) and it will continue for a while. I have appointments for mapping adjustments at Sunnybrook all the way until January 2011!

I’m told that one of the best ways to train the brain to make sense of the cochlea implant signals is to listen to an audio book while following the corresponding text on paper or on a computer screen. There’s a lot of stuff floating around on the web that can help and I’ve been checking out some of this today. For example, Project Gutenberg has loads of stuff. The nice thing about some of this is that the voices sound fairly normal (well, to me at any rate). Some commercial audio books I’ve listened to in the past are overly theatrical and have music added into the background. That’s OK for some but it’s not what I want for this purpose.

Monday, January 19, 2009

Hospital Then and Now

On being admitted to Sunnybrook Hospital prior to surgery, I was asked by the nurse if I had ever had an operation before. I told her that I had an operation at the age of 7 or 8. She replied that things had not changed much. But some things have changed!

Then (1963)
Hospital: Royal Ear Hospital in London UK. Old, probably Victorian. Inside covered with white tile and outside with red brick. Think “Carry On, Doc”.

Length of stay: one week for what seems a very simple procedure(*)

Nurses: all very young with blue serge dresses and starched white aprons. Also wore cuffs, broad black belts and little hats. Nurses do just about everything. Bossed by the Matron who was a sort of General Patton in nursing outfit. Everyone deferred to Matron except (possibly) the surgeon.

Ward: one big ward for all the kids. Lots of fun: played board games with each other and gave rides on bedcarts when the nurses were not looking. Big, tall windows with drapes.

Food: awful. Worse than school dinners. We had to eat every last morsel. I still gag at the smell of boiled turnips.

Injections: lots. Seemed to be an injection at least once per day for this and that; usually in the buttocks. I think this is how the nurses got their revenge for bad behaviour.

Now (2009)

Hospital: Sunnybrook. Mostly new (post 1980). Sprawls over a leafy green campus on the edge of the Don Valley.

Length of stay: 24 hours for something that in 1963 would have been considered science fiction.

Nurses: on average, older and more experienced. Nothing very uniform about them either. They are much more specialized; they do nursing, not bed-making, cleaning, etc.

Ward: I was in the general ward. No windows. Each bed had its own dimmable light.

Food: wasn’t there long enough to have any substantial food so I can’t comment.

Injections: only one and that was to install a ‘drip’. Everything else goes in with the drip mechanism. Painless but makes it harder to run away.

(*) My understanding (only pieced together in retrospect and I may be totally wrong) is that the blood flow in the inner ear was supposed to be improved by blocking sympathetic nerves in the stellate(?) ganglion. I do remember that the side effect was supposed to be droopy eyelids and my Mum was not too keen on this. It was tried temporarily using an anaesthetic. As that didn't seem to help, the more permanent surgery wasn't attempted.

Sunday, January 18, 2009

Snowed In

I've been home now for a couple of days and so far so good. I'm taking the prescribed antibiotics and that's probably making me a little sluggish. I don't remember ever having to take antibiotics before. If I have, it was a long time ago, perhaps 25 to 30 years!

I did a little research on this particular antibiotic (Cephalex). It was first isolated from a sewer in Sardinia in 1948 by Italian scientist for Guiseppe Brotzu. Where would we be without sewage?

My balance is still off but is improving. It's worst in the dark or if I've been lying down for a while. Walking around seems to help ... likely, the eyes and touch convince the brain that it should listen to them and ignore that traumatized vestibular system.

Taste is still affected but it hasn't become any worse since yesterday.

Barb went skiing today but is just back. Monica came by this afternoon for a cuppa tea and kindly gave me a ride to the video store and back.

Friday, January 16, 2009

Back Home

I’m back at home now. The whole thing took 24 hours almost to the minute.

The staff at Sunnybrook Hospital were all great, especially the night-shift nurse, Janet Scott. And, of course, the surgical team but I have to admit I saw little of them and heard even less.

I’m feeling pretty good now. There’s not much pain and what pain I have is probably less than the typical earache. I’m wearing my hearing aid in my left ear but nothing in my right ear (the implanted ear). I can understand Barb fairly well with my left ear plus lip-reading but it takes a bit more concentration than before and I have to cock my left ear towards her.

I do have some ‘side effects’, none of them unexpected. I’m told that these should go away in a few days:
  • My balance is off, especially if I move my head up and down. Left to right is not so bad. I’ll have to be very careful going up and down stairs.
  • There’s some taste disturbance. For example, a tangerine tastes like a tangerine on the left side of my mouth but like piece of rag on the right side.
  • I have some tinnitus (noises) in my right ear. I normally have some tinnitus in both ears and it comes and goes. It’s usually peeps, clicks and whistling noises. But this is a new noise: a deep pitched hum that comes and goes.
After getting home, I had a shave. My electric shaver is very loud so I usually turn off my hearing aids while shaving. Usually I can still just hear the shaver when I shave close to each ear. Not today! The right ear doesn’t hear a thing. So now I’m completely and totally deaf in my right ear and it will stay that way until January 30th when the external processor is connected and turned on. A bit scary.

Some Photos





A 'before' picture. Short haircut as I won't be able to wash it again for a week or so.




The assistant surgeon (sorry, I didn't get his name) drew some things on me to make sure they don't do the wrong ear in their excitement to get going. Ironically, this is the electronic symbol for amplifier.




OK, this is a bit gross. But it will start to look better soon. The staples will come out on Jan 28th. The yellow stuff is some sort of disinfectant. The electronics are somewhere under the shiny bit. I can't even feel a bump or anything so far. There may be a small bump after the swelling goes down.




My brain huuurts!

Thursday, January 15, 2009

Heading down recovery road

I left Steve a little over an hour ago with 2 servings of of Jello and a book he has been reading - "Singled Out: How Two Million Women Survived Without Men After the First World War." Both promising signs of taking small pleasures where and when you can.

He looks good despite the intimidating bandages. Tylenol 3 is handling the pain and if tonight's X ray and the surgeon's inspection tomorrow morning go well, we will be home before noon.

Barb

So far so good

Surgery started later than expected, but everything seems to be in place.



I left Steve in the O.R. surrounded by various specialists (all gorgeous). Each one made a point of connecting with him before have gave up his hearing aids and glasses. Sandra and Bruce's friend Shirley also came by to wish him well. It's reassuring to have all this support at the hospital and from all of you blog readers who have called and emailed your best wishes.

I'll post again shortly,

Barb

Going In

Thanks to everybody for the e-mails, phone messages and blog comments. They are very encouraging!

The surgery is scheduled for 13:00 (1 pm). We have to check in at 11:00. Not as early as I expected and a good thing as I'm not a morning person.

No messing with the subway today! The traffic at that time of day should be light so we might as well drive anyway. I hope the car will start as it's bit nippy here (a mere -16C ... it's -40C in Algonquin Park and -36C in Huntsville and Gravenhurst).

Barb will post something here later today to let everyone know how things have gone.

If all goes well, I should be back home sometime tomorrow.

Wednesday, January 14, 2009

Feelings

Matthew asks how I'm feeling. Something like this:
Seriously, sometimes I still wonder if I really need this. Perhaps I'm not deaf enough! And I have to remind myself that, even though it's another hole in the head, it's considered to be relatively minor surgery. I gather it's not nearly as traumatic as, say, an appendectomy and certainly nothing close to brain surgery.

Sometime this afternoon, Sunnybrook will call Barb and give her the time of the operation and the time that we need to be there tomorrow.

Meanwhile, I seem to have dodged a bullet of sorts and have avoided getting a head cold that is afflicting a lot of people right now.

Monday, January 12, 2009

Decisions, decisions

Leading up to the decision to have a cochlear implant (CI) installed, I did quite a lot of research using the web, various newsgroups and some books. Many recipients have created their own blogs or web pages describing their personal stories. For example, I found this one especially useful as it has lots of pointers to other blogs and resources:
Chronicles of a Bionic Woman

One concern was that this was new, untried technology. I was surprised to find that CI’s have been around for about 30 years. In that time, some 150,000 people have been implanted worldwide. The device failure rate for the internal device is low and continues to fall. So I will hardly be a guinea-pig.

Speaking of guinea pigs, a second concern was that I would potentially lose any residual hearing in the implanted ear. This would mean that I would be no be able to take advantage of any future medical advances such as gene therapy. Reading up on this, it was apparent that such breakthroughs, while promising, are a long way off and to date are only at the guinea pig or lab-rat stage. It seems improbable that this technology will become available in my lifetime. Also, the cause of my hearing loss is unknown and it’s likely that this type of intervention would only be useful for very specific types of hearing losses with a well-understood genetic basis.

I was also concerned about obsolescence. The life-cycle for hearing aids is assumed to be about five years; in fact, manufacturers will not repair aids that are more than ten years old because parts can not longer be obtained. A hearing aid can easily be replaced with a newer model but this would not be an option for a device embedded in my skull. I was reassured to find that most of the development is happening with the external processors and, especially, with the software ‘maps’ that the processor uses to translate sounds into electrical signals for the implant. Many of the early implantees are still using their original implants but with upgraded external hardware or software. If I were to get 30 years of use out of an implant, I will be well into my 80’s. That would be pretty good run!

And I was mystified about the actual surgery process. The cochlea is very small: about the size of a pea. Within that space there are three separate channels or cavities all coiled up together. If it were uncoiled, it would be about 4cm long. How was a surgeon going to feed 24 electrodes into that one of those channels? I’m still not entirely sure how this will work but I was somewhat reassured after watching this video of the operation:
Cochlear surgery
(don’t watch this during dinner!)

Friday, January 9, 2009

A bit more history

In my late 40's, I found that I was becoming increasingly reliant on lip-reading. I could no longer understand radio. TV shows and movies were becoming impossible to understand unless they had 'talking heads' or captions. And in the past year, I've had to stop using the telephone for anything but brief and predictable conversations with people I know.

When I realized that I could no longer hear high-pitched sounds such as birds, smoke alarms and the 'beep' of the microwave telling me the porridge was done ... it was time for action!

My audiologist at The Toronto Hospital re-tested my hearing and found that it had taken a measurable dive when compared to previous tests. I was now at 110db (left ear) and 115db (right ear) for 2000Hz which is around the critical frequency for a lot of consonant sounds ("ch", "sh"). Other frequencies were not much better. That meant I was considered to be profoundly deaf.

The end result was a referral to the Cochlear Implant centre at Sunnybrook Hospital. There was a bit of a wait for the initial appointment but after that everything seemed to happen quite quickly. Those horror stories you sometimes read about ridiculously long waits under the Ontario Health Care system don't seem to have affected our family.

The first appointment was with an specialized audiologist. She put me through a number of tests, some of which were new to me and some that were more detailed versions of the initial hearing test at TTH. At the end of it, she confirmed that my hearing level was within their guidelines for cochlear implant candidacy. She also explained that it was likely I would do well with an implant because my speech was fairly normal and I had lived in the 'hearing world' for all my life with the assistance of hearing aids - i.e. I had not been through a long period of sound deprivation. But she warned me that the surgery, if it happened, would just be a starting point and that it would likely take a lot of time and effort to become fully effective with the device.

More tests followed at later appointments including a CT scan, a balance test and an interview with the surgeon. The tests evidently showed no abnormalities that would preclude a cochlear implant. Dr Chen explained the surgical process in detail and what we could expect afterwards. He also said that, while it was possible for some residual hearing to be retained, the likelihood was that much or all of it would be destroyed during the implantation process. A one way trip, if you like.

After he left to see another patient, we realized that we had not talked about which ear would be implanted! Someone fetched the Dr again and he said that it likely made little difference in the end since both ears were similar in degree of hearing loss. My preference was to have the right ear implanted since my left ear seems to have slightly more functional hearing and thus a bit less to lose.

Having had some time to think about this during the initial wait for the appointment, my mind was already made up. There seemed to be little to lose and, possibly, a lot to gain. After a brief consultation with Barb, we booked a date (2009-01-15) and signed the consent form.


Thursday, January 8, 2009

A bit of history

As far as anyone can tell, I was born deaf. When a newborn, I had no reaction to soft sounds and would jump at my parents' approach or at a car door closing because I had not heard any warning sounds. They say that none of their other 5 children showed this behaviour.

At about the age of eighteen months, my father noticed that I didn’t come when called while in the garden. At this point they took me to see a doctor; the doctor was skeptical of deafness and thought it might be temporary due to ear infections, etc.

I evidently learned to hear and speak without any noticeable developmental delay. My brother Francis would talk to me very loudly and and my mother would get cross with him. Only in retrospect did she realize that he was doing this because I was deaf.

I started school (4yrs 9 months)without a hearing aid. I was placed at the back of the classroom in Grade 1 on the basis that I was one of the taller kids in the class. I was seated under the letter “Y” for Yacht. I thought this was an interesting word. I don’t think I learned much else in first grade.

Late that year, I was fitted with a hearing aid in the right ear and apparently got along well with it. This was a National Health (Medresco) body aid that ran on one AA cell. It was very robust and often fell on a hard floor surface without any apparent damage.

Later on, in my teen years, I was fitted with a behind-the-ear (BTE) aid. I also went bilateral. I did quite well in High School and CEGEP. University was more difficult and I found it hard to follow lectures in large lecture halls where I could not rely on lipreading.

During my 20's and 30's my hearing ability stayed about the same with only a very slight decline. For most of this time, I was able to use the phone effectively and I have to say that I found very restrictions in day to day living. The only situations where I found my hearing impairment to be a real problem were noisy ones (loud parties, traffic noise) and watery ones (swimming, boating).


Introduction

I'm setting up this blog so friends and relatives can find out how I'm progressing with my cochlear implant.

On Monday (Jan 5th), we went to Sunnybrook hospital for the pre-op assessment. No hitches there. A nurse took my blood pressure and said that it's a bit high. Nothing new there; I think it starts to go up whenever I get close to doctors and hospitals. The anesthetist was not concerned by my BP. He was a bit more interested in the family history of heart problems but said that my ECG looked fine so it was unlikely to be a problem.

I'll have to be careful not to pick up a cold or other infection before the surgery date. That could be challenging as a lot of people at work have something or other and it's hard to avoid snifflers, etc, on the subway. I'll just have to be fastidious about washing my hands and not touching my face.

Today, Thursday (Jan 8th) is one week until surgery. I'm starting to get a bit nervous! Not so much from fear but more from the realization that this is going to be a big change in many respects.

Why "SevenEars"? Well, mostly because the names "FourEars" and "SixEars" were already taken. But then it occurred to me that I actually own seven hearing aids of various states of repair. And each "Seven Years" seems to represent a phase in ones life so maybe it's appropos of that too.

Googling the term "Seven Ears", finds that it appears in the Bible and in script of the "Joseph and the Technicolour Dreamcoat". Different kind of ears; metaphorical perhaps.