The Cochlear Implant Experience of Another Deafened Audiologist


I have a friend and colleague, Dr. Nashlea Brogan, with is also an audiologist with a profound hearing loss.  She received a Cochlear Implant on July 23rd of this year and was activated recently on August 23th.  We have been emailing back and forth a bit about how things were progressing for her.  I asked her if I could post these exchanges in my blog.  I think you will enjoy reading about her experience.  

A few background notes:

1. Nashlea received the Med-El Cochlear Implant. 

2. Nashlea was born with normal hearing.  She believes her hearing started to decrease in her teens.  She was tested at age 14 and by 18 years received her first set of hearing aids.  Since that time her hearing continued to progressively deteriorate such that she lost most of her hearing in her twenties and early thirties.  

2. Med-El, Cochlear, and Advanced Bionics all use different numbers of electrodes in their CI’s. So when Nashlea talks about the 13 electrodes, thats the number that Med-El uses.  My CI is from Cochlear Corporation and has 24 electrodes.  Note also that the length of the electrode arrays differ between the manufacturers.  There is on-going debate as to what the optimal length and optimal number of electrodes should be which I am not going to discuss here, but I just wanted you the reader to be aware of this.

June 17, 2012

Hello Peter,

Well, I have my big day for cochlear implant surgery on July 23 and activation on August 23rd in London. I was expecting the surgery to be in the 2013 winter but they called last week with an opening for this summer, eek!!!!

If you have any advice or recommendations I would truly appreciate it.  I have to continue managing my Hearing Centre’s during this time and do not know what to expect or how to even possibly plan. How long is recovery? Did you work between surgery and activation? After you were activated when did you return to work? Many people reported that they were exhausted in the first few months from sound? Did you travel during the initial months? What was work like when you returned? Sorry for all the questions, I am trying to leave the month after surgery and 2-3 months after activation as open as possible, but I am a planner. Is there anything you would have done differently?

Hi Nashlea.

I am very excited for you!

1. Recovery: varies greatly from person to person. I had my surgery on a Thursday. Went home next day Friday. Was back at work Monday. Others get really dizzy and need a week or two off.

2. Yes I worked between surgery and activation. I only took one day off.

3. I was not exhausted from sound. But I was impatient. You need to really chill out and wait. It takes months to get full benefit.

4. Read my blog!!!!

Aug. 10, 2012

Hello Peter,

Thanks for the reply and I really enjoyed your Blog both from the cochlear implant perspective and as an Audiologist.

I had my surgery and all went well, they made a full insertion through the entire cochlea with all 13 electrodes of the Med-El. I wasn’t really myself until 10 days after surgery, I had a lot of ear pain 5-6 days post surgery.   I am also living with my FM system, I never truly grasped how difficult having monaural hearing was.  My FM system, has made car trips, dining, work and any public situation manageable. I don’t know what I would have done without it. So, next the step is activation on August 23! Now I need to learn patience.

Thanks again

August 29, 2012

Hello Peter,

Activation a dream come true.

I had my cochlear implant activated last Thursday.  Now, I had prepared myself for a difficult time, I was scared from talking to other people and not being able to wear my hearing aid for three months in my other ear. I had advised my receptionist that I wouldn’t be able to see patients until I could understand some speech, I was terrified.

Today, I feel like I won the lottery of life!!!!! The audiologist first tested all 13 electrodes from 250Hz to 6000Hz and I could hear all of them. Once I was activated both the Audiologist and my husband sounded like daffy duck or mermaids!!! That sound lasted only a few hours, we went to a restaurant after my appointment and I could hear the waitress, the music, the other people talking. It has since gotten better hour by hour.

My biggest and most rewarding moment of all this was my children. For the first time, I heard all my 3 year old girls little words!!! She hasn’t stopped talking to me since. I can hear my nieces and friends children talking. When they say mommy to me from behind or another room I hear them. Not hearing children was the hardest part of having a hearing loss for me. I was happy going to work, I did public talks all over Sarnia, I travelled, went out, the hearing loss was more of an inconvenience for these things. But with children I felt isolated and dependent on other people to help me understand what my 3 year old niece was asking me, even my own daughter! I was nervous going to my sons mothers day’s tea in SK because of me not hearing him singing, or if his friend might ask me something with the other mothers looking on.

No sounds have been too loud, all the environmental sounds are exactly as a I remember them. A little history on me, I was born with normal hearing, they think it started to decrease in my teens, at age 14 I was tested but not enough loss for amplification and by 18 years I received my first hearing aids (I had normal hearing to 1500Hz at that time), I have lost most of my hearing in my twenties and early thirties.

I just never imagined this…..its so wonderful and to think its getting better!!! The one thing that i have never heard or read about CI’s is how separate every sound is. I always felt with hearing aids that all the sounds were meshed together, for example I could hear lots of noises in a car, it was loud and made speech hard to understand but the sounds were all blended in one big ball of background noise. Now, I can hear all the indicators, the sounds the buttons make when you press them, the tires hitting the road or cracks, and the acceleration of the motor every time the gas is pressed, and speech is separate not competing with the car sounds.

I haven’t felt any background noise since the moment of activation, in restaurants, cars, and the mall. I hear all the sounds of people walking, talking, machines, music but I wouldn’t describe them as background noise like a hearing aid!

I could type forever. I feel so happy, so full of energy, I don’t even want to take the implant off at night. What an amazing and incredible device!!! What sounds should I go listen to today, ha ha!!

Well Nashlea, thanks so much for allowing me to share your experiences.  I want the readers to know that everyone’s CI experience is unique.  I had no post-surgical ear pain or dizziness, yet Nashlea did.  On the other hand, I needed months to achieve the benefits from my CI that Nashlea received in only a few hours.  Patience is the key.

Details about Nashlea’s Audiology practice:

Bluewater Hearing Centre
316 George St.
Sarnia, ON
N7T 4P4 Canada
Phone: 519.344.8887
Fax: 519.344.4873email:info@bluewaterhearing.ca
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Where NOT to Leave Your Hearing Devices


I blew a gasket yesterday.  Not proud of it, but it served to reinforce some points about how much I love hearing.

It was a hot a sticky day…about 34C with the humidity (thats about 94 degrees F, my dear American readers).  I was assembling my new tree stand in the garage but I was sweating like polar bear in Florida.  First I took off my shirt.  I can do that now and not have people scream in horror.  Got a chance to show off my new tat in the process.  But I was still too hot and sweaty.  Even though both my hearing aid and cochlear implant are water resistant, I still don’t feel comfortable getting these expensive devices drenched in sweat.  So I took them off and put them both on the hood of the car.  I turned around and went back to my project.

Here’s my new back piece Tattoo. It doesn’t have too much to do with the story, but I needed a picture.

Meanwhile, my son is having a real hankering for some Indian food.  He earlier asked me for a couple of shekels for this..I gave him enough for himself plus extra for some butter chicken and naan bread for me.  Point is, I knew he was going to drive off at some point, so this is not his fault.

So I am working away in the garage with my back turned to the car.  After about 15 minutes I turn around to get a glass of water in the house and see that my wife has returned from her errands. I start to talk to her but say “Hang on,let me get my hearing aid and CI which is on the hood of the car….Holy S#@*!”.  I now realize the car is gone along with my hearing aid and cochlear implant.  I am cursing like a trucker…screaming like a banshee…swearing like a sailor…angry like a, well you get the picture now.

Half a block away we find the hearing aid.  But so what.  I barely hear with that thing, its the CI I really need.  We continue to search the road while at the same time we are calling and texting my son to stop driving and pull over.  I am still panicking.  I have mental images of my cochlear implant becoming road kill.  Finally, he gets the message. Turns out the magnet on the CI kept it stuck to the hood, even though he had been driving for 20-30 minutes.  He pulled it off the hood and brought it home.  The CI still worked despite bouncing around on the hood of a moving vehicle.

 

Lessons learned:

1. Don’t put expensive hearing devices on the hood of a car.  Duh!

2. Try not to curse too much when you can’t hear.  You can’t monitor your loudness.  Turns out the whole neighborhood heard me.  (Sorry folks.  But maybe you learned a few new fascinating words? They may come in handy later.)

3. Boy do I I love to hear.  So much so, that the thought of having to wait a few days to get a replacement CI freaked me out.  I can go an hour or 2 without hearing, but not more than that.

4. I still wish I never needed these things.  Normal hearing people can sweat, swim, get dirty and still hear just fine.  But there is no point wishing for something thats never going to happen.

5. I was very lucky yesterday…maybe I should go out and buy some lottery tickets.

My fellow people with hearing loss or parents of kids with hearing loss…do you have any stories like this to share?

Bear Encounter with a Deafened Dad


An Ontario Black Bear

I have had several opportunities this summer to camp in one of the most beautiful places on earth: Algonquin Provincial Park.  It is located about 3 hours north of Toronto and is pretty big.  It is 7,725 square kms which, for my American friends, is about the same size as the states of Delaware and Rhode Island combined.   For my European friends, that is about one quarter the size of the country of Belgium.

Algonquin Park has over 1,500 lakes and 1,200 kms of streams and rivers.  It is also the home of lots of wildlife.  I personally have seen many species of wild animals in Algonquin Park including beaver, huge moose, deer, wolves, and finally black bears.  It is an encounter with the latter animal, Ursus Americanus, which serves as the inspiration for this story.

For years I have camped in Algonquin and never once saw a bear.  But in 1999, the spring bear hunt was cancelled in Ontario.  Some say that this caused the population of black bears in Ontario to rise from 100,000 to over 250,000.  Others argue the increase is smaller than that.  I am not going to go into the reasons why they cancelled it or whether I agree with it.  But needless to say, when the bear population grows over 150%, the chances of encountering a bear increase.

So, a few years ago, my son (who was about 12 at the time) and I decided to do some backcountry country camping in Algonquin.  We packed up our gear, loaded the canoe on the car and off we went.  We selected a lovely site on a lake so we could swim and fish.  We had just finished an afternoon swim and I was starting to make dinner while my son went to gather firewood for a campfire.

Of course, I did not have my cochlear implant on because I was still drying off from the swim.  I was barefoot and just in my bathing trunks.  Delicious meat with no wrapping on it.  I turned to go to the tent, which was about 4 meters or 12 feet behind me, to get a t-shirt.  And there he was..Big George the Bear as I later called him.  George was just sitting there beside the tent and staring at me, probably wondering why I was so calmly ignoring him up until that point.  Well George, you snuck up on a deaf guy that’s why.

This is not George, but looks almost exactly like him. George has a green ear tag.

He was a beautiful bear with a gorgeous coat…but I would have preferred to see him on a high definition television or in a zoo like 99% of the rest of the sheltered world.  I was close enough to see that he had a green tag in his ear.  This indicates that he had already been tranquilized, tagged and relocated for bugging people.  Well, I guess George wanted some more Doritos from the car campers which were only about a one hour paddle away.

Note that George was not interested in anything I had in the tent.   I am a very careful camper.  All food and toiletries are safely suspended high up in a tree and not in the tent.  You would be surprised what bears consider to be food (which is almost anything).   I have heard of people leaving Preparation H hemorrhoid cream in their tents only to come back later and find a bear happily munching away on the tube.  Yuck.

After my initial surprise to see a wild bear right behind me, my thoughts turned to my son.  Where was he?  Should I call out to him? But I did not have my CI on so I would not hear a thing if he responded.  I stupidly forgot to bring bear spray or bear bangers with me.  For those unfamiliar with these protective devices, bear spray is a large can of  pepper spray under high pressure.  If needed, you can squirt it into a bears face and it will take off but in intense pain.  I had the unfortunate experience of spraying a tiny amount into the wind and having it come back at me.  It was extremely painful even though the amount was only miniscule.  Pepper sprays such as bear spray is actually illegal in many parts of Europe, but that makes sense.  Why would a European ever need it? There are no dangerous animals there.

Bear Spray

I recall reading about what to do if you encounter a bear.  Note that your strategies for black bears will be different than brown or Grizzly bears.  Black bears are excellent tree climbers so don’t bother trying that.   With Grizzlies, you more or less play dead and pray to what ever Deity you worship.  With black bears, I have read, you actually try to make your self appear big and scare it away.

Black Bears are excellent climbers…so don’t climb a tree!

So I made my decision.  I was going to scare the bear.  If he ran, great.  If not, at least my son would be protected, he could have me.  Believe me, there is plenty of meat on me, particularly back then when I was a chubby deaf guy.  So I grabbed the pot I was boiling water, dumped out the water, got a spoon and started banging it while at the same time roaring at the bear.  I must have been quite a sight.  Shirtless, shoeless, chubby white deaf guy chasing a bear with a pot and a spoon whilst dropping F bombs.

The thing ran so fast.  I heard bears are fast runners, but to see it live with my own eyes was something else.  But most importantly, my son was safe.  He returned out of the woods with a look on his face that said “That’s it, my old man is now crazy”.  He never did see the bear himself.

So what did I learn from this experience?

1. I am very proud that my first instinct was to protect my child.  We all hope that we will do so, but it is nice to have been tested and passed.

2. I never go into the backcountry without bear spray and bear bangers now.  This is of particular importance to a person with hearing loss.  In humans, hearing is the best sense we have for detecting danger.  It works 360 degrees, 24 hours a day, 7 days a week.  Our other senses can’t match hearing for danger detection.  So, all the more reason for a person with hearing loss to protect oneself whilst in bear country.

3. It is true what the experts say about what to do if you encounter a wild bear.  I would suggest reading up on that if planning a trip to the back country.

4. But I am not afraid of bear encounters, just respectful of the animal.  Statistically speaking, I have a greater chance of being killed on the highway while driving up to the park.  Just keep the campsite clean, store food and toiletries up in a tree, and bring bear spray for protection.

Here are some pictures of a recent trip my son and I did on Algonquin.  Enjoy!

Sunset in Algonquin from our campsite

My son Alex filling his head with knowledge.

That’s me in my kayak.

Working Out Deaf


I won the contest at work.  We had a bet who could lose the most percentage weight.  Yippee for me!  I lost 29 lbs in 9 weeks.  Just over 11% body weight reduction.  I still need to lose about 25 more to finally put an end to the “chubby deaf guy.”

Working out Deaf…do you wear your hearing instruments or not?  Yes, I have a water resistant hearing aid and cochlear implant.  But years of being taught  to fear moisture on my expensive hearing devices still is in me and I can’t seem to get over that.  Thus I always remove my CI and hearing aid when I work out.  This has pros and cons.

Pros:  I like being in my own little world sometimes.  I enjoy the peacefulness, and I seem to focus better on exercising.  I can work out as intensely as I wish with no concern about damaging my hearing instruments.  Lastly, at the gym, there can be some arrogant jocks spewing off stupidity.  My son tells me some of the conversations he has heard.  A real classic was some meathead dude looking forward to visiting LA because  “Almost all the women in LA have done porn.  Its true dude!”  These are the times I consider myself blessed to be deafened.

But there are some cons and some safety points to consider.

First, I think I need a t-shirt that says “I am not a douche-bag…I am deaf”.  Although I try really hard to not block anybody and be aware of my surroundings, sometimes people ask me questions like “are you done with that machine”.  I look like I am ignoring them, which gets erroneously interpreted as arrogance.  I mean, thats what guys do in the gym, right?  It is almost a dick slapping contest.  Well, no, not for me…I am not a jerk like some of the other guys in the gym, I am just deaf.

Then there are the safety issues.  I also run outside with no hearing aid or CI.  Let me officially state that I am not advocating this for anyone because you may not hear a car and get run over.  The safest thing would be to run on a treadmill if you insist on doing it “deaf”. Or use your hearing instruments whilst running outside.  Try protecting them with products like the Hearing Aid Sweat Band or Ear Gear.  I have not personally used these products, so don’t interpret this as an endorsement…but check it out.  Lastly, you when you are done with your exercising, put the hearing instruments in a Dr-Aid kit of some type.

There are now hearing aids that are water resistant.  Phonak has the new H2O line of hearing aids as does Siemens with the Aquaris product.  In addition, the Cochlear Nucleus N5 is water resistant, while the Advanced Bionics Neptune is actually waterproof.

But I have taken some steps to increase my safety, namely by enhancing my visibility.  First, I wear a reflective safety vest.  This makes me pretty much glow when headlights shine on me.

This vest makes me more visible.

But I didn’t stop there.  I also added some flashing lights to the vest.  I have a white at the front and a red one on my back.  If you can’t see me now, should you legally be driving?

These lights make me look flashier than Elton John.

The decision to exercising “deaf” is entirely personal.  I prefer it for myself, and I accept the related risks (not hearing traffic, and not hearing jocks).

What Do You Do When You Can’t Hear Anymore?


Here’s a simple question that seems to confound many hearing health care professionals.  What do you do with a patient who can’t hear anymore?

I guess we should back up a bit a define what we mean by “can’t hear anymore”.  What I am referring to is patients with hearing losses typically in the profound hearing loss range with auditory-only monosyllabic word identification scores typically around 25% or less.  Note that we need to look at both the hearing loss and the word identification score as the variability of communication performance in this hearing loss range is massive.  Additional, we should look at auditory-visual word identification to see how well the patient can utilize the addition of lip-reading information.

Lets look at a case that I recently encountered.  The woman had a left corner audiogram.  Word identification score was 0%.  Auditory visual speech perception was not much better, but was not assessed by the clinical audiologist with an AuD so we don’t really know.

I was contacted and asked if I could help with the FM fitting at this office.  I agreed, but as is always the case, I was not given all the details.  I got there, asked to see the file and my jaw dropped.  The conversation with hearing health care professional (HHCP) went something like this:

Me: So what are we doing with this patient?

HHCP: We are fitting an FM system?

Me: Why?

HHCP: What do you mean why?

Me:  I mean “why?”, thats what I mean.  What will the FM system do?

HHCP: It will help the client hear better.  She and the family are pretty frustrated.

Me:  Well of course they are.  But how will the FM help the client hear better?  Will it improve her word identification score?

HHCP: Sure.

Me:  How?

HHCP:  By improving the signal-to-noise ratio.

Me:  When you did the word identification test, did you do it in background noise, or in quiet?

HHCP:  In quiet.

Me:  So we are already looking at the best possible score and thats 0%.

HHCP:  I guess…

Note that this is not the first time I have had a conversation like this with an audiologist or a hearing instrument practitioner.  It seems to me that most clinicians have no clue what to do with patients who have little or no hearing.  I am not 100% sure of the reason for this, but I suspect that it goes back to our problems with our training. And that is as follows:  We are only trained on how to assess hearing and how to fit a hearing aid.

The audiologist in this example is, like most of my colleagues, a good and decent human being who truly wants to help the patient, but doesn’t know how.  He is simply the end product of his training.

As an audiologist who also had 0% word identification and little hearing, I would like to offer my hearing health care professional colleagues a few suggestions on what to do with these kinds of patients.  This is just a starter list…books could probably be written on this topic.

1. Counsel the patient.  Specifically, let them know that they cannot hear anymore and we need to change tactics.  In the case example above, and with the managing audiologist’s permission, I sat down the patient and her family and told them just that.  The woman’s son practically had tears in his eyes…tears of frustration.  He said “You are finally the first person to finally tell us what we have been saying for years, “my mother can’t hear”.

2. Let them know what a hearing aid can realistically do.  In this woman’s case, it might provide a few basic awareness cues of loud sounds in the environment.  Thats it.  It will do little for speech perception.

3. The patient has two basic choices now.  1. Cochlear Implants or 2. Switch entirely to a visual approach.

4. Cochlear Implants:  Make the referral to the closest implant program.  Give a basic description of what it does, but stress that you are NOT a cochlear implant audiologist and they should get the correct information from the proper professional.  Resist the temptation to give too much information here, unless you are very informed about CI’s.  And don’t worry about candidacy.  Let the CI centre work that one out.  Most audiologists wait way too long to refer to an implant centre. When in doubt, refer to the CI centre.

5. The second option is to switch to visual approach.  This can include learning sign language, using written notes, using text messaging via a mobile phone, things of that nature.

6. Lip-reading as an exclusive method if communication is not an option in my opinion.  An explanation why is another entire blog posting, but basically far too many words look the same on the lips and it is extremely exhausting to lip-read all day long.  It is best used as a supplement to hearing.  Works great for folks who still have some usable hearing.  See a fellow blogger’s posting on this topic.

7. Discuss alerting devices that use visual or tactile stimulation.  This folks need to know when there is someone at the door, if the phone rings, if there is a fire etc.  Hearing Ear Dogs could be discussed here as well.

8. Give options for phone communication.  In the past that would have meant getting a TTY (sometimes called TDD’s).  Nowadays, we have even more options including text messaging, instant messaging, email via computers, email via smart-phones etc.

9. Make sure the patient knows about captioning.  This includes TV, but also real-time captioning (CART).

I provided all this information to this lady and her family.  I also took back the FM and told them that it would be a waste of money at this time, but if they got a cochlear implant, an FM system can be added then.

This woman, who’s hearing loss was progressive over the years, should have started using an FM system when her hearing loss was moderate-severe.  Her time for the FM came and went.  FM systems need to be added much earlier, not when the client is a CI candidate.  That’s too late.

Seeing the Forest for the Trees…What’s Wrong with Audiology


I love my Audiology colleagues.  But I do not always love my Audiology profession.  For the most part, Audiologists are very skilled and knowledgable professionals.  We do an excellent job of assessing hearing levels, and identifying the site of lesion of the hearing loss.  We have incredible diagnostic tools at our disposal ranging from basic pure tone audiometry (we still mask better than anyone else), to ABR, to Otoacoustic emissions.  We understand how hearing aids work, how to fit them, and how to verify performance using real ear measurement techniques.  In short, we are very well trained at performing assessments.

So whats my beef?  Let me illustrate from a few examples.

  1. When I started working as an educational audiologist in the 90’s, I was asked to report on the progress of child with hearing loss.  I did the usual…hearing assessment, hearing aid selection and verification.  I was an early adopter of the RECD, and I proudly showed how well the hearing aids were meeting DSL targets.  But the parents kept asking me why their kid couldn’t hear well, and I just kept thinking “Beats me, but I did a great job of hitting targets, so there”.  This started to make me realize I needed to look at things differently.
  2. I have had numerous times where I have been asked to assist with an FM fitting on an adults who essentially who have no hearing left.  As recently as just a few months ago, an Audiologist, who was a recent graduate from a Doctor of Audiology (AuD) Program, asked me to help with a client who only have hearing at 250 Hz and 500 Hz.  In other words- deafened.  I thought, “Now you want to try an FM system on this client?  You should have introduced this 10 years ago when the client had a moderate-severe loss.”
  3. The percentage of people with moderate severe losses or greater who use FM systems is disappointingly low.  Yes, I can hear my colleagues protesting saying “Adults won’t use FM”.  Well, if you polled the patients with hearing loss and asked them why they don’t use an FM, their likely answer will be “What’s an FM system?”, or “I was never told about these devices”.
  4. People with hearing loss routinely complain of hearing in noise yet we rarely assess this.  We cannot just do a pure tone audiogram in quiet.  We need to assess the problem that is vexing our patients the most and then find equipment and strategies to deal with that.
  5. How often are the limited number of rehabilitative lectures at Audiology conferences pushed back to Saturday morning.
  6. How many patients know about other assistive devices such as vibrating alarm clocks and fire alarms that are also needed for daily living with a hearing loss?
  7. I frequently am asked situational based rehabilitative questions.  For example, “Peter, how do you help a client hear in meetings” or “How can I help my client who works in a call centre?” etc.  Audiology seems poorly equipped at finding solutions to these situational problems.

What we need is to change Audiology practice from one that is almost exclusively diagnostically-driven to one that is also rehabilitative in nature. We have daily opportunities to do both in parallel:  to complete exemplary testing and then guide the rehabilitation of the patient based on test results.

Frankly the AuD has not helped expand the scope of our interventions, in fact, it has made us even more diagnostically focused.  This bias reduces our practice habits to those of technicians rather than professionals who practice to the full scope of our expertise.

In 2002, the World Health Organization introduced a classification of functioning, disability and health (ICF) to measure health and disability at both individual and population levels. The ICF “takes into account the social aspects of disability and does not see disability only as a medical or biological dysfunction. By including contextual factors, in which environmental factors are listed, ICF records the impact of the environment on the person’s functioning.” (www.who.com). The ICF can help identify: What is the patients level of functioning? What treatments or interventions can maximize functioning? What are the needs of persons with various levels of disability- impairments, activity limitations and participation restrictions?

How do we apply this framework to Audiology?  We view hearing loss as medical/biological dysfunction and our practice culture encourages us to focus on this.  We cannot stop at this – we must go further to examine patient’s functional capacities.

Without question, every patient should have their hearing levels fully and accurately assessed. In addition, we need to accurately determine, to the best of of ability with our non-invasive procedures, the site of lesion. The hearing loss is the genesis of the problem and we cannot proceed we fully understand what we are dealing with.  This is where Audiology shines.

Next we need to look at function.  At a minimum, we should perform a Hearing in Noise Test such as the LiSN-S PGA an all of our clients.  The world is a noisy place and we need to know in what situations our patients will have difficulty.

Functional capacities can also be assessed by asking our patients directly how they function in the context of their own daily lives using a tool such as the COSI.

Once we identify functional concerns, we need to then determne how to maximize function.  Here we need to consider all of the equipment needed.  For example, consider a client with a moderate severe hearing loss that performed poorly on the LiSN-S PGA and has identified several hearing in noise problems on the COSI.  Such a client will likely need a hearing aid with directional microphones, an FM system, and perhaps some alerting devices.  Then this client will need to be counselled how to use these devices properly.  This is a wholistic treatment plan.  But too often, a hearing aid is selected solely based on cosmetic concerns.  Nothing else is recommended, equipment such as FM systems are not discussed.  This is unacceptable.  We owe it to our clients to counsel them properly on the pros and cons of different equipment choices and on how to best navigate the world at-large with a hearing loss . In the absence of this collective practice change, our clients will succeed or fail only through trial and error. I believe that we are capable of delivering more.

These fundamental changes need to occur at the University level.  Audiologists are intelligent and compassionate people; they are fully capable of practicing in this model.  They are simply not taught to think in this way.

Once we shift our focus to maximizing client function, we will be able to see not only the trees but the forest as well.

Research on Music Perception with a Cochlear Implant.


As you all know, I love music.  I wish I loved visual art or sports more, but I don’t.  I love music and with my verkakte ears, its not an easy task.  I decided to review the literature and see what the research tells us about music perception in cochlear implants (CI’s).

If you look at some of the earlier research prior to 2000, you barely see much reference to music perception in CI’s.  I think the researchers, and engineers were busy working on getting good speech perception.  Makes sense.  And as the speech perception abilities of CI users began to improve, interest began to shift to other important listening  abilities such as musical perception.

One researcher who has done a lot of work in this area is Dr. Kate Gfeller.  In a 2000 article (J Am Acad Audiol. 2000 Jul-Aug;11(7):390-406), Gfeller et al found that 83% of adult CI users reported diminished music enjoyment post-implantation.  In fact one third of the CI users even avoided music altogether as they found it to be an aversive sound.  These are not encouraging results.  But do remember that these folks received their implants in the 1990’s.  This technology is now 20 years old.

Looi et al, 2007 (Ear & Hearing: April 2007 – Volume 28 – Issue 2 – pp 59S-61S) did a study comparing the music perception of CI users compared to hearing aid (HA) users.  Note that the HA users were all potential CI candidates, so they all had significant hearing loss.  This study showed that while neither device (HA or CI) provided satisfactory music perception results, the CI users gave slightly better ratings than the HA users.  So now we are actually seeing some data showing music perception getting better with a CI, but still not great.

Another study by Looi et al in 2008 (Ear & Hearing: June 2008 – Volume 29 – Issue 3 – pp 421-434) looked again at CI users and HA users who were potential CI candidates. So again these HA users also had significant hearing loss.  On a rhythm recognition task, both groups did about the same.  On the pitch perception task, the HA users outperformed the CI users (oh oh, not good).  In fact many of the CI users needed two pitches to be at more than a quarter of an octave apart before the notes sounded any different.  Not good.  In western music you need to be able to hear a one semitone difference.

After reading this article, I checked what my skills were like using a CI only.  I had my brother play a bunch of two note pairs on a piano keyboard.  My task was to say if the two notes were the same or different and then secondly which note was higher in pitch.  For the notes above middle C, I was able to reliably report if the two notes were same or different even if they were only one semi-tone apart.  I was about 80-90% accurate at identifying which note was higher or lower.  For notes below middle C, I needed notes to be at least one full tone apart to get the same level of accuracy, but performance deteriorated as the pitches got lower.

So here’s the thing now.  Looks like I am not getting good low frequency pitch perception with the CI which is so critical for music.  Low pitches may not be that important for speech as the consonants are mainly high pitched and consonants give you speech intelligibility.

I therefore personally decided to use a hearing aid in my non-implanted ear.  I hear music much better whilst using a combination of a HA and a CI.  But is it just me?  No.  A study be El Fata et al (Audiol Neurootol. 2009;14 Suppl 1:14-21. Epub 2009 Apr 22) looked at 14 adults who continued to use a hearing aid in their non-implanted ear after getting a CI.  Subjects were asked to identify excerpts from 15 popular songs, which were familiar to them.  The presentations were done bimodally, with the CI alone and then HA alone. Musical excerpts were presented in each condition with and then without lyrics. Those subjects who had more low frequency residual hearing (> 85 dB HL in the lows) did much better on all the tasks with both a CI and an HA than either the CI only condition or HA alone.

Another study by Gfeller et al in 2007 (Ear & Hearing: June 2007 – Volume 28 – Issue 3 – pp 412-423)  also confirms the need for better low frequency hearing for music perception.  In this study, CI users which electrical only stimulation (the regular type of CI) were compared to subjects with a hybrid implant.  The hybrid implant uses a shorter electrode array for giving you the high pitches whilst still using a hearing aid type of air conduction for the low pitches.  Usesing low frequecny acoustic hearing significantly improved pitch perception compared with elctric only CI’s.  But before you go rushing off asking for a hybrid implant, you need to know that not everyone can get one of those.  You need to still have sufficient low frequency hearing.

So here’s what I can conclude from these articles:

1. The newer studies seem to show better music perception in CI users than older studies.  This is most likely due to improvements in technology in which the newer implants give a richer sound than the older devices.

2. Music perception with a CI via electrical stimulation could still be improved.  It seems to be related to the poor perception of the low frequencies.

3. If you still have some usable residual hearing in your non-implanted ear, use a hearing aid in that ear.

4. Help your ears by making music easier to hear.  Use some of the techniques I use by adding FM technology to your CI and hearing aid for either live music or with an iPod.

More Gig Pics…


Performing live music in a band is like a dream come true for me.  I still can’t believe that I am able to do this with my hearing loss.  On one hand, I am a bit pissed that I have a hearing loss at all, but the fact of the matter is that shit happens to all of us in one form or another. Hearing loss is the hand that has been dealt to me, but I am going to play this hand the best I can.  If it was not for cochlear implants, hearing aids and FM systems, I would have been really screwed.  But I am not.  This pictures are proof of that to me.  I am one lucky dude.

Again, I must thank my friend and professional photographer Arsenio Santos for taking photos of the event.  There were so many good ones to choose, but here are some of my personal favorites.

Thanks also to me awesome bandmates Deb, Luigi and Warren.  I love you guys!  Thanks also to my buddy Dave for doing the acoustic set.  And one more shout out to one of my best friends in the world, Ryan Switzer from Massive Tank Studios, not just for doing the sound, but for helping me become a musician.

Deb is such a passionate singer.

Looking cool in a B&W photo

Warren is a fantastic drummer.

Luigi singing and playing guitar. You are awesome Luigi!

I am having a good time, can you tell?

But I do need a haircut.

Awesome Gig Pics of Maxine, Dave and Pete…


My friend and professional photographer Arsenio Santos was so kind to take pictures of our event.  As you may recall, the first part of the show was a selection of acoustic songs.  Here we see myself on acoustic bass, Dave on his 12 string, and Maxine vocals.  Thanks Arsenio, the pics look awesome!  Looking forward to seeing the other pictures!

This is my buddy Dave.

Lovely and talented Maxine.

More pics of the lovely Maxine...she's much easier on the eyes than Dave and I.

Behind The Scenes with a Deafened Rock Star.


Ok, this title is wishful thinking.  Deafened, yes, but rock star, perhaps not.  We did a gig to raise money for a friend and colleague Warren Estabrooks whose organization is called “We Listen International”.  Warren and his team provide professional education, training and consultative services for professionals who work with children, teens and adults with hearing loss.

We started out the evening with some acoustic covers of some songs.  I played my acoustic bass whilst my buddy Dave played his 12 string and sang.  Later, my friend Maxine Armstrong, also an audiologist, did a beautiful rendition of Tom Petty’s Free Fallin.

My son’s Band Sticks and Stones were up next.  They played all original material that they wrote themselves.  Their sound is sort of “Indy” with jazz-like instrumentals.  Absolutely fantastic stuff.  If these guys had a recording contract, I am sure they would be hugely successful.  Check out their You Tube stuff here.  Also, you can download their songs here.

Finally, my bandmates and I got up to do about 18 songs.  I am so proud to be playing with these guys, everyone put in such a fantastic effort.  None of us are professional musicians, but we did our best to sound like it!

Speaking of professionals, special thanks to my good friend Ryan and his assistant Laura from Massive Tank Studios for doing the sound for the evening.  I love you guys!

Interestingly, while it is fun and exhilarating to perform music and have folks cheer for you, it is also quite stressful.  Why?  Because nothing ever goes exactly as planned.  The key is to not freak out, persevere, problem solve and find creative solutions. Lets take a behind the scenes look at the day to show you what I mean.

1 p.m.:  Start loading up the PA system, speakers, stands, bass amp, bass guitars, mics, cables etc etc.

2 p.m.: Start unloading gear at Pub.  First surprise.  Only one outlet box for all the gear.  Go and find more power bars and hope we don’t blow any fuses.

4:30.  Go to Music Studio to rehearse Free Fallin with Maxine.  Plan is to have two guitarist and one bass.

5:00.  Maxine still stuck in traffic.

5:15.  Rehearse with Maxine.

5:30.  Rush home to change.

6:00.  Go to Pub to finish setting up gear.  Three cables are dead, need to find replacements.  Deb, our singer needs a music stand.  Call wife to get her to bring one.  Forgot MyLink Receivers.  Call wife again to get those.

6:30.  My son has not arrived yet to do his set up and sound check.  He’s still at the tattoo parlor getting two new tattoos.  Really buddy?  On the day of the gig?  Is that a good idea?

7:00.  Supposed to start, but still setting up.  Someone has unplugged my TX300V FM from the Aux Out 1 and used it for something else.  I don’t think so people.  Deaf guy gets first dibs on sound.  Plus its my mixing board, so I get to call the shots.  Slightly tense conversations ensue, solution found.

7:40.  We start to do the acoustic set that was supposed to start 40 mins earlier.  First three songs are fine as we over-rehearsed these.  Maxine comes up to do her song.  Ryan was supposed to join us by playing guitar, but we ran out of inputs on the PA for another guitar.  Bummer, because while I love my buddy Dave who is playing guitar, he is rhythmically impaired.  Maxine sings like an angel, but I lose my timing.  Sound man Ryan sees I am struggling and becomes my human metronome.  I read his lips as he is counting out the time.  While I am playing some other folks with Cochlear Implants are requesting the MyLink FM receivers I promised.  Shit, they are still in my car.  Cant’ get them now, I am playing (for Pete’s sake!)

8:00.  Son’s band sets up to play.  No sound check because my philosophical artsy son decided to get tattoos earlier.  Their performance was fantastic, but the pub owners are complaining it is too loud.  Trying to get drummer to play as lightly as possible so everything else can be turned down.  All drummers are now unhappy.  I think all drummers were all born as Bam-Bam Rubble.

8:10.  I am using my son’s band as an opportunity to check my sound through the FM.  I discover the compressor is set wrong. Knee point is too low, compression ratio is too high and release time is too slow.

8:25:  Adjust compressor.  Hope its ok.  Run to car and get MyLink+ receivers. and hand them out.

8:30.  Start to play first set with my band.  Sound still not right.  Mouth to Ryan the sound man to increase vocals to Aux Out 1.  Reach behind me and increase knee point on compressor a bit.  Raise output on FM but over did it.  Sounds distorted.  It is peaking in the red too much.  Next song plan to lower it.  Can’t hear Luigi, the guitarist now.  Thankfully I know some basic chords on guitar, so I watch his hands to see what he is playing.  Luigi sees this, and moves a bit so I can see him play better.  He understands what I need.  I love you man.

8:35.  Discover I am not feeling the kick drum through my platform very well.  Look at mic on kick and discover its too far away.  Lower gain on FM.  Better.

8:40.  Move mic on kick closer, still not right.  But now I remember why…Warren, our drummer, is trying to play quietly (Quiet drummer…is that oxymoronic?).

9:10:  Finish first set, and take a small break.  Decide to play second set without my shoes on so I can feel the kick drum better.

9:25:  Start second set.  Sound is much better now.  I am feeling the kick drum on my platform through my shoeless feet  better now.  My timing improves.  Tweak the compressor a bit more.  Warren, the drummer, and I are communicating well via eye contact.  We are finishing our songs well.  If you pay attention to recorded songs, you will notice that they most pop songs don’t really end, but they are faded out by the recording engineer.  Live music requires a definite end, and getting everyone to finish a song at the same time is one of the challenges of playing live music.  We devoted an entire rehearsal to finishing songs!

9:50.  Sound is perfect now.  But that’s the last song.  Bummer.  We finally have everything perfect.

10:00:  Everyone is very kind with compliments.  Some of my brutally honest asshole “friends” also pay us compliments.  Hey, maybe we were good?  Actually, come to think of it, we were great.  Everyone loves our singer Deb, and they should.  She is a natural frontman (front-woman?) for a band.  I love you Deb!

10:15.  Tear down all equipment, load up cars, take equipment home.

11:30:  Go to Deb the singer’s house for drinks.

12:30 a.m.:  Son calls and says he needs to be picked up because his friends parents kicked everyone out of the house for being too rambunctious.  Hey, they are teenagers, what do you expect?

1:30 a.m.: Come home and unwind.

2:30 a.m.:  Go to bed.

Moral of the story.  Nothing ever goes as planned so don’t expect it.  Roll with it.