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.

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What Does a Person with Hearing Loss Know About Hearing Loss?


Recently I was sent an email from an audiologist (really nice recent grad) asking how to help a patient with hearing loss hear better in the noisy workplace.

When the issue of using an FM system came up, apparently the person with hearing loss stated “No, that would not work in my situation because it is too noisy”.  So I was asked to come up with some other suggestions.

Ummm, ok,  I have a whole bunch of problems with this.

First, I think we need to clarify when we need to listen to our patients and follow the patients lead.  At other times we, as audiologists, SLP’s, hearing instrument practitioners or hearing resource teachers need to provide leadership and guidance to our clients with hearing loss. As an Audiologist with hearing loss, I have walked in both sets of shoes, so I would like to offer some suggestions.

First, here is a list of things where the person with hearing loss knows best:

  1. Ask and find our all the different situations in which the person with hearing loss is having difficulty.  List them all and seriously look at how we are going to help overcome those challenges.
  2. The patient knows and can tell you how it feels to be in a given situation.  Don’t be afraid to ask about this.  When a patient says ‘I could not hear at my daughter’s wedding” find out how they felt about that.  It is good to just let the patient explore their feelings and frustrations.
  3. Discuss past experiences both good and bad to see what you are up against.  For example, find out if the client ever tried an FM system or ever used directional microphones in the past.  Likely if something was a failure in the past, find out how much coaching the patient had in how to use the equipment.

In short the patient knows, better than you the clinician, the situations they are having the most difficulty in, and what it feels like to have a hearing loss.  But here is what the patient does not necessarily know and where the expertise of the professional is required.

List of Things a Patient with Hearing Loss Does NOT Know;

  1. Whether or not a hearing aid is even needed.
  2. What electroacoustic characteristics are needed in the hearing instrument
  3. What style of hearing instrument is most appropriate.  A patient can wish all they want for a tiny hearing aid, but if the loss is too severe, it can’t be done.  Period.  Yes, many patients have lots of choices of the form factor, but some do not.  We need to lead here, not follow.
  4. What technology for managing noise is needed?  For example, if a client has a moderate severe loss and a speech in noise test such as the LiSN-S PGA indicates that an FM system is needed, the hearing health professional NEEDS to communicate this to the client.  The client does not know what technology is required.  They just know the situations they find challenging.
  5. How to effectively use the equipment.  You cannot simply toss the equipment at the client and hope they figure out how to use it in the difficult listening situations that were identified.  Patients need our counseling and coaching here.

Now back to the patient who can’t hear at work.  The specific situations at work need to be fully explored.  Ideally, you can do this formally with the COSI.  Again, the patient understands this so much better and he needs to tell us as much as he can about his challenges if we are going to have any chance of finding solutions.  Next we need to explore why he feels that an FM system would not work.  He likely does not know how the technology works or how to use it effectively.  There are excellent FM counseling tools available for this purpose.

But we have to stop letting patients dictate the wrong things.  I have seen in my 20+ years of professional experience numerous patients who are wearing “dirty little secret” tiny aids and are not getting the correct amplification.  We need to provide leadership here and work the client towards more appropriate amplification.

Similarly, we must always consider not just the amplification needs but also the hearing in noise needs as they relate to the client’s own personal situation.  Will the client need directional microphone technology?  Should it be fixed or adaptive directional microphones? Will directional microphone technology be enough or will FM technology be needed?  Most patients with moderate severe loss and greater will likely find themselves in situations in which a hearing aid or cochlear implant is not enough.

I agree that we cannot force anyone to take our professional advice.  But patients do have a right to make an informed decision.  In my opinion, we are obligated as Hearing Health Care Professionals to give the patient all the facts.  Too often, when I give talks about directional microphones, FM systems, and other assistive devices,  a patient will ask me “How come this is the first time I am hearing about this stuff?”

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.

Hearing Not Required…


Shumka Dancers

I took my parents to see a Ukrainian Dance Troupe last night called “Shumka”.  This group based out of Edmonton Alberta (surprise, surprise) has been in existence for 50 years.  They put on an absolutely dazzling performance.  While my expertise on the art of dance is limited, I am certainly not ignorant to the elements of fine dance as I have been to about 10 ballets in my lifetime.  Last night’s performance, at least from my perspective, was every bit as technically sophisticated and beautiful as a ballet, but a heck of a lot more fun!

As I was watching and enjoying the performance, it dawned upon me that I was fully enjoying this event just like everyone else in the audience.  Sure, the dances were choreographed to music, but I heard that well enough. The music was not the focus of the performance, it was the dancers- their athleticism and ornate costumes.  I really did not need much hearing to enjoy this activity.  I just sat, clapped, and cheered like everyone else.

It seems that so many regularly occurring things in life are affected by hearing loss. Work, communication, enjoying television, theater, movies, music, going to a restaurant,  and going for drinks with friends, all require both technical assistive devices such as an FM system, and some accommodations from my family and friends in order for me to participate.  Not that I am complaining…I would not want to miss out on these important activities.  I am grateful that these devices grant me the necessary access and improve my ability to participate.

But its also nice to find exceptions to this through activities that are not taxing on the ears.  For me, these typically include hobbies such as fishing, archery, kayaking, hiking and photography.   And last night, it included dance!

Sometimes I wish I enjoyed more of the visual arts.  I have certainly tried…I have been to the Art Gallery of Ontario, the Musee du Louvre and Musee d’Orsay in Paris, the Met and MoMA in New York to name a few.  Sadly, visual art does not speak to me the same way that music does.  Perhaps I lack the training and education to fully appreciate the immensity of meaning these pieces of expression may hold.

In any event, there is much to enjoy in this world that does not require good hearing.  I find that it is quite beneficial to seek out these “hearing not required” activities to enrich our lives.  It also provides necessary relief from the challenges of hearing loss.  Its good for you!

For Family Day today, we are off to the Bell Lightbox (Home of the Toronto International Film Festival) to see a French film called Lancelot du Lac.  It will have English subtitles for all the viewers, not just me.  It should be fun!

10 Lessons My Hearing Ear Dog Taught Me.


As you may know, dear reader, my Hearing Ear Dog “Amie” has been living with cancer in her bladder (invasive transitional cell carcinoma) for some time now.  In fact, it has been almost 20 months ago that we were given the news that she may only have 2 months to live.  Somehow, she has beaten the odds and has survived much longer than expected.  All the vet can tell us is “Keep doing what you are doing.  I am not sure what it is is, but it seems to be working!”  To be honest, I am not sure either.

My wife and I were reflecting on the impact Amie has had on our lives.  In addition, how how Amie has changed my personality.

Here are some of the lessons Amie has taught me:

  1. Praise is Better than Punishment for Changing Behavior.  Amie never responded well to being punished.  She hated it and would shut down even if I simply raised my voice a bit. But boy did she love praise.  Works much better for humans too.
  2. Don’t Yell!  I was raised in an Eastern European household in which there was quite a bit of yelling.  We were all used to it and thought it was acceptable to fly off the handle once in a while.  Well, Amie never liked that, nor did my English wife.  However, whenever I had what our family referred to as a UTT (Ukrainian Temper Tantrum), Amie would hide in a corner and shake.  Within just a few short weeks of getting Amie, my UTT’s dropped off dramatically.  And they have stayed low for the 12+  years that Amie has been in our household.
  3. Virtue of a Simple Life.  We can get all hung up on the latest toys and gadgets in life.  Oh look, the Joneses next door now have an Acura and a Beemer.  But Amie had no use for any of those things.  Her favorite toy is a squeaky hedgehog and a tennis ball.  Her favorite activity was a walk in the woods.  She kept us grounded and humbled.
  4. Fortitude or Keep your Chin Up Despite Adversity.  Despite having herniated a disk in her spine, having cancer, and Idiopathic Vestibular Disease, Amie keeps wagging her tail, and loves our company. Similarly, being deafened may suck, but it clearly is not the end of the world.
  5. Forgiveness.  If I forgot to feed Amie, or didn’t take her for much of a walk, she always forgave me unconditionally.  So if, for example, someone forgets to speak clearly for me, I try to forgive.
  6. Identification of Good Character.  Amie is so sweet, she loves everybody.  There was no one that she hated, she saw good in everyone.  Some even overcame their life long fears of dogs after meeting Amie! But still, some folks did not like her.  And you know what, these people ended up not being nice people at all.  So having Amie saved me time but not wasting energy on these people.  On the other hand, there were folks I thought were unsavory characters, but because they took a positive interest in Amie, I also gave them a chance.  Turns out they were ok after all.
  7. Naps are a Good Thing.  Amie was always ready to alert me at any time, 24 hours a day.  How did she do it?  By being well rested!  We should all take more naps or at least get a good night’s sleep.
  8. Live Life to the Fullest.  A dog’s lifespan is much shorter than ours.  And there is nothing anyone can do about it.  Amie is 14.5 years old now, which is a pretty good life span for a dog.  But like all of our lives, it will end.  The Existentialists tell us that we could all use a healthy dose of Death Awareness to give us that kick in the butt we all need to get on with Living.  Nothing like seeing another creature’s life come to its end stages to reinforce that point.
  9. Adapt.  After Amie’s back surgery for her herniated disk in her spine, one of her back legs did not have the same strength.  But she quickly learned to get up and down stairs by lifting up this weaker leg.  For larger flights of stairs, we carried her up, but she didn’t complain.  So if we need to communicate differently due to our deafness. so what?  Wear the damn hearing aid, use the FM system, stop complaining and get on with participating in life.
  10. Be Sure to Say “I Love You”.  Ok, Amie can’t speak, but she can sure communicate her thoughts.  She always ran up to my wife, son, or myself with her tail wagging and gave us kisses.  Every single day!  You never get bored of being reminded that you are loved.

What Does a Cochlear Implant Sound Like?


It has been almost 7 years since I received my Cochlear Implant.  However, it seems just like yesterday.  I can still remember every detail from the time of surgery, to my first activation, and all the steps along the way to the restoration of my hearing.

I was not always deaf.  I was born with normal hearing.  I did not have meningitis, nor do I have any family history of hearing loss.  The only thing notable thing in my clinical history was that I had a series of painful ear infections.  It is likely one of those infections that caused the damage to my inner ear.

I began using hearing aids at the age of 5.  Over time, my hearing continued to worsen.  By the time I was in high school, my hearing loss was moderate-severe.  In University, my loss was in the severe range.  Interestingly, I did not begin using an FM system until my third year of University.  I simply did not know such devices even existed. I wish I was made aware of FM systems earlier, as I suffered academically from not hearing well.  In high school with smaller class sizes, I was an Honour Role student.  But in first year University, my average dropped to 60% and my initial hopes for studying Medicine were dashed.

I vowed to ensure that all people with hearing loss become fully informed of all the hearing devices or other forms of help that are available.  I did not want to see others struggle needlessly from hearing loss.  Thus, I decided to pursue studying Audiology and make this my personal mission.

But back to my original story about my CI.  Even though my loss was now in the severe range, hearing aids and FM systems provided me with considerable assistance.  My word identification scores were still in the 70% range.  However, as I crossed the line into a profound loss of hearing, my ability to understand speech started to diminish considerably.  By the time I became a candidate for a Cochlear Implant, my word identification scores were 0% for my right ear and 10% for my left ear.  Phone use was virtually impossible.  I struggled to lipread every word.  It was exhausting to try to carry on a  conversation.

I received my Cochlear Implant from the excellent surgery and audiology team at Sunnybrook Hospital in Toronto.  The surgery process went without a hitch.  I was out of the hospital the next day, and took a only a few days off from work.

After a month of healing, I went for my initial programming session.  I thought that I would be well prepared for this appointment.  After all, I am a trained Audiologist.  I have counseled patients myself about not having unrealistic expectations, especially on the first day.  But I knew there were some patients who could hear speech even on the first day of activation.  I wanted to be one of those people.  I felt I was entitled to be one of those people.  I was wrong.

After the initial Mapping was done, I listened to speech for this first time.  And it sounded like…GARBAGE.  Specifically, it sounded like R2D2.  It was just all a bunch of beeps and chirps.  I drove home that day and decided a nice bottle of single malt Scotch was needed.  I was feeling every emotion from anger, to bewilderment, to sadness.

But to make a long story short, the changes that occur over the next 6 months were rapid.  After about 2 weeks, the implant started sounding like Sammy the Snake hissing sentences into my head.  That’s better than R2D2.  Then it changed to Alvin from the Chipmunks.  Next it started to sound like a young Jerry Lewis.  Now it sounds pretty normal, at least to me.

My word identification score started to rapidly improve.  I cannot recall all of my scores, but after about 6 months I was understanding about 70% of monosyllabic words in isolation and 100% of words in sentences.  After one year, my monosyllabic word identification score for words in quiet improved to 96%.  I was and continue to be completely blown away by this.  After all, I started hearing just beeps and chirps.

Given that I recall having much better hearing, I can describe the difference between hearing through a CI vs a hearing aid.  Basically, when I had enough hearing to benefit from a hearing aid, speech and music sounded full and rich.  But as my hearing loss progressed, all I heard from the hearing aid were low pitches.  Everyone sounded like they had mashed potatoes in their mouths.

The CI sounds very crisp and precise.  I hear all the high frequency fricatives (s, sh, f, th etc) quite well.  I have been told that my speech has improved immensely, although I never realized that my speech production was deteriorating with my progressive hearing loss.  In hindsight, it makes sense.

Music and hearing in noise remained problematic.  To help with hearing in noise, we can get the same improvements hearing aid users get from the use of Directional Microphones or FM systems.  I use both with my CI and it helps.

For me personally, the use of a hearing aid in my non-implanted ear has helped with music perception.  Without a hearing aid, I can barely hear any bass at all. Bass makes music sound full and rich.  On the other hand, the treble I get from the CI makes speech and music sound clear and crisp.  Thus the CI on its own is fine for speech, but makes music sound like it is coming out of a small radio rather than a big stereo.  The hearing aid on its own sounds pretty bad for any type of sound, speech or music.  Combined with the CI, it does not help with speech, but does give music a richer deeper sound.

For those of you considering a Cochlear Implant, my single best word of advice to you is be patient.  Do not expect miracles, especially on the first day.  The improvements will come as your brain relearns to makes sense of these electrical signals.

Please remember too, that everyone is unique.  While my experiences are not uncommon, your pace of improvements and the final levels you reach could be better or worse than me.

I am so glad I took the step of getting a Cochlear Implant and would do it all over again in a heartbeat.