Things to be Thankful for…


In Canada, this is our Thanksgiving Weekend.  While the originally designed to give thanks for the harvest, we generally use this holiday to share a meal with friends and family and reflect on all things for which we are grateful.  For me, the following represents things for which I am most thankful. There is no particular rank order here…

 

  1. Cochlear Implant Technology.  This technology has dramatically changed my life in enormous ways.  Simply put, without it I could not function.  Communication would be almost impossible.  I probably would have embraced sign language to a greater degree, but I would be limited to communicating to a much smaller and limited set of people.  I would have completely lost my ability to enjoy music.  Do I wish for improvements from this technology?  Sure.  Music perception and hearing in noise and are still challenges, but I have developed some additional compensatory techniques.  Still, a day does not pass in which I remind myself how my different my life would be without the CI.
  2. Wireless Microphone Technology.  While the the cochlear implant implant is amazing, it is the synergy of the FM system in conjunction with the CI that provides me even greater capabilities.  Adding FM technology allows me to use my mobile phone via Bluetooth, hear in noisy cars, restaurants, and bars, enjoy social events more fully, and enhances my ability to hear and perform music.  I wish more CI users would realize how much more they could get out of life if only they added FM or other wireless microphones.
  3. Music.  Music brings light to my soul.  It always has the ability to brighten my darkest days.  I am so grateful that I can still not only enjoy listening to music, but to perform it as well.  It has not been easy to keep music a part of my life.  I needed to experiment with vibrating platforms, compressors, equalizers, FM systems, and soundboards to make it happen.  Lots of money and time has been spent on this.  But it can be done.
  4. Family.  I have a wonderful, intelligent and beautiful wife that puts up with my shenanigans.  And I have a handsome, brilliant, and kind hearted son who is so full of passion.  I love you both.
  5. Health.  A weird thing happened the other day.  My son’s friend was looking at some pictures of both my son and I from his early childhood.  The friend remarked that I look younger today the I did 10 years ago.  That was such a compliment!  Losing 40 pounds of excess weight and getting into better shape has had the effect of turning back the sands of time.  Next week I will be completing a half marathon, something I never dreamed I would be capable of doing.  I am so grateful that I am finally on the road to better life.  It feels great.

 

Happy Thanksgiving!

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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.

How to listen to your iPod…


If you have a hearing loss and you want to listen to music on your iPod or similar device, you have a couple of options.  But each has advantages and disadvantages.

  1. Take off your hearing instruments and listen via headphones.  This only works if you have a fairly flat hearing loss.  But if you have a different amounts of hearing loss at different frequencies, then the music will sound weird.  For example,if you have a high frequency hearing loss, then the music will sound like too much bass.  Also, the hearing instrument has a maximum power output that has been set by your audiologist.  When you take off your hearing aids and listen only via headphones, you might damage your hearing.  So I do NOT recommend listening via headphones.
  2. Use a DAI Cable and Proprietary Audio Shoes.  This option works with behind-the-ear (BTE) hearing aids with direct audio input (DAI) capability.  The advantages of this connection are that the music will be shaped to meet your hearing loss configuration.  Moreover, the loudest sounds cannot exceed the maximum power output of the hearing aid as set by your audiologist.  Therefore, this is a safer option.  Lastly, these cables preserve the stereo separation, so you will enjoy the left and right panning in the music.  The disadvantage is of course that you have a cable.
  3. Use a Streaming Device. These kind of devices are made by several hearing aid companies.  This link here shows the one made by Phonak called an iCom.  These devices are cool in that they wirelessly send a stereo signal to all kinds of hearing aid styles, not just BTE’s.  Here is a picture of an iCom.
  4. Use an FM System.  This is the option that I use.  The reason is that I cannot use any of the previous options since I wear both hearing aid and a cochlear implant.  I cannot get one cable that works with both devices simultaneously.  I also cannot use an iCom as that only works with the hearing aid.  So I plug in my iPod into my FM system and this transmits the signal wirelessly to my receivers.  It works with both my cochlear implant and hearing aid.  It is also a very safe option.  The only disadvantage is that the FM signal transmits in mono, not stereo, but that’s not too big a deal.  Here is a link to some FM options.  And below is a picture of the FM system that I use:
This is the transmitter called a SmartLink+
 This is the Naida UP hearing aid with the FM receiver (green circle) added on the bottom:
This is the Freedom CI again with an FM receiver (green circle) added on the bottom:
Lastly, there are some cool things to do with your iPod to make it work better for you.  See this link on iPod accessibility and hearing.