(Sorry it's bit long and Thanks to Larry M Sivertson of Hearing Loss Web Home which he posted it on bhNEWS on Yahoo Groups)
Breaking Through: Cochlear Implant Advances
Presented by Tina Childress of Advanced Bionics
This is a report on Tina's presentation at ALDAcon 2006 held in St. Louis
in October 2006.
~~~~~
I lost my hearing at age 28 in eight months. Yet I've never attended an
ALDAcon before.
Bilateral implantation
Localization Cues - now that I have bilateral CIs, I can localize well
enough to know where my daughter is calling from. Our brain uses the
signal from both sides to get information. A good analogy is the use of
an eyepatch, like when you get your eyes checked. When you use only one
eye, you don't have very good depth perception, so you're not allowed to
drive.
Head Shadow Effect - The head blocks sound, so if you only hear out of
one ear, it's hard to hear sound coming from the other side. But in a
noisy environment, that can work to your advantage. The head can block
the noise you don't want to hear, so you can hear better what you do want
to hear.
Binaural Squelch - This refers to the ability to focus on and listen to
one speaker in room full of noise. Being able to do this requires two
ears.
I had a Hearing In Noise Test (HINT) three months after I got my second
implant. This is a test of ability to hear sentences, and in my test, the
sentences were 10 dB louder than the noise. I scored 74% in the ear that
was implanted first, 52% in the second, and 92% using both.
Binaural summation - This refers to the fact that sound perceived from
two ears is perceived as louder than sound perceived from a single ear.
Candidacy considerations
The decision to get a CI has always been an important one. Now people
also have to decide if they should get two CIs at the same time.
Q. Does insurance cover a second implant?
A. Some do. Talk to your CI center, because they are familiar with which
companies cover a second implant.
Q. I have never had bilateral hearing. Would bilateral CIs work for me?
A. That's a question for the CI center. They would have to evaluate you.
Bilateral CIs are a big advantage when a person is trying to hear in
noise. The average binaural advantage is 5 dB, which usually equates to
about 30% gain in HINT scores.
Localization is important for safety, hearing in groups and finding
distant sounds. I lost my car in a mall parking lot after I had bilateral
implants. I activated the horn and I was able to find my car. I never
could have done that with a single implant.
Unlike other hearing aid and CI microphones, our T-Mic sits right in the
ear. So it takes advantage of spectral intensity cues provided by the
outer ear. The outer ear also helps shield against other unwanted sounds,
and it allows people to use standards headphones.
Other considerations for bilateral implantation
If you have an implant now and get a second one, your first one will
probably be your dominant one for a long time. And the longer the time
between the two implantations, the longer the first will be dominant. If
you get them closer together in time, the dominance isn't as great and
won't last as long.
For those who do pretty well with the first one, the second one may not
progress as fast as the first. The differences you see may be quality
issues - things will just sound better.
A voice barely heard at 10 feet with one ear can be heard at 40 feet with
two ears.
Listening with bilateral implants is less tiring and stressful.
Things sound more like what we remember as hearing people.
It's instructive to compare the situation with bilateral CIs now with the
situation with hearing aids in the 1970s. That's when it became common
for people to use two hearing aids. Now we're going through a similar
thing with CIs.
If you have questions or want to talk to a bilateral user, come by our
booth and we'll put you in touch with one.
Speech Processing Strategies
Sound can be characterized by three domains, and it's important to
consider all of them in a processing strategy.
Intensity Domain - We give your brain as much information as possible and
let your brain do the work. Our input dynamic range is 96 dB.
Temporal Domain - We use up to 5200 hz sampling rate and 83K pps.
Spectral Domain - The HiRes120 has 120 channels.
120 spectral bands via current steering
Because we can stimulate multiple electrodes simultaneously, we are able
to effectively create virtual channels, which allows to provide more
frequency information. This is especially important for music and
listening in noise.
This 120 channel capability is available to people implanted since the
spring of 2001, because the internal device supports the required
technology.
It may help some people to understand the various domains by considering
a digital camera analogy.
The Temporal rate can be compared to the camera resolution (pixels). The
spectral resolution can be compared to the number of colors. And the
Intensity or Amplitude can be compared to the camera's dynamic range.
Harmony BTE (new processor)
Our new processor is the Harmony BTE. We have maintained accessory
compatibility with the Auria, so all of your Auria accessories will work
with the Harmony. It features:
- Smallest, least conspicuous headpiece
- Durable processor engineered to withstand rain, sweat, and moisture
- Only processor that supports 120 channel
- Built in Telecoil
- Improved battery life - 50% better - up to 18 hours on a battery
- Built in multi-function LED status indicator, which provides a lot of
information, including an indication of how much battery life remains
Why is there such a difference in how well people enjoy music?
a. Different physiology - more nerve survival, etc.
b. Auditory memory of what music is like.
c. Musical background
d. Characteristics of music you listen to (full orchestra or just a
couple of instruments or a voice)
Understanding various music terms
Rhythm - most people with hearing aids (HAs) or cochlear implants (CIs)
do pretty well getting musical rhythm.
Timber - this is the sound quality, the difference in the sound of the
same note played by different instruments. Most HA and CI users can tell
the difference between 2 instruments. They may not be able to name the
instruments, but can tell the difference.
Pitch - This is the frequency of the notes, and is the most difficult for
CI users. Some HA users with good low freq hearing still do pretty well
with pitch. People with a CI in one ear and a HA in the other seem to do
pretty well, also.
Loudness or Intensity - This is the loudness of the music. If it's too
loud, it will sound distorted.
Melody - Melody is a combination of all the others characteristics. If
you don't do well in one or more of the above, you may have a problem
with getting the melody.
What can you control?
Attitude and realistic expectations - It's important to have a good
attitude and realistic expectations. If you weren't a music expert before
implantation, a CI won't make you one. Also you may want to learn to
enjoy new types of music, or enjoy it in a different way from how you did
before your CI. It's important to practice. We suggest starting with a
single instrument and adding complexity as your music listening improves.
Also start with music you know, so your brain will help you hear the
music.
Music quality - Use good recordings, don't play it too loud, listen in a
quiet room with good acoustics
Choose your input - use the direct audio input (DAI) or the T-coil, or
use headphones over the T-Mic. All of these methods will reduce or
eliminate background noise.
Simply listen
Establish goals for individual practices - Perhaps you can focus on a
male voice or a female voice.
Keep listening
Lyrics may be difficult. You can find them on the Internet and follow
along. Again, start with songs you know.
There's a great group called the Association of Adult Musicians with
Hearing Loss. You can find them online at AAMHL-Association of Adult Musicians with Hearing Loss
Nothing beats live music. The visual cues can help a lot, and the
excitement of a live performance really contributes to the listening
experience.
Use assistive listening devices (ALDs). Plan ahead. Can you get a
suitable device at the performance, or should you bring your own?
User Panel
Deb Hollingsworth - CI user using HiRes120
I woke up deaf one morning at age 17. They think it was caused by
antibiotics. Hearing aids didn't work for me, so I went 31 years with no
hearing at all. When I got my CI, I got 60% discrimination pretty much
right away. We were in clinical trials for three and a half years. Two
years ago I tried the 120 channel program, and it's amazing! Music has
changed tremendously!
Jim Allsip - bilateral HiRes120 user
I lost my hearing in 2 weeks due to autoimmune disorder, and I wore
hearing aids for several years. In January 2004 the remaining 15% hearing
in one ear started to fade. I got my first CI in July 2004, and my second
CI in Jan 2006. I was pretty ambivalent about getting the second implant,
because I didn't know how much it could improve my hearing. So I wasn't
expecting much, but it made a huge difference; it improved sound quality
a lot.
Q. I've had my CI about eight years, but not working well now and I'll be
reimplanted next month. I'm wondering if I should get bilaterals, but my
doctor is against it. So that makes me a bit nervous.
A. Deb - I had an early implant in 1985, and now I'm trying to get
information about the implant I had and see what kind of electrodes it
had to see how viable it is for me to have the bilateral.
A. Tina - We don't know your hearing history, so don't know why your
doctor is not in favor of bilaterals, but I think you should find out the
reason for his objection, and make sure you have open communications.
Q. My concerns are that they are always improving and that it may not
work well for me. Do they have implants that do not require destroying
the hair cells, because I'm scared of losing the hearing I have.
A. Tina - So your concern is that when you get a CI you'll lose your
residual hearing. That is a very personal decision. I know there are a
lot of people who hold on to the remaining hearing they have, and that's
a very understandable thing to want to do. For some people like Jim and
me, we had very little to lose, so it wasn't a big decision.
They are working on electrodes that are less traumatic. Technology is
always improving, and it's up to you to decide when you want to take the
leap. For me, I wanted to hear my daughter, so I was ready for the CI.
C. Someone asked about being able to tell directions. I was recently
driving a car, and the person giving me directions was directly behind
me, and I was able to hear and follow directions while driving. I don't
think that would have been possible if I didn't have bilateral CIs.
Breaking Through: Cochlear Implant Advances
Presented by Tina Childress of Advanced Bionics
This is a report on Tina's presentation at ALDAcon 2006 held in St. Louis
in October 2006.
~~~~~
I lost my hearing at age 28 in eight months. Yet I've never attended an
ALDAcon before.
Bilateral implantation
Localization Cues - now that I have bilateral CIs, I can localize well
enough to know where my daughter is calling from. Our brain uses the
signal from both sides to get information. A good analogy is the use of
an eyepatch, like when you get your eyes checked. When you use only one
eye, you don't have very good depth perception, so you're not allowed to
drive.
Head Shadow Effect - The head blocks sound, so if you only hear out of
one ear, it's hard to hear sound coming from the other side. But in a
noisy environment, that can work to your advantage. The head can block
the noise you don't want to hear, so you can hear better what you do want
to hear.
Binaural Squelch - This refers to the ability to focus on and listen to
one speaker in room full of noise. Being able to do this requires two
ears.
I had a Hearing In Noise Test (HINT) three months after I got my second
implant. This is a test of ability to hear sentences, and in my test, the
sentences were 10 dB louder than the noise. I scored 74% in the ear that
was implanted first, 52% in the second, and 92% using both.
Binaural summation - This refers to the fact that sound perceived from
two ears is perceived as louder than sound perceived from a single ear.
Candidacy considerations
The decision to get a CI has always been an important one. Now people
also have to decide if they should get two CIs at the same time.
Q. Does insurance cover a second implant?
A. Some do. Talk to your CI center, because they are familiar with which
companies cover a second implant.
Q. I have never had bilateral hearing. Would bilateral CIs work for me?
A. That's a question for the CI center. They would have to evaluate you.
Bilateral CIs are a big advantage when a person is trying to hear in
noise. The average binaural advantage is 5 dB, which usually equates to
about 30% gain in HINT scores.
Localization is important for safety, hearing in groups and finding
distant sounds. I lost my car in a mall parking lot after I had bilateral
implants. I activated the horn and I was able to find my car. I never
could have done that with a single implant.
Unlike other hearing aid and CI microphones, our T-Mic sits right in the
ear. So it takes advantage of spectral intensity cues provided by the
outer ear. The outer ear also helps shield against other unwanted sounds,
and it allows people to use standards headphones.
Other considerations for bilateral implantation
If you have an implant now and get a second one, your first one will
probably be your dominant one for a long time. And the longer the time
between the two implantations, the longer the first will be dominant. If
you get them closer together in time, the dominance isn't as great and
won't last as long.
For those who do pretty well with the first one, the second one may not
progress as fast as the first. The differences you see may be quality
issues - things will just sound better.
A voice barely heard at 10 feet with one ear can be heard at 40 feet with
two ears.
Listening with bilateral implants is less tiring and stressful.
Things sound more like what we remember as hearing people.
It's instructive to compare the situation with bilateral CIs now with the
situation with hearing aids in the 1970s. That's when it became common
for people to use two hearing aids. Now we're going through a similar
thing with CIs.
If you have questions or want to talk to a bilateral user, come by our
booth and we'll put you in touch with one.
Speech Processing Strategies
Sound can be characterized by three domains, and it's important to
consider all of them in a processing strategy.
Intensity Domain - We give your brain as much information as possible and
let your brain do the work. Our input dynamic range is 96 dB.
Temporal Domain - We use up to 5200 hz sampling rate and 83K pps.
Spectral Domain - The HiRes120 has 120 channels.
120 spectral bands via current steering
Because we can stimulate multiple electrodes simultaneously, we are able
to effectively create virtual channels, which allows to provide more
frequency information. This is especially important for music and
listening in noise.
This 120 channel capability is available to people implanted since the
spring of 2001, because the internal device supports the required
technology.
It may help some people to understand the various domains by considering
a digital camera analogy.
The Temporal rate can be compared to the camera resolution (pixels). The
spectral resolution can be compared to the number of colors. And the
Intensity or Amplitude can be compared to the camera's dynamic range.
Harmony BTE (new processor)
Our new processor is the Harmony BTE. We have maintained accessory
compatibility with the Auria, so all of your Auria accessories will work
with the Harmony. It features:
- Smallest, least conspicuous headpiece
- Durable processor engineered to withstand rain, sweat, and moisture
- Only processor that supports 120 channel
- Built in Telecoil
- Improved battery life - 50% better - up to 18 hours on a battery
- Built in multi-function LED status indicator, which provides a lot of
information, including an indication of how much battery life remains
Why is there such a difference in how well people enjoy music?
a. Different physiology - more nerve survival, etc.
b. Auditory memory of what music is like.
c. Musical background
d. Characteristics of music you listen to (full orchestra or just a
couple of instruments or a voice)
Understanding various music terms
Rhythm - most people with hearing aids (HAs) or cochlear implants (CIs)
do pretty well getting musical rhythm.
Timber - this is the sound quality, the difference in the sound of the
same note played by different instruments. Most HA and CI users can tell
the difference between 2 instruments. They may not be able to name the
instruments, but can tell the difference.
Pitch - This is the frequency of the notes, and is the most difficult for
CI users. Some HA users with good low freq hearing still do pretty well
with pitch. People with a CI in one ear and a HA in the other seem to do
pretty well, also.
Loudness or Intensity - This is the loudness of the music. If it's too
loud, it will sound distorted.
Melody - Melody is a combination of all the others characteristics. If
you don't do well in one or more of the above, you may have a problem
with getting the melody.
What can you control?
Attitude and realistic expectations - It's important to have a good
attitude and realistic expectations. If you weren't a music expert before
implantation, a CI won't make you one. Also you may want to learn to
enjoy new types of music, or enjoy it in a different way from how you did
before your CI. It's important to practice. We suggest starting with a
single instrument and adding complexity as your music listening improves.
Also start with music you know, so your brain will help you hear the
music.
Music quality - Use good recordings, don't play it too loud, listen in a
quiet room with good acoustics
Choose your input - use the direct audio input (DAI) or the T-coil, or
use headphones over the T-Mic. All of these methods will reduce or
eliminate background noise.
Simply listen
Establish goals for individual practices - Perhaps you can focus on a
male voice or a female voice.
Keep listening
Lyrics may be difficult. You can find them on the Internet and follow
along. Again, start with songs you know.
There's a great group called the Association of Adult Musicians with
Hearing Loss. You can find them online at AAMHL-Association of Adult Musicians with Hearing Loss
Nothing beats live music. The visual cues can help a lot, and the
excitement of a live performance really contributes to the listening
experience.
Use assistive listening devices (ALDs). Plan ahead. Can you get a
suitable device at the performance, or should you bring your own?
User Panel
Deb Hollingsworth - CI user using HiRes120
I woke up deaf one morning at age 17. They think it was caused by
antibiotics. Hearing aids didn't work for me, so I went 31 years with no
hearing at all. When I got my CI, I got 60% discrimination pretty much
right away. We were in clinical trials for three and a half years. Two
years ago I tried the 120 channel program, and it's amazing! Music has
changed tremendously!
Jim Allsip - bilateral HiRes120 user
I lost my hearing in 2 weeks due to autoimmune disorder, and I wore
hearing aids for several years. In January 2004 the remaining 15% hearing
in one ear started to fade. I got my first CI in July 2004, and my second
CI in Jan 2006. I was pretty ambivalent about getting the second implant,
because I didn't know how much it could improve my hearing. So I wasn't
expecting much, but it made a huge difference; it improved sound quality
a lot.
Q. I've had my CI about eight years, but not working well now and I'll be
reimplanted next month. I'm wondering if I should get bilaterals, but my
doctor is against it. So that makes me a bit nervous.
A. Deb - I had an early implant in 1985, and now I'm trying to get
information about the implant I had and see what kind of electrodes it
had to see how viable it is for me to have the bilateral.
A. Tina - We don't know your hearing history, so don't know why your
doctor is not in favor of bilaterals, but I think you should find out the
reason for his objection, and make sure you have open communications.
Q. My concerns are that they are always improving and that it may not
work well for me. Do they have implants that do not require destroying
the hair cells, because I'm scared of losing the hearing I have.
A. Tina - So your concern is that when you get a CI you'll lose your
residual hearing. That is a very personal decision. I know there are a
lot of people who hold on to the remaining hearing they have, and that's
a very understandable thing to want to do. For some people like Jim and
me, we had very little to lose, so it wasn't a big decision.
They are working on electrodes that are less traumatic. Technology is
always improving, and it's up to you to decide when you want to take the
leap. For me, I wanted to hear my daughter, so I was ready for the CI.
C. Someone asked about being able to tell directions. I was recently
driving a car, and the person giving me directions was directly behind
me, and I was able to hear and follow directions while driving. I don't
think that would have been possible if I didn't have bilateral CIs.
