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Cochlear candidate

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In reply to @Bimodal_user

@Bimodal_user said:

some time ago you wrote that you’re interested to test Music program, because it provides the least processed sound, have you tested it?

I’m going to test my music program, on the 13/2. I’m off to see the Military Tattoo, bagpipes are the only genre of music that I really struggle with 6.5 yrs on. I’m going armed with the this music program and a mini mic. (I put this on the charger this morning, now I just have to remember to pack it) It’s weird listening to pipes, I can hear the bottom hand clearly then the top 3 notes on the top hand just disappear, I can’t hear them. It doesn’t matter how much rehab I do I simply can’t heat the top notes. So time will tell

Do you have all electrodes active?

What are frequency range in your bagpipes? Up to ~950 Hz?

In my case, yes, at the beginning of music rehabilitation Music program makes user troubles to differentiate particular instruments, but music is fuller. I turn to SCAN 2 program and suddenly I can differentiate.

However I try to push myself with Music program anyway, perhaps I’ll finally distinguish between them.

I am (by no stretch of the imagination) a hearing expert, but maybe the Earlens might be a viable option instead of Cochlear implant(s). The neurotologist with whom I’m involved mentioned, in a casual conversation, that many patients who are referred for Cochlear evaluation benefit greatly with Earlens instead. Mentioned was the increased frequency response versus traditional hearing aids. The frequency range is much broader, too. Professional musicians are among the patients.

The permanent part, the “lens” is implanted in-office as an out-patient procedure. The rest of the device is similar in form to a hearing aid.

Audiologists don’t fit these, it is done by an otolaryngologist, neurotologist or otologist.

Downside? They are quite expensive and many insurance companies won’t pay for all of the cost.

Just something you may wish to inquire about.
Paul

In reply to @Raudrive

@Bimodal_user said:

I turn to SCAN 2 program and suddenly I can differentiate.

@Raudrive said:

This is interesting. It just might help with decisions about processor upgrades.

Thanks

You’re welcome. That phenomenon described by me it’s because SCAN 2 (and some another programs) is “n of m” strategy, so using usually 8-12 electrodes out of all 22 to transfer most important speech cues (the rest of electrodes may transfer noise so they’re temporarily deactivated).

The Music program has all 22 electrodes continuously activated, hence impression of “merging” of sounds and difficulties with differentiation.

I think I will improve with Music program.

In reply to @PJB12

@PJB12 said:

e Earlens might be a viable option instead of Cochlear implant(s)

Earlens are not substitution of cochlear implants. If someone has poor word recognition score that usually means that cochlea is damaged so much. In that condition there is lack of hair cells which can transfer acoustic energy to electrical.

Cochlear implant bypasses that by providing direct electrical stimulation, Earlens not.

However that doesn’t mean it couldn’t be a viable option for you, but keep in mind that its benefits it’s mainly from no feedback risk and broad frequency response, but it is ancient in another technologies (Bluetooth, etc.)

@Bimodal_user said:

Earlens are not substitution of cochlear implants

That’s why the work “might” is in my post. We have no idea if the Joesan (or any others reading this thread) have damaged cochlea. No one can determine that by a guess over the internet.

The examining physician will be the one to determine if Earlens is appropriate. (Note well the word “examining”.)

Edited
@PJB12 said:

The examining physician will be the one to determine if Earlens is appropriate. (Note well the word “examining”.)

Yes, this is why there is a term “ evaluation” - you can see in my past post that this is very often used denotation.

However, if someone has mean 60 hearing loss and below 60% , there is legitimate indication to recommended that evaluation. And if someone has 10% WRS - it’s highly probable that traditional amplification won’t give much benefits apart from stimulation before CI rehabilitation.

We can operate on probabilities - majority of forum users has hearing loss aidable by hearing aids or Earlens, but there are some less or even more obviously individual hearing loss characteristics which let us recommend CI evaluation with greater confidence.

I don’t think Earlens will work for me. I’ve been in contact with Cochlear and Med EL to learn more about . Cochlear’s vitual meeting included an interview with a user, which was good. I am scheduled for a CI evaluation with implant surgeon at end of February. My biggest concern is the complete loss of hearing after CI. I think that’s why many users go for bimodal but then I wonder is the improvement only in one ear enough improvement over ’s. The inputs from this forum are very helpful. Thank you!

@joesan said:

My biggest concern is the complete loss of hearing after CI.

I’m also, my I have less high frequency and more low frequency than you. Not much though.

I still have a slight amount of residual hearing in my ear. It’s not a useful amount to hold a conversation though. Nor is it enough to use the Hybrid attachment. Yes you will lose some residual, you have more high frequencies than I had at time of surgery.

After you have been evaluated you need to ask your surgeon what his/her success rate of residual preservation is. Be aware that residual preservation is not guaranteed for your lifetime. Good luck.

In reply to @joesan

@joesan said:

My biggest concern is the complete loss of hearing after CI. I think that’s why many users go for bimodal but then I wonder is the improvement only in one ear enough improvement over HA’s.

From memory I think you can plan on losing 25-30 percent of whatever hearing you have before the surgery. For many that leaves them with pretty much no hearing.

/hearing aid can be nice for many. It creates a balance to their hearing. Being bilateral I absolutely can not tell any difference from normal hearing, it is normal to me.

When I went bilateral the first week or two was an eye opener not having any hearing, deaf. I got over quickly. The CI is superior to any hearing aid for all CI candidates. Many have very low word understanding scores and CI typically gets you 75% word understanding or higher. That’s a huge life changing thing!

When you talk to your surgeon ask him/her if they recommend a CI brand and why. This was a big part of my CI decision.

In reply to @joesan

@joesan said:

I wonder is the improvement only in one ear enough improvement over HA’s.

when you’re and your , and your phone are set up properly, everything is paired your HA will stream automatically. It’s connected to your phone and your CI so everything streams bilaterally. If you have streamed with your current HA you will have some concept as to what streaming does for your hearing. It makes life a heck of a lot easier, phone calls are easy to understand.

I’m making good progress on my evaluation and the surgeon is quite sure I will qualify. Initially I expected no residual hearing in the CI ear but now I’m learning that hybrid is very likely based on the surgeon and the implant brand. My understanding is the Med El has the best likelihood of preservation with their flea electrode. Does anyone have experience with this?

Edited
@joesan said:

My understanding is the Med El has the best likelihood of preservation with their flea electrode. Does anyone have experience with this?

My mind is blank about which member went with MedEl for the same reason you are asking about. He deeply studied the brands and found MedEl to be the best using robotic equipment to insert the implant. He ended up losing all residual hearing, became very upset about this. Maybe another member will remember his name, I am blank this morning. @Deaf_piper , @Dani , @joanhawsey

Found the member I was thinking about @jcech

Sales pitches can be misleading for sure. I have never read about anyone saving any worth while residual hearing after an implant by any manufacturer. Odds would be low to say the least.

Yes, I commented about residual hearing and Med-El. I am bi-modal having been implanted with their Flex 28 array performed with robotic insertion via IotaMotion. While little is published about residual hearing loss outside of translocation (perforation of the membrane that separates the ST from the other 2 chambers), I chose the ME system because of deeper insertion and a more flexible array that had a better track record of correct insertion. Using the IM robotic insertion only maximized that likelihood.

Now 2 years later I can confirm both these goals were accomplished. The electrode placement was correct and I have “some” residual hearing. The array length while longer did not reach the apex in my case, so there is no stimulation at frequencies below 500 Hz. Interestingly, that’s where my residual hearing is limited.

My conclusion is that the residual hearing I have is limited to the region that does not contain the array, while being almost non-existent where the array is placed (>500Hz). Consequently I would conclude that the presence of the array in the ST, effectively interferes with the transmission of sound waves. Given the high cross area of the electrodes vs the diameter of the ST chamber (up to 30+%), this doers not surprise me.

Hopes this helps.

Thanks for responding, valuable experience.

You have been gone awhile, how’s the doing?

Edited

Cochlear also has an EAS attachment when residual has been preserved post op. I wore this EAS attachment for 15 months. My residual dropped off at 15 months post op, rendering the EAS virtually useless, as my high frequencies had decreased the predicted amount through surgery. I had to switch from the EAS to electronic mode. IMO the placement of electrode array is more important than the actual electrode in preserving the residual I could be wrong with this as well. I have a CI522, that’s a full length electrode array.

What you need to remember is that your residual hearing post op is never guaranteed. Do some research into the surgeons history in residual preservation. If you’re determined for your residual to preserved you might have to change clinics, as some surgeons have better preservation rates than others

The frustrating part for me was that the surgeons couldn’t give me any answers as to why my residual dropped off after 15 months. I was told “it’s just one of those things” for me that’s not an answer.

Reading through forums on the internet on residual preservation, it appears to me that it could be age related. But I really don’t know what caused mine to drop off.

Good luck.

In reply to @jcech

Hi jcech,

What you did is what I’ve been considering. The Med El with Flex electrode and the iotaMotion robot assist. Where did you have the surgery and who was the surgeon. There are not many hospitals that use this robot assist process. How has your hearing improved from ’s without hybrid? Thanks for your reply its very helpful.

I had my surgery at Jefferson in Philadelphia by Dr Jacob Hunter. The surgery was actually done in Cherry Hill NJ as that was the only place authorized to use the iotaMotion system. While the included an EAS attachment, I found it clumsy and of no benefit over electronic stimulation so I switched it out. Here are a few other observations:

  1. The improvement in speech understanding is dramatic and highly beneficial over , esp in one on one situations. Noisy environments are still a challenge.
  2. Music appreciation is NOT improved. It is changed. I find there is significant distortion of music, enough so that without the benefit of my HA in the other ear, I might not even recognize pieces I have known for years. I am still working on why and it may be due to the filters intended to serve as noise reduction.
  3. Other sounds (birds, wind, etc) are also very much improved. Without my CI I could not hear any of these.
  4. DO THE TRAINING. There are wonderful apps that help and with diligence you will see your scores for comprehension improve. Like the hearing tests, too many are 1 syllable words with choices to select. With time you should try to identify the word without looking at the choices. After you see improvements, do exercises with more complex requirements (sentences, questions, stories). Avoid reading them. Just listen, but don’t focus on hearing each individual word. That is too exhausting and not what you did before. Listen for understanding of the message.
  5. Don’t be afraid to experiment with your audiologist, esp early on. I did anatomy based fitting where the scan measured the exact location of each electrode and the mapping was set to the frequency of those locations. I find the pitch match my unaided ear.
  6. Streaming. Med-El claims that any enabled HA can be paired with their CI. While that is true (it took a little effort to get this done), there is a latency difference that I have discovered is associated with the protocol used to transmit signals. The CI comes first then the HA. The effect is enough lag to make understanding very difficult. They get around this with a streamer and this works reasonably well

I hope this all in helpful. In the end, I am happy I did this and even after 2 years continue to see small improvements

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