Third Mapping and a Surprise

A couple of weeks ago I had my third mapping.  I had been informed that two of my sixteen electrodes were open, meaning they were not functioning correctly.  Had I not been told of this, I would not have known as my own tests using the virtual piano from the www.citheory.com website gave me no hints anything was amiss.

Sara, my audiologist, had told me she was not available to test my implant in the operating room following my surgery, so another audiologist performed this test.  Apparently that person forgot an important procedure to “clean up” the electrodes.  Sara didn’t know what had happened in the operating room, but she suspected this hadn’t been done.  This procedure is called “conditioning” because when the electrode array is threaded into the cochlea air bubbles can form on one or more of the electrodes, preventing them from functioning.  Sara hooked up my processor to her laptop and ran the conditioning procedure, which only took a few seconds.  She saw immediately electrodes five and eight were functioning as designed and therefore all sixteen electrodes were on line.

Sara then proceeded to map each electrode as she had done in previous mappings.  She noted that my hearing with the CI had changed significantly since my previous mapping six weeks before.  Plus, the fix to the open electrodes would now produce a different map.

Then we discussed which of the four software programs would be loaded into my processor.  A week before my mapping I had lunch with Rick, another recipient of a cochlear implant.  I was discussing the various software programs, called strategies, noting I didn’t have a handle on which one worked best.  It is terribly difficult to evaluate these strategies in the audiologist’s office.  Rick reminded me that I actually had two processors when you count the backup processor Advanced Bionics provided.  (They actually gave me two of everything except a battery charger.)  So, Rick said, have your backup processor loaded with two strategies and my primary loaded with two more.  That allows me to take four strategies home to evaluate.

Sara thought that was a good idea and she proceeded to load the processors.  As she was doing that I slipped on my skeleton earpiece that holds the T-Mic in place so I can wear my processor while working out.  I modeled it for Sara as she had been unaware this type of earpiece existed until I informed her at my first mapping.  I learned about it from a couple of CI wearers writing in the Hearing Journey website.  I will write about this exclusively in a future post complete with pictures.

I have now had a chance to evaluate all four strategies at home and am pretty sure I identified the best one for me.  It is the HiRes P Fidelity 120.  I realize this is Greek for those outside the world of Advanced Bionics.  A short description from the blog “Chronicles of a Bionic Woman” explains better than I:

“The latest software development is the HiRes speech strategy option with     Fidelity 120 options. This is an option that can help you in noisy conditions, appreciate music and on the telephone. The only way I can describe it is if I compare it to a camera. A hearing aid is a Polaroid and HiRes with Fidelity 120, is a 4MP Camera. I can hear in noise much more easily than I could ever hear with a hearing aid.”

I have now finished three audio books.  I listen to the tapes with my processor and read along.  It helps me get use to speech using only my processor.  When I watch TV or go out I wear both my CI and hearing aid.  That works pretty well.  The more I use my CI the better my hearing in my implanted ear gets.  Still a long way to go before I am satisfied.

Next mapping in three weeks.

Second Mapping and a New Strategy

Tuesday I received my second map.  I’m back on the HiRes P 120 program (from HiRes S 120) but the high freq electrodes have more volume than before.

I also ordered a skeleton ear mold to house the T-Mic.  This will hold the T-Mic in my ear so I can participate in sports without the processor falling off my ear.  I’ll post a picture of it when I get it.  I learned about this in the Hearing Journey site.  Costs $71.

At the end of my mapping my audi did a hearing test.  Prior to my surgery I scored 59% on the quiet HINT sentence test with both of my hearing aids.  With my CI and HA I scored 79%.  I am finally hearing sounds at the 2000-8000 Hz levels.  Prior to my surgery, I could not hear any sounds over 2000 Hz.

Rather than continue to use the learning rehabilitation exercises, I have decided to listen to “The Da Vinci Code” audio book and read along.  This will train my brain to get use to human speech.  Once I am satisfied I have made significant progress in that area I will return to the rehab.  This was my decision.  I didn’t think of this until I had left the audiologist’s office.  I have another map in three weeks, so we’ll see how that goes.

Activation and First Map

After waiting a month after my surgery I finally got my processor and headpiece sixteen days ago.  It took that long for the incision to heal and the swelling to subside.  It had been a frustrating month.  Prior to the surgery I could hear with two ears.  After surgery I only had one ear.  It appears now that the surgery killed all remaining hair cells in my cochlea.

I checked in to the Kaiser Permanente center in Denver at 9:30 on February 2 for my activation and was met by my CI audiologist Sara.  Beth accompanied me to observe and take pictures.  The first thing Sara did was to open my processor kit supplied by Advanced Bionics, the manufactor of my implant as well as my processor.  The kit looks like a small suitcase.  In it are several accessories that interface with the processor and batteries.

After checking out the hardware Sara placed the processor on the back of my ear (it looks like a behind the ear hearing aid).  We were pleased to find the electrodes in the cochlea fired off as expected and the processor worked just fine.  A couple of exceptions were electrodes five and eight.  Sara noted these electrodes are not functioning as expected.  When I listen to the frequencies emitted by these electrodes I can’t tell that there is anything wrong.  I will discuss this with Sara on my next mapping.

To make a long story short, Sara set each electrode to a comfortable volume and programmed the processor with 2 programs for me to try.  That was all that happened at activation.  She told me to practice with listening exercises and come back in a week for my first map.

A map is essentially adjusting the volume of the electrodes and finding a program that is suited for me.  That first week after activation was frustrating for me.  I couldn’t discriminate between many of the words during the listening exercises.  “Whip” sounded like “roof”.  “Mop” sounded like “op”.  I couldn’t differentiate between “sold” and “my”.  You get the idea.

Now after my first map I have a new program, more detailed instructions and several new listening exercises.  One of my Facebook “friends” who is an electrical engineer and worked in the hearing aid business alerted me to the website www.citheory.com.  A tool at that site assists the CI wearer to identify which electrodes are set too soft or too loud.  With that information I can tell my Audi which electrodes need adjusting.  It turned out electrodes ten through sixteen were set too soft and Sara adjusted as necessary at my first mapping.

I am now doing my listening exercises daily and listening to the audio book  “The Da Vinci Code” while reading along (saw the movie but had not read the book).  Beth is helping by doing some listening exercises that requires her to read a word or sentence without my lip reading and for me to identify what she just said.  Progress is slow, but my Audi and surgeon remind me it has only been two weeks since activation.

I have gone to a crowded restaurant a couple of times and experienced the high frequency sounds my left ear has not heard for many years.  My brain will take some time to adjust.  More later.

Sara Checking out the Processor

My Processor and Headpiece. Note that the Processor is connected to Sara's laptop.

Sara's Laptop Application to Adjust my Processor Software

Chart I used to let Sara know if sound is too soft or loud

Three Weeks after Surgery

Three weeks ago I had surgery to implant a cochlear device in my head.  It was an Advanced Bionics HiRes 90K implant with a Helix electrode array.  If everything goes ok I will have that little computer in my head forever.  It has a 10 year warranty.  After doing a fair amount of research I am convinced this is the best CI available today.  Although it has only 16 physical electrodes, they can be made to fire 128 virtual electrodes.

In one week I will be activated.  That is when the real work of rehabilitation of my brain will begin.  For many years my brain has been unable to “hear” frequencies at 1500 Hz and above, so I need to train my brain recognize speech with high frequency sounds; like sh, s, ch and so forth.  I have been collecting rehab resources for several weeks now, so I will be ready to dive in when I get my processor and accompanying software.

Prior to my surgery I read what others experienced after surgery, so I was ready for anything.  Among the risks I was aware of were:

. Paralyzed facial nerve

. Loss of taste for a few days

. Numb tongue

. Dizziness or vertigo

. Ringing or freight train noise

. Pain in my ear or neck

. Chest pain just after surgery

. CSF leak just after surgery (escape of the fluid that surrounds the brain and spinal cord)

. Trigeminal neuralgia (severe facial pain)

. Nausea from anesthesia

Among others.  None of these things happened to me.  What I did experience was:

. I felt woozy a few days after surgery due to the anesthesia.  I thought this would wear off quicker.  Expectations too high.

. Implanted ear felt plugged up.  The surgeon put some material in my ear to protect my eardrum due to swelling of my ear.  I still have that plugged up sensation and look forward to having it removed.  Not really a big deal though.

. Immediately after surgery my ear felt like it was folded down and kept that way with a head band aid.  It really wasn’t; I even had my surgeon check it.  It felt that way as a result of the incision behind my ear.  That started to go away once my head band aid was removed the morning after my surgery.

. Rather than pain, I felt a dull throb for a few days.  It did interfere with my sleep a couple of nights so I took a pain pill or two.  No pain pills were necessary during the day.  I guess I took a total of 3 pain pills.

. Four days after surgery I noticed a bit of blood on my pillow case.  We called the doctor’s office and he requested I come in for a visit.  A nurse applied a suture strip on my incision and sent me home.  I experienced no bleeding after that.

Basically that’s it.  I consider myself lucky, but the surgeon’s skill was the real reason nothing went wrong.  I look forward to getting my hearing back in my left ear.  It’s frustrating hearing with only one ear.

Five Days after Surgery

I have been recovering from the anesthesia for the last five days.  I have been too woozy to post.  I had expected to be in better shape earlier.

Back to the surgery itself.  At 7:40 am I was wheeled into the operating room.  To my right I saw Dr. Nosan the surgeon, a resident and one other person.  On my left I saw the anesthesiogist and about three others.  I am awed by the number of persons who carry out surgery.  The last time I was under general anesthesia was 1982.  I remember watching the anesthesiologist inject the anesthesia into the IV.  This time I must have been distracted because the next thing I remember is waking up in recovery.

I could feel myself “coming back” by the minute.  I remember catching a glance of Dr. Nosan as he left the recovery room.  I was offered ice chips and pudding.  I noticed I had not lost my sense of taste.  I also had no pain, which pleased me.  The head band aid and O2 tube were really the only things I noticed.

Fast forward to the next morning.  Dr. Nosan kept me in the hospital overnight as a precautionary measure.  I was up surfing on my laptop when the resident came in and removed my head band aid.  It was good the get that thing off.  Dr. Nosan came in a half an hour later and examined the wound.  No bleeding had occurred since he put the band aid on 20 hours earlier.

So what have I been experiencing these 5 days?  An occasional dull throb rather than pain.  I noticed however, this interfered with my getting to sleep, so I took a couple of pain pills (Hydrocodone) which allowed me to drift off into some quality sleep.

I slept only one afternoon.  The rest of the time I surfed the web and watch Dexter DVDs.  I fixed my own meals and generally walked around the house without assistance.  It was good that I had shopped for food prior to surgery but I was too cautious with my food selection.  I simply did not need yogurt.

I noticed my bean with bacon soup tasted slightly off, but I would not have noticed if I had not thought about it.  Several people commented they lost their sense of taste for a few days after surgery so I made an effort to notice. Also I experienced no nausea at any time.

Next up….post op with Dr. Nosan Tuesday to remove the sutures.

Dr. Nosan examining me a few hours after surgery

Nurse Teresa and Dr. Nosan

Next morning as the resident removes my band aid

My incision

Surgery this Morning

Totally successful.  Into OR at 7:45 am and wheeled to Recovery at 11:45.  Surgeon used Advanced Bionics Helix Electrode.  All 16 electrodes fired successfully in OR.

Now resting in hospital room.  Surgeon will come by tomorrow morning and remove bandage…..then home.

More to follow with pictures later.

What Happens at the Hospital?

If you want a short tour of what happens at the hospital visit Kate’s blog at http://katelocke.wordpress.com/2009/06/29/cochlear-implant-surgery/

By the way, Kate hosts one of the best Cochlear Implant blogs on the Web!

Surgery Next

The pre-op with a nurse and surgeon Tuesday is behind me now.  Surgery at 7:30 am Tuesday is next.  The first question I will ask the surgeon when I wake up will be: “did you get all the electrodes in?”  Some surgeries to implant the device are not 100% successful because the array could not be fully inserted into the cochlea.  Hopefully mine will be.

Surgeon said the operation will take around 3 ½ hours.  That is a little longer than I thought.  I am curious to know the cost of the procedure if I did not have insurance.  Tens of thousand of dollars as I understand it.  My cost for the surgery and one overnight stay in the hospital is $210 thanks to my Kaiser Medicare Advantage coverage.  The hospital stay is a precautionary measure rather than a necessity.

We picked up my meds after doing a mystery shop at 5 Guys Burgers on the way home.  Included were pain pills.  I don’t know how much I will rely on them to reduce pain.  I have a fairly high tolerance of pain, but that was in my younger days.  A CI user I had lunch with said he didn’t use them as much as prescribed.

I am quit curious how I will feel the hours following my surgery.  I am lucky to have received a Word document from one CI user relating her post op experiences.  She did a lot of sleeping on a recliner the next couple of days.  She relied on a neck pillow as well.  I bought one at Wal-Mart last weekend.

New Years day at the in-laws to celebrate Christmas and catch up on the latest news Saturday.  A neighbor has volunteered to snowblow my drive while I recover if it snows.  No lifting anything heavier than 10 pounds for three weeks.  Yikes!

Hello world!

I am scheduled to get a Cochlear Implant in my left ear January 5, 2010.  I have no hearing at 1500 Hz and above, so not even the most powerful hearing aid will give me any hearing at the high frequencies.  My right ear is slightly better, but that ear hears nothing at 2000 Hz and above.  Still, with a hearing aid in my right ear I can just get by.  That is the way it has been my entire life.

The implant will provide me with hearing at all frequencies, so I will have to train my brain to recognize human voice just as normal hearing people do.  It will likely take months of rehab to achieve this.

Pre-op is scheduled for December 28….Monday!  Things are moving along at a rapid pace.