A Marathon to Hearing: Getting a Cochlear Implant
by Karen Brockett
Early in the morning of March 6th, 2014, I checked into Oregon Health Science University (OHSU) in Portland, Oregon to undergo a surgery that has change my life. It was for a procedure called a Cochlear Implant, and was done for my left ear.
What is a cochlear implant? OHSU Cochlear Implant Program describes it as follows: “A cochlear implant is a device that provides sound to individuals with severe to profound sensorineural hearing loss. The implant works by bypassing the damaged structure in the inner ear, and by providing electrical stimulation to the hearing nerve fibers directly. The brain is able to recognize this stimulation as sound.”
The description of a cochlear implant seems pretty straight forward. A person has the implant, recovers from the surgery and then, ta da, that individual goes forth into the world as a “hearing person”! If only it was that simple and if only “normal” hearing was the outcome of having a cochlear implant (also referred to as a CI). The surgery itself is the simplest part of the process. Having a CI is, in fact a process, not a one shot deal. It is like being in a marathon. The surgery is only the starting line.
“On Your Mark”
After my last hearing aid adjustment my Audiologist told me that he thought I was at the point where my hearing loss was severe enough that I would be a good candidate for a CI. What that means, in a nutshell, is that my hearing loss is so severe that I have reached the limits of what the most powerful hearing aids can do for me. He referred me to OHSU for formal evaluation for a CI. The goal of the evaluation is to determine if an implant will provide the best hearing and communication for me. The first part of the evaluation was performed by a Cochlear Implant Audiologist to determine the type and degree of my hearing loss. Implants are done on individuals who have severe to profound hearing loss in both ears. The second part is a speech perception test done while wearing hearing aids. A CI candidate must show that she or he cannot understand speech (60% or less speech discrimination) under ideal listening conditions while wearing hearing aids. The final part was a medical work-up and included a MRI and CT scan, followed by a consultation with an Otologist. The purpose of this particular examination is to determine whether there was any abnormality in the inner ear that would make an implant not an option and to ensure that I was healthy enough to tolerate the surgery. I met the criteria of an ideal candidate for a cochlear implant and was able to get approval from my health insurance provider to cover the surgery.
“Get Set”
The surgery was done in the morning and took about two and a half hours. It was performed while I was under general anesthesia. Afterwards a protective cup was placed over the surgery sight and held in place by a compression bandage. After recovering from the anesthesia I was released later that day from the hospital. 24 hours later I removed the compression bandage and return home to Albany, Oregon.
For a short animated video that explains the cochlear implant procedure and how a CI functions, refer to the link, a YouTube video produced by Med-El the manufacturer of the cochlear implant that I chose. The procedure and how the implant functions is the same regardless of the manufacturer. https://www.youtube.com/watch?v=ykjikrz8BPo
At this point the implant was not activated and all remaining hearing in the implanted ear was destroyed. I am now totally deaf in my left ear. This is not an unusual side effect with cochlear implant surgery. A few individuals do not loose residual hearing but most individuals that have a CI do. I was aware of this possibility and took that into consideration when I made the decision to have the procedure. A week after the surgery I returned to OHSU for a post-operative exam. It had been decided by the Audiology department that on that same day I would have the implant activated.
“Go!”
The cochlear implant has two parts, the internal processor and the external processor. The internal is the part that was surgically inserted under the skin of my head against the skull. The electrodes of the processor are coiled into the cochlear. It is this device that generates the sounds and transmits them to the auditory nerve in the brain. Before activation the internal processor is like a tiny computer fresh off the assembly line with the software installed but not activated. The external processor sits on the outside of the head and connects to the internal processor by a magnet. Batteries inserted into the outside device provide power for the implant and has a microphone that feeds sounds to the internal device. It is also the conduit for the audiologist to program the internal device using a computer in a process called “mapping”. Before I was able to “hear” the CI had to be activated and programed or “mapped”. Activation of the CI is when the work really begins for the recipient. It is the activation and initial mapping that really starts the long process of learning to understand the sounds that the implant is sending to the brain. It is a marathon to hearing.
“Donald Duck” and “Mickey Mouse” are characters frequently referred to when CI recipients describe how the human voice first sounds to them after activation. I think voices sound more like everyone has inhaled helium. However the experience is described, the sounds the brain is deciphering via the implant are not at first perceived as “normal”, unless the recipient has never heard voices or sounds before. As a young child I had normal hearing but it began to decline in my teen years, degenerating to the point where my hearing loss is considered severe to profound. I have however been able to maintain enough hearing with the use of hearing aids that I was able to hear, if not understand, the human voice. Consequently the “new normal” is taking some adjustment. I have been told by other CI patients that eventually the brain does adapt and voices and other sounds do not seem odd. It varies from person to person. Some individuals’ brains adjust almost immediately while for others it take years before it clicks in for them. I have no idea where I will fall within the group. I still use a hearing aid in my right ear. A hearing aid works differently than a CI. It amplifies sounds before sending them to damaged and undamaged nerves cells in the cochlear of the ear and the brain then deciphers them into sounds and speech. Whereas the cochlear implant generates the sounds electronically sending them to the auditory nerve. So my brain is deciphering one type of auditory signal in the left implanted ear and another type in the right ear. Making sense of it all can be a challenge.
What is amazing is that with the implant I am hearing sounds in my left ear (or more accurately my left side, since the ear itself is not actually hearing) that I have not perceived in decades; the sound of the windshield wipers on the drive home from Portland and the clicking of the turn signal. I now hear the jingling of my dog’s tags when she shakes her head. And I was almost brought to tears by the sound of rain pattering on the windows. Of course I am not always able to identify every sound because I have not heard so many for so long. I frequently find myself asking my husband Larry, “What is that sound?” It is not uncommon for me to be looking around trying to figure out what it is that I am hearing. My brain must relearn many sounds because they are different from what I remember. This is also true for understanding speech. Some people are easier for me to understand than others. Some words make sense to me and others do not. Although the longer I use the implant the more my brain will identify and accept the new auditory input. My progress is helped along by the mapping appointments for my CI.
“Covering the Distance”
The mapping is being done at OHSU. At each appointment the audiologist connects the external processor to a computer by using a cable. I am wearing the outside processor during these programming sessions. A series of sounds are generated to the internal processor through the external device and I tell the audiologist if the tones are too soft or too loud, or like Goldilocks, just right. When done I return home and live with the new mapping settings. As my brain adjusts to the new levels of volume, or loudness of sounds, I return for another mapping to go through the process again. The frequency and number of mapping appointments varies and depends on the health care providers who do CI mappings and also with the individual patient. Usually within the first couple of months the programing is done every other week dropping off to less frequently as the CI recipient progresses with understanding speech and deciphering sounds. Eventually once my “normal” listening levels are established I will go in for CI check-ups annually.
“So you have normal hearing now?”
Cochlear Implants do not restore what is known as normal hearing. Listening situations where there is a lot of background noise still are and always will be problematic for me, however I should, once mapping is completed, do better with the CI than I did with hearing aids alone. Again, time will tell. When more than one person speaks at once I still have difficulty figuring out who is speaking because many of the nuances that make up individual voices are not processed the same when generated by the CI as compared to how the human ear can understand voices. I may or may not ever be able to use the phone without the need for some type of assistive device and/or captions. I am still considered hard of hearing or partially deaf even though I have a CI because for health reasons, the external processor cannot be worn 24/7, just as it is not recommended for anyone to wear a hearing aid for that amount of time. When I am not “plugged in” I hear very little in my right ear and nothing at all in my left. However with my latest technological device when I am “plugged in’, the world of sound is available to me in a way it has never been before. The marathon to hearing continues and like a marathon runner I will always be in training.
Karen Brockett is a member of the Rotary eClub of the State of Jefferson (D5110). She first joined Rotary in 2000 and is past president of the Corvallis Morning Rotary Club (2005-06) and a Rotary Leadership Academy graduate. Karen retired as a Counselor and Academic Advisor for a community college in 2002 and sits on two boards of state organizations that advocate for the Hard of Hearing.