Considering Second Implant--Will sound quality approximate "normal"?

Cochlear Implants
#1

Briefly about me: I’m 70 and have had progressive hearing loss all my adult life, for no discernible reason (no guns, no heavy machinery, wasn’t in a band, etc.) I have worn hearing aids for 35 years. In 2007 I had a stapedectomy on my left ear that didn’t go well—it increased the ear’s volume but hurt acuity. Meanwhile the right ear continued to regress. In recent years I’ve been more and more cut off from human communication except with people whose voices I know well and speaking in quiet environments and without masks.

I had CI surgery on my left ear last September and October 20 was Turn-On Day. AB Naida M (I think) with a paired Phonak hearing aid in the right ear. The results have been spectacular, life-changing. I can listen to the car radio, I can understand people in meetings and in usual day to day scenarios, I can understand movie and TV dialogue, I’m not afraid of meeting new people. I even do pretty well in noisy restaurants.

Yesterday I had my six-month follow-up. In the left ear, where pre-op I had tested at 0% on the two-person no-noise conversation test, yesterday I was at 80%, and with both ears (Phonak in the right) I was at 90%.

The one downside to the implant is that the sound quality is a bit off. A little low and draggy, not a lot of treble, voices and music don’t sound quite right. While my right ear acuity is bad (around 30%), the sound quality with hearing aid is pretty good, especially in the treble range. So the two ears together average out in my head to something like normal sound. Streamed music sounds very good, for example.

I’m getting to my question now. In yesterday’s meeting, my surgeon discussed the benefits of a second implant. His main points were: (1) my implant tone tests show the implant is providing treble, and the treble I hear from the right ear is largely brain subjectivity; (2) With two implants, localization is improved, thus improving sound quality; and (3) that down the road my right ear will go “kaput” (his word) and that age and morbidity might preclude an implantation. (Btw, my surgeon has performed over 900 implant surgeries, and is very well respected.)

My main concern is that with my current set-up, things are so good I hate to mess with success. So, while recognizing that there’s a lot of YMMV with CI’s, for those of you with implants in both ears, how do you find sound quality? Does it approximate “normal” sound?

I’m glad I found this forum, and thank you for your patience with an over-long initial post.

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#2

Welcome to the forum and congratulations on your CI success.

You are asking great questions.
I have a couple for you.
Can you localize or do you have directionality now?
What is your word understanding scores for your hearing aided side only? In quiet and noise if you can.

As you know the CI is a learning process. The longer your brain doesn’t get sound from an ear the longer the rehabilitation might be.

I am a little over two years bilateral CI.

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#3

No, I don’t have localization now, i.e., I can’t tell the direction of sound.

My right ear, unaided, word score with no noise is 25-30%. With noise, about zero. The acuity numbers don’t really change with the increased volume of the hearing aid.

Currently, the implant is doing the heavy lifting on actual hearing/acuity, and the right ear is just providing sound coloring.

Thanks.

Thanks.

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#4

We have bimodal CI members who will chime in soon I hope.

I got localization for the first time in many years about a year after implants. I practiced this by going out into the yard and listening to the birds. The trick is to pinpoint a particular bird by it’s sound. Then go find it. By doing this many times I learned directionality.

If your aided ear is getting worse there is no time like the present to think about CI. If it is not getting worse staying bimodal might be best.

@Deaf_piper is bimodal and doing great. She has questioned getting the second CI many times but is great otherwise.

Have you had a CI evaluation for that aided ear?

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#5

Yes, I’ve had the CI evaluation which is what led to the discussion yesterday. My surgeon is recommending the second implant. Based on the results of the first, I’d do it in a minute but for the sound quality question.

#6

CI sound quality is a tuff question.
It’s going to vary big time between each person.

For me the more I practice at hearing something the better it gets for me. Like noisy bars or restaurants were tuff at first for me but have gotten much better. I just needed to subject my brain with the new sounds to learn.
Music is the same way but more difficult for me. It’s getting better and better. Others have gotten music down and are doing great with it.

It’s all up to you and how badly you want to hear a particular thing.

Good luck

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#7

User530 welcome to the forum and congratulations on your success with your CI.

As @Raudrive said I’ve been thinking about going bilateral for a couple of years. I have Cochlear N8. Reading your story about your hearing loss is similar to mine. The one very big difference in our stories is my HA ear is congenital loss. This ear hasn’t heard high frequencies for over 7 decades now. Where from reading your story your loss is age related.

I sent my AuD an email asking for her thoughts on my going bilateral.
She responded with some excellent points.

  1. Doing a serious amount of rehab might not be enough to get me a good result.
  2. Getting a good result from this HA ear might be out of my control.
  3. If I only got half the result of my R CI ear would I be happy? No I wouldn’t, as I be worse off than I am now.
  4. Generally speaking the second CI ear doesn’t do as well as the first CI ear.

Being bimodal now I have some directionality, but not very much. I can find birds but not which direction emergency vehicles are coming from unless I can visually see them.

Have you had your HA ear evaluated for a second CI?

Good luck with your decision it’s a tough call.

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#8

It looks to be a now or never decision… To your point, after age 75 you will probably not want to have any unnecessary surgeries. Only you can decide where you should go from here. I would be cautious. It sounds like you are pretty functional, how do you know that a 2nd CI will be better? Could be worse. Are you ready for that?

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#9

I don’t have a CI - yet. I see the surgeon in two weeks. So I can’t really answer your question. (I plan on posting about my situation this weekend.)

But… in the literature the Audi (who did my CI evaluation) gave me about AB CI’s, it says that the AB CI can link to a Phonak Nadia CROS to send sounds from the aided ear to the CI. That will not help sound quality, but it will help deal with one-sided hearing if you decide against going bilateral and later loose more hearing in that ear.

#10

With apologies to Joni Mitchell:

“I’ve heard the sounds from both sides now
From left and right and still somehow
it’s sound illusions I recall
I really don’t know sound at all.”

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#11

Welcome - good to see you here. I am 4 months post activation with AB and the Phonak Link Aid. I understand the tough call and how the HA ear rounds out and enriches the sound of voices, and for me, music. It would be tough to lose that. On the other hand, I find that my brain is still not blending the two as smoothly as I hope it will be one day, and have wondered if my hearing would actually improve if both ears had similar sound input through two CIs.

There is an active Facebook group for Advanced Bionics implant users and there are a good many bilateral folks there. Most seem to like it, some say it’s not as good as the first. So, how do you function with just the CI? If you were to plug your HA ear, could you navigate comfortably? Can you hear phone calls?

I have seen people post having had CI in their 80’s, so maybe give it some time to settle in. How long did it take you to get think about your CI decision?

Keep us posted.

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#12

Thank you all for your thoughtful comments.

@Joanhawsey: Regarding your specific questions:

  1. With just the CI, I function very well. But everyone sounds lower and droopier than they should. The right HA doesn’t add much functionality, but provides “color” that makes voices and music sound much more natural. How much do I put that at risk with the second CI is my main concern, balanced against the risk that I may want a second CI down the road and not be able to get one (which is my surgeon’s main point). And this all in recognition that there are no guarantees in the CI world.
  2. Re how long it took on my decision for the first CI, I had gotten pretty desperate and once I focused on the CI, the process went quickly. To a very happy outcome.

Thanks also for the info on the FB group, I’ve applied for membership.

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#13

Voip,I like that and thank you.

#14

Your story sounds like mine. I am scheduled for an MRI/CT on Thursday as I experienced a noticeable change in word comprehension back in September, even though my most recent audiometry test looked about the same as last summer.

This is potentially the start to evaluate getting a CI and is intended to see if there are any issues that preclude going this route.

I have read a lot of comments by those who have gone to CI and those considering it. The most common concern I read here of those considering it is the loss of residual hearing and the potential for a poor outcome. Unfortunately, most of those who decided to get implanted, haven’t come back to tell us how things went. Yours is the best outcome I think I have heard.

My concern is the potential for lost music as I once knew it and relearning new sounds that replace the ones I can still hear. I also have the impression that thwere is little new development in improving the sound quality. background noise and signal interference appear to be limiting the number of channels that can be used.

I noticed you did not post your hearing profile. That will help us understand better where you were when you went with the CI. I am also curious whether you had options for the brand and model you have, or is this what the surgeon is most experienced with and supported by the provider.

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#15

Raudrive,

Your hearing profile is closer to mine. It would be helpful if others who have been implanted included their profile to see how improvement tracked with initial hearing loss. Maybe even the brand they went with.

For me I have reached the point where hearing in a noisy environment or even a larger group has become impossible. Conversations one on one in a quieter surrounding is even possible with my HA. Not the best but understandable. For TV I use a Bose wireless noise canceling headset (also w/o HAs) and this works.

Unless I can make significant improvement in noisy environments with min loss of music appreciation, I am questioning whether the cost, invasive surgery and long training is worth it at my age (75).

Your thoughts?

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#16

You have 7 years on me.
My hearing loss was pretty bad for a number of years. My right ear implanted first took a couple months to be able to have a conversation on a phone with the CI only. I was pretty frustrated the first month or so then sounds started making since quickly. At 3 months I had the second ear implanted. That ear had speech understanding at activation.

My last office visit a few months ago my right ear scored 90% and the left 95%. Together I can only guess it would be close to 100%. I hear much better with both CI. Now it’s been a little over two years since the implants.

If you are healthy and active a year or two isn’t long to have your hearing back.

You have been pretty negative about CI for a while. If you do decide to get a CI it is something you really need to want. It takes a genuine want and open minded approach to do well. It really is amazing technology.

It took me about 1.5 years to get localization.
The past few months I have been listening to much more music. Old music I grew up with and know. It is getting much better. You do well with what you try to learn.

Good to see you thinking about improving your hearing.

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#17

Great suggestion - I just updated my profile summary. My audiogram is from before my left ear implant. I was considered a “borderline” candidate and I decided to be proactive and do it early. I had great early success and as of my recent “mapping” appointment where they check progress and make any adjustments needed, I tested within the normal hearing range across all frequencies with just my CI ear. Me pre CI left ear booth testing word recognition score was 40% and now it is 95%. I am just four months post activation. This is admittedly fast and very good progress, and not all CI folks have that fast a ramp up, but having some hearing still left seems to help with better/faster results. I chose Advanced Bionics and use the linked Phonak Marvel hearing aid in my other ear. Hands free blue tooth is awesome.

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#18

Raudrive,

If I come across as negative about CI, that is not my attitude. What I am is more skeptical about the benefits and the risks involved with such a delicate and invasive surgery. I know several CI recipients, including my sister and am trying to understand the technology more. That is the scientist in me that always needs to understand how things work and the limitations and drawbacks of the current state of the art.

I had cataract surgery about 10 years ago and embraced it readily because of the low risk and near perfect improvement. CI is much more involved and less dramatic in the improvements from what I see. That doesn’t mean that it is not worthwhile especially for someone with my hearing profile.

I appreciate all the input I have gained from you and others who have taken this journey.
Thank you.

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#19

The tech does work as advertised but the problem the non static brain function is causing a lot of the differences in performance… The only way to ‘see’ the performance is to get the device implanted. the brain will auto adjust the differences but it won’t work if somebody haven’t been exposed to sound … the key to high performance is your brain because your brain will adapt to the stronger pattern recognition signal

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#20

Speaking of music, My Ci ear have a different personality than my hearing aid ear when it comes to music… I was listening exclusively with just my CI., my hearing aid ear found the music meh but my CI ear really like it… it is like having 2 different personality in one brain, when i went bimodal with my hearing aid ear the hearing aid ear didn’t like the music… it is so weird…

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