Evaluation Process for CIs - Your experience?

Cochlear Implants
#1

So based on discussion in a different thread (and not wanting to clutter that one further, sorry) I wanted to ask folks what their experience was like being evaluated for cochlear implants.

For me, I was referred from my hearing aid audiologist to an ENT. The ENT took extensive medical history and did a physical exam. They referred me to an MRI. They also referred me to an audiologist in their office that works with both hearing aids and cochlear implants. With that audiologist, I did pure-tone audiometry again, and tympanometry. Then she programmed hearing aids using that audiogram but using my molds and gave them to me to wear in the booth. We did word and sentence recognition with both ears, then she had me remove one hearing aid and do sentence and word recognition, then we did the same in the other ear. At that point she explained we would’ve normally done a repeat of the same testing in background noise, but I already qualified based on my hearing in quiet conditions (yikes…).

My hearing aid audiologist recommended I get a second opinion to help put my wife at ease, so I made an appointment with a different ENT. At that appointment, they did an extensive medical history again, recommended additionally a CT, another audiogram, and a battery of blood tests. They were interested in trying to determine more what caused my loss than to verify I was a CI candidate; they agreed I was and that I would probably do just fine (actually I believe he said “well”). I didn’t end up going forward with this testing; my wife and I discussed it and given the coronavirus situation and all the medical testing we’ve already been through this past year and not wanting to enrich doctors further just to maybe, maybe answer “Why?” we decided it wasn’t worth it (and this ENT straight up told me even while recommending all this stuff that most of the time they never figure out why and I have been through enough batteries of tests with no answer in the last couple of years).

What was it like for you?

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#2

My evaluation process started here on the forum. By reading others experiences I realized a CI might be good for me. I also waited for Medicare to come in due to not so good insurance earlier.

I ended up going to my primary care doctor due to ear infections that are very rare for me. He recommended seeing an ENT doctor to make sure about these infections. At the ENT office I learned that the ear molds probably caused the infections. While there I also asked about a CI evaluation. The ENT set the evaluation up with their office the next week.

At the CI evaluation I did word recognition tests for both ears, 4% right and 8% left and other tests I do not understand. The AuD did say my ears were healthy and functioning properly. She asked a number of questions about my hearing history. How long I have worn aids and where I got the aids. That led to my self programming the aids. She then mentioned that she would probably program another set of aids for me test with if my aids and programming failed. The last test performed was both ears aided for sentence understanding. I did surprisingly well at 69% for such bad scores on all other tests. I did not get tested for understanding in noise, I do wonder about that now.

The next person I talked to was a physicians assistant certified. She asked ab little about my history of hearing loss. She also asked a lot about my programming and was impressed with my aided hearing results. Then she said they do not recommend a CI based on the sound booth quiet sentence understanding of 69%.

After reading phobos512 post I wonder if I had a very good evaluation. It’s not that I want a CI but I do want to hear better. I will attach my evaluation results for those interested. Maybe we have a member with knowledge of these test results that could share their thoughts.

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#3

For those that have been tested in noise for CI, do you have any idea what SNR (signal to noise ratio) was used? The only thing that I’ve seen for testing for CI was that the HINT (Hearing in noise Test) was used, but it was used without noise. The HINT is a sentence test.

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#4

I have been doing a little reading about the tests given for the cochlear implant evaluation.

The immittance test basically checks the area on both sides of the ear drum, including volumes and nerve reaction.
http://hearing.wustl.edu/Hearing-Evaluation/Acoustic-Immittance-Testing

The DPOAE test is a mechanical device that evaluates if the inner ear parts function to hear and ability to hear in the 30 db or less range.
https://reeseaudiology.com/distortion-product-otoacoustic-emissions-testing-dpoae

There is so much more to these tests, it’s very complicated. Just trying to understand in layman’s terminology.

Unremarkable means normal, nothing odd or wrong.
Absent means not there. My absent DPOAE results basically said I can not mechanically hear 30 dB sounds.

If better layman descriptions are available I am all ears.
Thanks

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#5

If they didn’t do the evaluation with noise, they didn’t do the job. My recognition scores in quite were in the 90s, but were low enough in noise that I qualified with no problem.

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#6

It is recorded sentences presented at 65 db with a 60 db background babble.

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#7

Thanks. That sounds pretty challenging. I’ve never taken the HINT, just the QuickSIN, but I missed plenty when done at a SNR of 5dB (speech signal 5dB louder than noise)

#8

Thanks, this is what I have read too.
My wife is telling me to get a second opinion.

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#9

That is what I am thinking too is that you should get a second opinion. Let the Audi doing the word test with the aids program a set of their aids to your audiogram to see what happens. You have customized your aids over time get them the best you possibly can. My Audi is good and patient but I do not even think he would be able to match what time you have spend and give it his all like you have.

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#10

It occurs to me that Medicare does have the tightest set of requirements for implantation so that may be the issue, but I would still get the second opinion.

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#11

Not sure if you noticed but the Cochlear Implant Evaluation form had a OR between sentence testing in quiet and noise. By the form they did not have to do the noise test. I do know in noise I would fail miserably.

Cvkemp idea about letting them program their aids for the test is an idea. I know before I learned about aggressive frequency lowering my speech understanding was much worse than now. Things have to be just right for me to understand speech worth a nickel, lip reading is a part of it.

The sentence testing was a bunch of filling in the blanks. We all know the HOH are pretty good at it. This is why foreign accents and people that like to use big and fancy words during speech kick my butt.

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#12

So you were guessing? There are varying schools of thought on this. On either AB’s or Med-El’s site, I forget which, they encouraged folks to say what they heard only, not to fill in the blanks. I think I have read here that folks were encouraged to guess. Here’s the thing…All that lip reading, guessing, trying to figure out from context, that’s why we end up wrecked at the end of the day. It’s exhausting. If you aren’t hearing it, you aren’t hearing it. Doesn’t matter, in my opinion, if your brain can figure it out. It does that anyway. I was still guessing though; it’s like impossible to shut it off. Particularly when they come at you so fast.

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#13

The audiologists at the evaluation encouraged me to guess.

You are so right about all the work going into speech understanding. At the end of the day we are really worn out.

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#14

I found it, it was on cochlearimplanthelp.com, Assessment process | cochlear implant HELP

The testing the audiologist does is usually similar to hearing tests you have had in the past. You go into the booth and are tested on words and sentences and pitches or tones. You might be asked to repeat, or raise your hand etc. It’s important they know your actual hearing ability, so try not to make guesses or “fill in the blanks” on sentences and words.

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#15

Thanks for the attachment.
It’s very informative. It will take a while to absorb.

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#16

Yeah, listening should not be that hard, to need several hours of recovery in silence or soothing voices after one-two hour video call. Even when call itself isn’t of hard nature, but just with voices you don’t hear regularly.

To me it really helps having tests in German. I repeat the sounds I hear and it’s easier to realise when it’s mumble or unclear, since my brain cannot fill the gaps. With English I have to concentrate more not to fill the gaps. I guess in native tongue it just comes and is really hard to start listening with ears and not understanding with brain.

I think we all can pull the best in 30 minutes with high focus. But we need to remind ourselves that our daily, working life is at least 600 minutes long and we aren’t that highly focused all that time.

#17

Doing the CI evaluation tests in different languages would definitely be more challenging. Especially if it wasn’t your native language.

The guessing to put a sentence together could sure bring significant error in the test. Some people may be better at it than others. That shouldn’t be a part of the test.

#18

Contacted Cochlear a few days ago about my CI evaluation.

Today they got back with me after looking at my evaluation. They said I need a second opinion from a different office and I needed testing in noise. This information has been sent to my primary care physician for him to get that appointment scheduled.

We will see how that goes.

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#19

Oh that sounds good that (meanwhile?) your wife pushes you, too. Does she accept your needs for a CI? And yes, please go for a second opinion, it’s really worth it.

Oh I can tell you long stories about accents. Before my surgery I hardly could understand my polish colleague. He pronounces most of the words the wrong way, I had to ask him to repeat every sentence.
Since I have my CI activated he still pronounces the words the same wrong way but I can hear nearly each single letter so I can hear the complete word. It’s still difficult to understand him but he no longer needs to repeat himself any more.

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#20

My experience in evaluation process for my CI
In the past I regularly did a hearing test at my ENT. 4 years ago she recommended a CI based on the audiogram and single-word-recognition test. The latter was 55% for several years with both HAs in. I didn’t accept her recommendation. Until a day in July last year where I met Sheryl :wink:
At that time I went to a nearby hospital to check for candidacy. They did several tests and then said I am already late. At the hospital they did sentence-recognition tests with and w/o noise. Till today my test result in the booth are the same as pre-op. But in real life it’s a different like day and night.

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