Would you suggest I be evaluated for CI?

Cochlear Implants
#1

On June 24th I went to Costco as was considering replacing KS10 (Phonak) HAs with the Phillips 9040s. HCP suggested having private audi evaluate for CI as perhaps better investment/option to consider. While I am willing to go to audi, not sure this is worth the time/expense, your thoughts/advice? Thanks.

Note that Word Recognition Scores below my audiogram are not correct and I could not update (see below).

The HCP I met with who I had seen once before did (single) Word Recognition testing and on basis of that suggested that I might be better off being evaluated for cochlear implants and suggested audi who herself has implant(s). While my subjective exp of my hearing is that it is mostly adequate in my typical (speech in quiet, non-challenging) sound environments, I’d be happy for improvements.

During an hour of 1 on 1 talk via Zoom with someone I am familiar with I might ask 1 or 2 times for something to be repeated; with car radio and road noise with a trained announcer I might miss a word/phrase or two in 15 minutes. These are not very challenging listening situations and I do far, far worse in speech in noise.

Two years ago my Word Recognition Scores were R, L, Both ears were 56% 36. 48
And a few days ago had declined for each ear but stable for Both: 42. 32. 48%

I know that criteria for CI candidacy have softened and that my high frequency loss of >75 DB meets one of the key standards, and my single word WRS is poor and also meets criteria. Some articles indicate that recognition testing is also done with full sentences and that has never been tested - and subjectively and honestly with feedback from significant others isn’t all that bad.

I’m 78 years old, and while typically adhere to "if it isn’t (significantly) broken, evaluate cost/benefit of intervening. Thanks for your advice which would be based on far more knowledge than CC HCP who wasn’t even sure what the cut offs are for candidacy. He has perhaps10 years HCP exp. was well meaning but seemingly quite inexperienced with CI.

edited to add bold; and PS below

PS wearing HAs for 7 years; some decline in audiogram, from memory perhaps 15DB at high frequencies, but no major change at all in last 2 years.

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#2

Looking at your audiogram I see possible room for word understanding improvement, maybe.

You have the KS10 aids now, correct?
Do you know if the frequency lowering technology is being used in those aids? The reason I ask is your lower frequency hearing is pretty good. It’s your upper frequencies that are suffering.

I would suggest going back to Costco and asking to try frequency lowering if not already.
This technology will sound strange at first but it dramatically helped me in the past.
Ask the fitter to adjust the frequency lowering settings aggressively until the S sound starts slurring, then back it off a little. Do each ear individually for best results.

Good luck

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#3

Certainly no harm in getting an evaluation. Your word recognition scores seem low enough to qualify. However, you seem pretty satisfied with your hearing and I’m assuming you don’t have people in your life who complain about your hearing or seem frustrated with you?
I’m usually eager to recommend people get CI evals, but that’s for people who aren’t satisfied with their hearing and keep looking for better hearing aids. That doesn’t seem to be you. Trying out frequency lowering is a reasonable thing to do (if it’s not already on)

#4

Thanks @Raudrive Yes frequency lowering is already being used. I do some infrequent DIY programming and might tweak cut off point and mapping as experiment. Since you did not comment about whether being evaluated for CI makes sense in your opinion, I take it you have no “advice” there.

#5

Thanks @MDB for comments. Correct I don’t have people who are annoyed or complaining about my (at times lack of understanding them) and asking for a repeat. Freq lowering is already in place and I might experiment with different setting DIY. My interest in Phillips 9040 is its different from KS10/Phonak to sound processing AND long current thread of forum member comparing their 9040 exp with KS10. While their audiogram is really quite similar to my own in shape and severity, their WRS scores are much much better than my own. AND unlike me they do not have custom molds nor is frequency lowering being used. Good example of how audiogram is not necessarily very correlated with speech processing. And yes, I am most of the time, mostly OK with level of my listening/comprehension although at times it take significant concentration and focus.

If not too costly or if covered by insurance then will probably meet with private audi especially as she herself is CI user personally. Unfortunately I will listen to her between the words as there is some conflict of interest in having some inclination to create paid work for herself and audi clinic. Other good news is that they sell Oticon HAs so understands that approach.

#6

I didn’t push the CI evaluation because you seem to be happy with your hearing. I saw an opportunity to possibly help your speech understanding with frequency lowering. I still think you should get aggressive with that technology.

I also do not see why you shouldn’t get the CI evaluation. It is an informative testing that will educate you more about your hearing whether or not you get a CI. The information you gave us about your hearing would put you into the CI candidacy.

The Phillips aids do sound interesting on the forum but so do the Jabra aids. With your hearing loss you just might already have the best aids. Not sure if you know that I am bilateral CI and I self programmed Phonaks for many years. Which receivers are you using now? You mentioned earmolds, correct?

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#7

Again thanks … Medium power; yes custom molds. No hadn’t known you are bilateral CI, but believe I had recalled you are DIY. I will certainly explore pushing freq lowering and believe that in Target I have at least two stronger increments that could be enabled on the “S-SH” dimension.

I am not often with someone in restaurant or noisy background. I did buy used a Roger Select mic and the times I have used it, it is very effective. While I am curious about the Phillips, I expect I can get more good value from KS10s/Phonak with freq lowering and Roger, and while very expensive it doesn’t seem like Phillips (or Oticon) for me, would surpass the tech that I already have. Nonetheless, I might do a trial of Phillips via Costco and hear for myself whether there is greener grass …

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#8

I would probably be using P receivers unless you get very aggressive with the frequency lowering. Your high frequencies just about need UP receivers.

Do you actually hear tones in the upper frequencies when doing an audiogram? Not just noise or cracks or pops. This is important.

#9

Edma if it’s been suggested to be evaluated for CI I would go ahead and have that evaluation. The Ci AuD after all the evaluation process is done will be able to tell you definitely if a CI will be of any benefit to you. But even so, you get to make the final decision yay or nay to the implant.

When I went for my evaluation my AuD didn’t know if I would benefit enough from an implant. She said I might get 50-60% increase in hearing. I worked my butt off in doing hours upon hours of rehab to prove my AuD wrong. It’s not an easy path to go down if it’s not necessary. The thinking these days is the sooner the better for your hearing health. The cut offs for a CI have been relaxed considerably since I had the procedure done 4 years ago.

CI’s are fiddley little things, small parts that need to be changed. If your fine motor skills are still good you should be able to manage them well. Also if you are good with technology you will manage a Ci.

How do you manage phone calls now? Communication in group settings? And with a noisy background?

Good luck to you which ever decision you make.

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#10

Again thanks @Raudrive I’ve been lazy about my HAs and listening. You are correct it’d seem that at least for left ear seems I should be using P rather than M receiver. Don’t recall last audiogram. Just used online pure tone generator thru cheap computer speaker with HAs out, in left ear can still hear to 4K, right to 5K from just very quick playing around.

I’d have to look at my frequency lowering cutoffs but expect that an enormous amount of those higher frequencies are being “remapped”. Might be good to listen to some music with HA program that is not remapping to give ears and brain exposure to new stimulation.

#11

Thanks for input and encouragement Deaf_piper. I’m fine on phone calls unless there is a lot of wind or road noise on either end of call. I am rarely in restaurant by choice and most of my group interaction is via zoom and so typically there aren’t multiple people talking at once. I will see where this goes, and doing something particularly for left side (sooner) might be good.

#12

I know it’s hard to believe but most professionals are not crooks.

#13

Have you tried an audiologist that does best practices and does REM which is real ear measurement. You need to check that your aids are programmed properly to your hearing loss prescription. You can try hearingup.com to find an provider. I am a DIY and program my Phonak aids.

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#14

@Terost Yes, REM is required at Costco. The private audi I worked with for a few years seemed to follow most/many of the best practices recommended by Dr. Cliff and others that seem to be widely expected.

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#15

Any suggestions for my upcoming CI evaluation?

Unfortunately I was just informed that the very experienced audi who herself has CI has parted ways with the audiology clinic I will be going to. My appt is now with the youngest audi who graduated in 2021 and had done externship at this same clinic. I am not sure how much skill/experience is involved with CI evaluation, but would certainly prefer someone with at least 10 years of audi experience and with a good deal of that in the CI area. I might postpone appt until I can see someone with more experience.

#16

Sometimes the young fresh out of school types are very good. May be better than the seasoned professional. Try to be open minded if you can.

The CI evaluation is pretty straightforward. Mostly just tests that will be hopefully done correct.

Just follow as instructed, simple.

There might be a question and answer time if you are a candidate. This might include family life and why you want CI and much more. You can always say you need to think about it so don’t worry.

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#17

The only thing I can add to @Raudrive is it was a 2 hour long appointment when I was evaluated. The score requirements have relaxed a bit since I did it as well. But do take a bottle of water with you, so you can have a drink when/if you need it.
Good luck.

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#18

Thank you both for perspective and encouragement. I probably will con’t. with appointment as testing is routine and primarily “automated.” However the evaluation, counseling, etc. based on results, my needs and expectations requires skill and experience and it is primarily with regard to that where I expect someone more experienced might?? offer a good deal more.

#19

Edma if this clinic has the surgeon you want/like/trust or you look around after your evaluation. Then you do some research on clinics and what they offer. Some clinics offer 2 processors others only offer one. What processor would you like?

After activation and your first mapping if you don’t click with your current audiologist you can get everything transferred to a clinic of your.choice. Just because this audiologist hasn’t been qualified for long, doesn’t mean she doesn’t know her stuff. Give him/her a chance at least. Each company has their own audiologist you can always ask for one to attend your next mapping g session.

#20

I actually prefer newly qualified people as they do their jobs properly and are not slack!

Side note - everyone has to start somewhere as well. They are just as qualified as well.

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