Sunday, November 23, 2014

Cochlear Implants, Music, and Pitch Perception

I wanted to write a bit about music perception, specifically pitch perception with my implants.  I was a classically-trained musician for quite a long time during my youth when my hearing was more-or-less normal.  My pitch perception was relatively perfect, meaning, if you gave me a Middle C, I could re-create the entire 88 pitches in my head with very high accuracy.

When I got my first implant activated and started intensive music therapy on my own, using songs I know very well, the perception was quite inaccurate.  A specific example of this was using a guitar.  I would play various notes, and for the most part it "sounded like" buzzing during the first 2-3 months. After that, pitch started to come through, but a weird thing happened with the actual perception of each pitch:  I would perceive pitches as "different" going up and down a string, but there was also the presence of another pitch.  This is best demonstrated by a picture.


So essentially, the guitar string in reality was playing the "orange" note on the far left, but what I was hearing was a distinct "red" and "yellow" note.

It has now been 8 months since activation, during which I generally listen to about 2 hours of music during my commute.  I believe I am extremely close to the orange note on the far left, if not on it.  Music with which I am intimately familiar sounds more or less like it did when my hearing loss was very mild.

But I'd like to speculate here on causality for a minute.  The high frequencies of my hearing steadily decreased from the time I was very young, until finally disappearing last year.  They have been almost completely shot for at least a decade.  Given this, I have been functionally deaf in those frequencies for a long time.

So what happens when I am suddenly able to hear across the entire spectrum again?  It's like walking from a dark room outside after a fresh snow with full sun.  It's overwhelmingly bright, and details cannot be resolved!

People with normal hearing, even if they are musicians, are generally unaware of just how many harmonics are present in even a single tone from an instrument or a voice.  Also, the timbre that gives the instrument its unique sound.  But having been deaf to most of the spectrum for 10+ years, my brain was unable to "flatten" all those layers and properly perceive it as a single tone, instead perceiving harmonics and timbre as phantom tones and buzzing, respectively.

I find all of this very interesting to think about.  I also wonder how much my previous experience as a musician has aided my rehabilitation using cochlear implants.  I hope someday to be able to leverage my experience to improve the technology and coding algorithms for future generations of implants.

Wednesday, October 1, 2014

Bilateral Cochlear Implants!

And on the heels of my 6 month update, I am happy to share that I got my second implant two weeks ago!

I will be getting activated on October 14, and I plan to spend the first 2-3 weeks wearing only the new processor in an effort to equalize the new side instead of letting my good ear be a crutch/hindrance.

I'm hoping my second activation goes as well as my first.  Fingers crossed!

Cochlear Implant - 6 month update

How are things going?
Overall, I could not possibly be happier with my CI.  It has completely blown away even my highest expectations.  I've been using essentially the same sound processing strategies (Optima P, ClearVoice medium, IDR 60) for about 5 months now, with minor tweaks here and there.  The only time I even bother to change programs, is when I am in a very noisy situation like a restaurant, and want to use UltraZoom which allows me to focus on sound in front of me.

How does music sound?
This is probably the hardest part to explain, and is somewhat philosophical because I cannot possibly know how things sound to other people.  As a child, I had only minor hearing loss, and I was an active musician with perfect pitch perception.  So I also don't know what it is like for people who don't have good pitch perception.

Another thing that makes it hard to explain:  music through my CI is both infinitely better and far worse than it was with hearing aids.  I have not been able to effectively hear high frequencies for more than 20 years now, so to suddenly hear this entire range of music is insanely cool.  On the downside, low frequencies are sorely lacking through my CI, and clarity leaves a lot to be desired, especially in complex music.
My pitch perception is now better than it has been in about 15 years, and has improved slowly but immensely over the course of the last six months.

Can I talk on a phone?
YES!!!  To my great surprise, my iPhone is now the most effective way to communicate with people on the phone.  When I had hearing aids, I was only able to use high-quality speaker phones, and now they sound bad compared to holding my iPhone to my ear.

Challenges
Like hearing aids, CI's are not perfect and there are some very serious challenges that we face that can be confusing to people around us.  I can carry on a perfectly normal conversation with someone in a small room, and 5 minutes later find myself unable to make out anything being said.  The biggest challenges:
  1. Competing noise, especially other voices
  2. Rooms that have a strong echo
  3. Most TVs, radios, etc sound quite distorted

Saturday, March 29, 2014

Post-Activation - 11 Day Followup

I've gone back for my second mapping.  I had a moderately long wish list and we got through everything.

I cannot stress enough how vitally important it is to understand how cochlear implants work, and what the tunable parameters are, and what each one does.  It makes far better use of our limited time together if I can convey what I need in "audiologist language".

First, I wanted my favorite program in slot 1.  No brainer.  HiRes 120, Clear Voice medium, IDR set to 60, using tmic only.

So next, we had to kill the RF lock issue I was having due to my thick skin flap and some residual swelling.  We did this by overriding the automatic RF power.  We made two copies of my favorite program, and set the RF power to 8 on one, and 12 on another.  SoundWave estimates I will get 7 hours from the large batteries on level 12 instead of 22 hours on automatic.  OUCH.  But it's better than dropping RF lock all day long.

Finally I wanted one copy of that program with UltraZoom, and another copy with IDR set to 80 and ClearVoice set to low for listening to music and TV (next time I want CV off on this program).

Last night I was getting sore as the skin thins out from the pressure of the magnet, and was thrilled to find good magnet hold with only 2 of 5 magnets installed in my head piece!  Both the RF power required to hold RF lock, and the magnet strength required to hold the head piece seem to change day over day.  I imagine this will settle as all swelling subsides and my head gets used to having pressure from the magnet.

How is everything sounding?

  1. Speech in quiet is real awesome, though women sound more realistic than men.  Men all sound a bit like Kermit.  I think I need to boost M/T levels around 1000Hz
  2. Speech in noise is difficult, but combined with lip-reading it is workable for the most part
  3. Music.  Sigh.  For the most part music that is not overly complex has the best chance of sounding decent.  But then there's also a huge dependence on the vocals.  Anything with lots of percussion sounds good due to the large pitch range of percussion.  Rap sounds pretty normal.
  4. TV and Computers can be difficult.  I think it has more to do with the sound dynamics of the room, since hooking up to TV with comPilot sounds pretty excellent.  Need more practice.
  5. iPhone held to my ear is pretty workable.  Depending on the person's voice, it can sound quite excellent.  Speaker phones fall into the same category as TV and Computers for the moment.
  6. Rooms with a high amount of echo are a huge challenge!

Tuesday, March 18, 2014

Activation!

Well activation day was today.  I've got to admit, there may have actually been more excitement and anxiety than with the surgery date itself.  At the end of the day there's good news and bad news, but almost all good news.

First, the bad news.  I sat down in my audiologist's office and we assembled the Naida's, hooked them to her computer, and SoundWave recognized the processor right away, but sat there searching endlessly for the implant.  We swapped processors, cables, head pieces, everything.  Searching never ends, and implant is never found.  This feeling strongly resembles flying by a cop at 90 mph.  Sinking, nauseous, kill-me-now feeling.

The surgeon had said the skin flap was *very* thick, so I already knew this was a possibility, but hoped I wouldn't be in some tiny minority.  Can I at least win the lottery?  Now there's a minority we all would like to become a part of!  Not going through a surgery to discover that the computer can't find your implant.  We put the maximum number of magnets in the head piece and it just barely stuck in place.

My audiologist called AB and she starts searching her parts bins, and pulls out this HUGE "Platinum Series" body-word processor that looks like some toy from the 80's (hereto forth known as The Relic).  Hooks it up to the computer and sticks the head piece on, and 30 seconds later I'm hearing test sequences and we're adjusting volumes across 16 channels.  Awesome, except the SoundWave software refuses to let her do anything with the Naida because it can't find the implant.

So the work around is to program The Relic (which doesn't support all the new features obviously) and then copy the program to the Naida while it's off my head.  Then we try that program and see how it sounds.  Essentially we have lost the ability to tweak in real-time, which really sucks.

Now for the good news.  Even with The Relic, when she first turned it on, I was immediately able to hear her voice--quite clearly.  And since I have heard her before I lost all hearing in both ears, I know that it sounds pretty accurate.  No Darth Vader.  No helium-sucking-kids.  No chipmunks.

I compare the feeling to the whole "3D pictures from the 1990's".  You know, those stupid pictures that look like random paint splatters, and after staring at them for 10 minutes, it suddenly turns into a 3D object, and the moment you look away and then look back, it has vanished again.

I hear a lot of noise that sounds like old computer modems, and then voices will jump out plain as day.  Then it kind of fades back into that noise.  I suspect as time goes on, that noise permanently becomes the clear voices.  We'll see...

Thursday, February 27, 2014

Healing...

Lots and lots of healing.  The body is a pretty amazing piece of work.  I had a noticeable amount of swelling on the CI side of my face yesterday (day 2).  I don't really need any pain meds anymore--it just feels like a long-lived headache now.  I still can't chew properly because it seems the jaw muscles are very much connected to the muscles near the temple, and that region hurts like a bitch when I try to chew anything beyond yogurt/pudding.  Also the swelling in the ear area seems to be where a lot of the jaw action takes place, and that isn't pleasant either...

So day one was almost all sleep.  Day two, I was awake for roughly 5-6 hours total.  Today I have been awake for over 4 hours and still not drained.

All in all, I'm in surprisingly good shape.  Can't wait to feel completely normal again.  I feel the knock of boredom coming really soon.

Tuesday, February 25, 2014

Completely deaf ear is implanted

I had my surgery yesterday and got implanted with the Advanced Bionics mid-scala electrode. Surgery took about two hours, and pain in recovery was bad the first hour and I just felt miserable for a couple hours after that. I got home 6 hours after surgery ended and felt reasonably good by managing pain with Percocets. I'm not a back sleeper, so trying to sleep was a bit of a challenge. I slept mostly on my side and tried some on my stomach, but pain kept waking me. 

This morning I still feel okay with pain meds. I have to take off the compression bandage today so more to come.