Get the Balance Right

It’s been a year since my last mapping, which is CI-speak for reprogramming my cochlear implants.  When I first got them, I went to the audiologist weekly for new maps.  Then I progressed to every month, then 3 months and finally, 6 months.  This is the first time I’ve gone a year between mappings.

The audiologist who did my last 2 mappings was out on maternity leave, so this time I saw Kathy.  She did my original hearing tests when I first lost my hearing in 2008, and also did my CI assessment.  However, she was on maternity leave when I had my surgery and was activated, so she has actually never done a mapping for me before.  I was excited to work with her again because I really liked her and she was so nice and helpful when I was going through my evaluation process.

Kathy was still with another patient when I was brought back, so a different audiologist (Kris, who did my activation and most of the early mappings) and intern/student got me started.  They took me right to the sound booth for testing (my favorite thing, whee).  There doesn’t seem to be a set pattern with this – sometimes I’m given the hearing tests before my mapping and sometimes they wait and do it after I’ve been mapped.

I started with the tones, and they let me choose which ear to test first.  I opted to go with my right ear first, which is the one that’s been deaf the longest and performs worse on these tests.  It stresses me out the most to have this ear tested by itself, so I figured I’d get it over with and then my results would get better from there on in.  This actually took away some of my ‘perfectionist’ stress – the hearing tests always make me feel like a bit of a failure, even though I know that’s ridiculous.  (I mean, if I was tested without my CIs, I wouldn’t be responding at all – I looked at my hearing tests from when I lost my hearing and the marks are almost all along the 110 db line with little arrows down to 120 db, and a couple around 100 db.)  But starting with the worse ear and working my way up made me feel like I was accomplishing something as my responses got better.  Just one of my weird personality quirks, I guess!

They tested each ear separately and then both together.  I always forget to ask for the results of these tests (so I don’t have official results in front of me) but they did mention that I didn’t give a response for some of the higher frequencies.  These are still almost impossible for me – if I get anything at all, it’s just the sensation of the CI processor compressing the sound down because those high pitches set off the noise compression program.   This time I didn’t even sense that – I guess I just wasn’t hearing the higher pitches at all.  I think this was with my right ear – I know she said it happened with one of my ears, not both.  (I was using my regular listening program, not the background noise compression program, but even the regular program will compress.)  We did work on the high pitches later on during the mapping; more on that later.

After the tones, I listened to the man speaking sentences.  Last time I was tested, the audiologist spoke the sentences and I did much better than normal, especially once they added in the static/background noise.  This time, I did pretty good in quiet – I’m not sure about my right ear, but I got 100% correct with my left ear only and with both ears.  In noise, I think I just caught a couple of words with my right ear – it is very, very difficult for me to pull his voice out of all the background noise – and I did better with my left ear, and then FAR better with both ears.

I was quite relieved to get out of the sound booth and go back to the office for the official mapping!  Kathy started by asking me to just talk to her about my hearing for the past year.  I explained that for at least the past 6 months, I had been using the background noise program pretty much exclusively.  (My cochlear implants can store 3 different sound processing programs or strategies.  I have one for regular listening in Slot 1, one for background noise compression in Slot 2, and one for the Direct Connect earhook in Slot 3.)  The regular listening program was just too loud; I felt like it was overwhelming, my voice sounded very loud and echo-y to me, and the background noise compression program was just more comfortable.

I had really not used my Direct Connect program at all – I was mainly using this to connect to my mp3 player when I was using the treadmill, and now I walk with Dave on a daily basis and almost never use the mp3 player.  So I asked if I could try a T-coil program on that third slot instead (to help with the phone and utilize things like FM and loop systems that usually use T-coil).

When I get mapped, I have to take off the CI that is not currently being mapped.  I hand the other one to the audiologist and she removes the rechargeable battery and slips on a connector that connects my CI to her computer via a long cord.  Then I put the CI back on.  During all of this, I don’t hear anything at all so I rely on speech reading.  She hands me a chart to use to indicate whether the sound I’m hearing is too loud, too soft, comfortable, etc.  There are probably 8-10 different levels of sound I can indicate on the chart.  This time, I also got a chart to use for comparing the volume level of two different sounds.  This was totally new to me and I really liked it – she was using it to try to make sure all the electrodes were at a similar, comfortable volume.

So I’m sitting there in total silence and then all of a sudden I hear a “boop boop boop” sound coming into my ear.  I listen for a second and then indicate if it’s comfortable, too soft, too loud, etc.  Then I hear a different tone for a few seconds, then the original one.  Now I have to report whether one sounds louder or softer than the other.  It’s kind of tricky, because they are different in pitch – some are high pitched, some are low – and I need to just think about how loud they sound.  Most of this mapping was done with comparing the volume of two different electrodes, and it was really interesting to do it this way.  I felt like it really helped to be able to compare the volume of two different sounds rather than just listening to one and reporting whether it was too loud or too soft.

Once all the electrodes are mapped (and I’m still connected to the computer), the CI is turned on and I have to listen and let the audiologist know how things sound.  My initial reaction is to always say it’s too loud, partly because when I first put my CIs on, the big rush of sound is always a bit loud and overwhelming.  If I wait a couple of minutes, things settle down and sound okay.  So Kathy reminded me of this, and suggested we just talk for a few minutes.  I had Dave talk, so I could see how his voice sounded, and the four of us just chatted for about 3 minutes.  I was surprised to find that I didn’t need the sound lowered after all – things started to sound really good and comfortable volume-wise.

The right side was mapped the same way – I took off my left CI, was connected to the computer and, again, I compared the volume of two different tones for the majority of the mapping.  I still have some high pitched tones that just make me completely dizzy – I hear them and my eyes feel like they are spinning around in my head.  I discovered that I already had one electrode turned off on the right side (there are 16 electrodes on each side) and Kathy ended up turning off two more.  If I remember correctly, I think she said that they were probably in a part of the cochlea that wasn’t effective and if they stayed on, things would sound worse (and I would get that vibration/dizzy feeling).  When they turn off an electrode, the frequencies get allotted to another electrode so it doesn’t affect the quality of what I hear.  I hadn’t even realized I had one electrode already turned off on the right side, so this was a very informative mapping session.

Things sound really good now – she worked on those high frequencies to make sure I’m getting more of them.  Even though I don’t like the sound of high frequencies, they are really important for speech and clarity.  Now I’m using the regular listening program 90% of the time, and I only switch to the background noise program if I’m in a really loud situation.

I also found out that my background noise program was only at 40 IDR (Input Dynamic Range, which basically is how many sounds are allowed in).  Normal IDR is 60 (I believe she said it used to be 70).  You can have your IDR set up to 80 if you wish – it’s all about what you feel sounds best.  But 40 is pretty low!  She changed the IDR to 50 on my background program and made my other programs 60, but said I can have it increased if I want (or lowered).  Right now I feel like it’s a good setting for me – I can tell I’m hearing more on the background program, but the loud noises are still compressed so it’s kind of nice to get a bigger variety of sound.

I will probably go back sooner than a year if ClearVoice is approved before September 2011.  That’s a new software strategy that is currently in FDA trials and is awaiting final approval.  I know quite a few people outside the US that have it already and really like it, so I asked Kathy to email and let me know as soon as it’s available here.  She said they are going to start training on it in October (next month).

One final note – my SlimCell batteries were starting to last for only about 6 hours, which is really short.  I’ve noticed since my mapping that they last longer, which is kind of weird – but it’s a nice side effect, so I’m not complaining!