Friday, April 24, 2009

Some people who got CI have unaided audiograms I would rather have instead of CI!

Most people who qualify for a CI have profound hearing loss. Most profoundly deaf people don't have any hearing above 2000Hz. But since 2005, CI criteria has become way too lax and I am seeing moderately HOH people somehow getting CI. I am anonymously(not revealing who they are nor any personal information) blogging their audiograms along with facts, stats and opinions. This is not meant to offend, just be a learning experience for me and everyone else.

Below, I have found from a Google search,  some audiograms of people who got CI. I respectfully disagree with their choice. But I am never rude to anyone! They have so much residual hearing that I would be better off having their residual hearing and wearing HAs than getting CIs! Not only that, they would be able to hear plenty of low frequency environmental sounds unaided, something I am sorely missing out on! I do not understand why they can't be happy with their hearing that is leaps and bounds better than mine?

I did notice that they all had in common a desire to increase their % on speech comphrension/recognition. This is understandable, even by me. What I am confused is how are they having so much trouble despite having a great deal of residual hearing? My audiologist told me if my hearing was 20db better, I would hear perfectly with hearing aids. Those people happen to have 20db or more hearing than I do so you can see why I wish I had their audiograms!

Speech can be accessed by reading lips, sign language and written language. When I talk to others I look at their lips instead of eyes and most people don't even realize I am severely deaf. I did let some of them know as I am not hiding anything. It doesn't bother anyone so why should it bother me? Personally, I find it more inconveniencing not to hear much unaided and even aided not to hear as well as those with better hearing than me. I am missing out on some environmental sounds and there's no way to lip read sounds, just speech.

Ive noticed that some people do not try the best HAs available before getting CI. While I understand everyone wishes to hear better, trying the best HAs is a requirement that should be mandatory. This is exactly what I am doing and my own audiologist doesn't recommend a CI for me, he certainly won't recommend a CI for anyone with better hearing. When my HAs are reprogrammed, he feels I could achieve 15db aided in the low frequencies and up to 30db aided in the mid frequencies. Transposition, if it works for me will shift the high frequencies down to where I can hear them. 

Speaking of transposition, this is something everyone should try. If it works for you, great! Even if not, I don't understand the obsession with the high frequencies. Only 10% of the speech banana takes place at 2000Hz and above. I am able to understand 70% of what my dad says without lipreading. Ive seen others without high frequency hearing score way above 40% speech(HINT is one such test)  I probably would not be a CI candidate unless I score 40% or worse. But I am not getting a CI candidacy test as I don't need CIs at this time, I will wait for better technology or unless my hearing gets alot worse.

I am not against CI and you have to understand that I would get a CI myself if the benefits vs. risk ratio was favorable enough. CI is real surgery with many different kinds of risks. It's also a permanent choice and the majority will lose most or all their residual hearing in the implanted ear.

Still considering that CIs usually destroy your natural unaided hearing, this is not something I would trade away, especially when it's enough to hear plenty of environmental sounds unaided! My loss starts too high for me to hear the majority of environmental sounds unaided. I essentally am deaf without my HAs and live in a silent world. That person apparently wasn't happy with having no high frequency hearing. I used to be that way but now I believe high frequencies are overrated.

For all audiograms, red is unaided scores, blue is HA(Phonak Naida V UP), green is CI. Note that the HA scores are the theoratical maximum they can achieve with the best HAs. Those aided scores are what I could possibly have if I had their unaided audiogram. I recreated those audiograms from different CI blogs and sources and made them easy to read using paint. I did have to extrapolate 125Hz and some half octive frequencies that werent tested on the audiometer for some of the below audiograms. No personal information has been disclosed about anyone, all info I found was already made public by the respective authors. Everything on my blog is for educational purposes only.

You may leave me a comment as long as it's not rude or offensive. Feel free to debate, agree or disagree with my assertions and opinions. Maybe I can learn something. Everything I have learned at this point is on my blog.

Audiogram 1:

My opinion and comment: This person has a moderate low frequency loss that slopes precipitously down to nothing. That 1500Hz result might even be a response based on the cochlear dead region phenomenon rather than true hearing at this point. That person did respond at 120db in some of the high frequencies which further supports the dead cochlear zone theory. Youd just hear a noiselike sound, distortion or wooshing of air and still respond, thinking it was a puretone being played. The person failed to respond to 1500Hz in one ear. I am giving the benefit of the doubt and recording the 1500Hz as valid but nothing above that. The person even mentioned in the blog that the hearing quickly whittled down to nothing. No one would argue that 120db at 1500Hz is pratically useless and nothing to get excited about. Any further progression of HL would wipe out the residual hearing at 1500Hz. That could have made sense as another reason for CI, but still there was so much low frequency hearing!

Doing the math, that person would have with HAs:

125Hz-500Hz 100% of 60%=60% access to speech
500Hz-2000Hz 67% of 30%=20% access to speech
2000Hz-8000Hz 0% of 10%=0% access to speech
Total access to speech is 80% with HAs

Doing the math, that person would have with CIs:

125Hz-500Hz 67% of 60%=40% access to speech
500Hz-2000Hz 100% of 30%=30% access to speech
2000Hz-8000Hz 80% of 10%=8% access to speech
Total access to speech is 78% with CIs

Additional comments: This is about the same. That person could have tried the best HAs and heard much better than CI in the low frequencies. CI was worse in the lows but better in the mids and highs. I would never get CIs for myself if I had that audiogram. I would prefer that person's HA scores than CI scores on myself in my opinion. If I could choose to have CI or to have that person's audiogram and wear HAs, I would choose that audiogram and wear HAs.

Audiogram 2:

My opinion and comment: This person has a moderate low frequency loss that slopes down to 120db at 4000Hz. At least that person still has minimal high frequency hearing. My audiologist correctly says a loss of 120+ db is useless for any HA. It is not even certain that person would respond to any tones at 4000Hz during an aided test, besides it would be outside the speech banana anyway. For the matter, even the 3000Hz is pretty much useless save for the possibly of faintly hearing a whistle or birds singing at close range. It is no surprise that some of today's audiometers, including the one that tested me on March reach up to a maximum at 115db at 3000Hz. Interestingly, the other ear is actually worse in the low frequencies but better in the highs. It had a cookie bite audiogram(80, 95, 100, 95, 85, 75) More interestingly, it actually scored better in speech. I am not surprised since that person was still able to be aided well enough to access speech in the lows. A 65db gain at 250Hz would yield 15db aided.

Doing the math, that person would have with HAs:

125Hz-500Hz 100% of 60%=60% access to speech
500Hz-2000Hz 95% of 30%=28.5% access to speech
2000Hz-8000Hz 10% of 10%=1% access to speech
Total access to speech is 89.5% with HAs

Doing the math, that person would have with CIs:

125Hz-500Hz 80% of 60%=48% access to speech
500Hz-2000Hz 95% of 30%=28.5% access to speech
2000Hz-8000Hz 80% of 10%=8% access to speech
Total access to speech is 84.5% with CIs

Additional comments: This is 5% worse for speech but much worse for environmental sounds. That person could have tried the best HAs and heard much better than CI in the low frequencies. CI was worse in the lows but better in the mids and highs. I would never get CIs for myself if I had that audiogram. I would prefer that person's HA scores than CI scores on myself in my opinion. If I could choose to have CI or to have that person's audiogram and wear HAs, I would choose that audiogram and wear HAs. That person obviously doesn't care for environmental sounds.

Audiogram 3:

My opinion and comment: This person has a moderate low frequency loss that slopes down to 115db at 2000Hz. That audiogram is actually similar to mine but with only a moderate loss instead of the severe loss I have. Thus that person can still hear some sounds unaided while I can't. That's the main advantage over my audiogram. The other advantage is the possibility of getting to 0db aided, something my audiologist said was not possible for me. He says 15db aided in the lows and 30db in the mids is realistic for me. This would still make me happy and not feel the need for a CI as no one gets to 0db with CI either, they get between 25-40db with CI so this would only help in the highs of 2000Hz and above. That's something I might achieve with transposition and even if not, I can live with that. Ive never really heard the highs so I don't know what they are like and therefore don't know what id be missing. But ive been told by hearing people that high frequencies are annoying and that they would give up the highs if it won't affect their speech.

My audiogram:

My opinion and comment: My own audiogram is similar to audiogram 3 but I am missing alot more of the low frequencies. Today, I am not even sure ill hear 2000Hz. Ive seen my audiograms in the past and had more tests recently and my lows have remained basically unchanged. I lost whatever little high frequency I had as a kid and lost most of my mids. They were never great to begin with a 100db loss at 1KHz to 6KHz straight across. But at least the most important frequencies, the lows are still in the severe range instead of profound range. The lows alone account for 60% of speech and 75% of sounds. So you can see why id love to have the audiograms you see above. It would make the biggest difference in speech and sounds as well as being able to hear unaided.

Try every HA before CI! This guy now scores 80% speech with HA!

The story that Overthepond linked to me: 

Now that I have found the source, I am adding it:

*****source*****  <---------- copyright by him. All credit goes to him!

I was on my way to deliver new hearing instruments to a man named Jim whom I have never met before. I was thumbing through his file to get to know him and found out that he had gotten hearing instruments about a month ago and returned. He went to a popular retail hearing aid chain and decided that he wasn’t hearing any better with his new instruments.

I noticed that his word recognition was about 20%. Wow! I thought this will be a huge challenge. Upon arrival I was trying to have a conversation with Jim and you could tell he wasn’t hearing what what was said. He was very somber, but who wouldn’t be, he couldn’t participate in anything that was said.

Well, he was fit with the Phonak Naida V’s and even though I have had such great luck with these, I was scared. When I turned them on and started to talk with him he could answer everything I said. I started walking around the room and from 15ft away with his back to me he could answer my questions. I was floored, but he wasn’t! His wife talked to him behind his back and he could answer every question she asked, butt still no reaction. I told him that I was happier then he was. His wife said ” he has been so disappointed with hearing aids that we can’t get excited anymore.” So, on that note I hoped and prayed that he would do well.

I went for his followup about four days later and when I walked in he was smiling. He sat down and said, ” I think I am going to keep these.” I asked him what made him come to this conclusion. He said, ” I can hear my wife and I can hear my dinner guests, but this was the first time I have heard the preacher at church in years.” Whoaaaa, he blew me away!

His word recognition was 20%, but after four days later and using some word exercises his recognition went up to 80%. Amazing!
What else can I say. “What a day!”

Do high frequencies really matter much at all?

I used to be more obsessed(I have OCD) about wanting to hear high frequencies but after researching it on the internet, I begin to wonder exactly how important the highs are? Someone in this forum said 75% of environmental sounds are low frequencies so 20% must be mids and 5% highs. Thus I am missing very little in the way of environmental sounds and ive been told by friends and family that they too would not miss the annoying high pitch sounds as long as their speech comphrension remained normal. Hear Again no longer hears above 2000Hz(too annoying) and doesn't miss it since her speech comphrension remained unchanged. She even said music sounds better without those annoying high tones!

As for speech, several posters here keep saying how important 2000-4000Hz is but Hear Again had 6 high frequency electrodes disabled and doesn't really hear above 2000Hz anymore, yet her speech comphrension has not dropped at all! My own dad has a moderate high frequency loss, yet he has absolutely no trouble understanding speech and can even hear S, F, TH sounds! I even checked the speech banana and most of the letters fall in the low(er) frequencies. The highs help with S, F and TH but even those speech sounds aren't puretones and have lower frequency components. I can hear S and F, just not tell the difference between the two.

From reading on the internet and that article I posted I have logically concluded that low frequencies(125-500Hz) account for 60% of speech, the mids(500-2000Hz) accounts for another 30% and the highs(2000-8000Hz) account for the last 10%. My dad and Hear Again is missing that 10% but still understands 90% of speech. My dad understands close to 100% since he hears unaided naturally.
I am also missing that 10% and alot of the 30% but I am able to access all of the 60% and some of the 30% which is why im currently understanding about 70%(up to 80%) of what my dad says without lipreading.

My results are probably a little above average. Look at this post where this profoundly deaf man scores over 90% speech! So if people like him, me and many others can still score great on speech comphrension using our residual low frequency hearing, it sounds like(pun intended) high frequencies simply add clarity and details to speech and sounds(which is never a bad thing) but low frequencies are the fundamental structure of speech as well as environmental sounds.

I gotta be honest there that I have no real idea what high frequencies are like, how can I miss what I don't know? It's like my colorblind brother, to him, his world looks normal(in it's browns, blues, yellows) and he argues that colors aren't that important. I guess it's nice to see all 1 million colors instead of only 10 thousand. But I agree that my brother's colorblindness hardly affects his life other than posing some inconvinences when many different colors appear identical and he confuses them. He has trained himself to differnate colors by hue, for example red and green look like different hues of brown with red being a much darker hue.

I have learned something akin to what my brother learned with sounds. I can fill in the missing gaps when listening to speech. S and F sound like "ehhh" to me and when listening to sentences, I can usually deduce the proper letter unless the word happens to be a rhyming word such as "fit" and "sit" but put in a sentence, I usually know what the word should be. My own audiologist says I should keep training my brain to discern different words then it will begin to come naturally to me instantly and readily. I notice my brother discerning colors instantly because he has trained his brain to differnate the hues.

To summarize it up, high frequencies 2000Hz and above account for only 5% of environmental sounds(shrill whistles, squeals and squeaks) and only 10% of speech(S, F, TH consonants) so I ask again exactly how significent is missing on a small percentage of speech and sounds? How much of a difference does it make to those who are hearing or still have high frequency hearing? Has anyone tried a comparsion? I will be trying that at my audiologist by telling him to turn off the gains above 500Hz then to turn off the gains below 500Hz.

Monday, April 20, 2009

I scored 35% speech CNC with a home test administered by dad.

 My dad read me a random list of 25 CNC words. I wrote them down then compared them to the list and used the official scoring system. It was done in the home office and I could hear the hum of computer fans and the TV in the next room. I would of scored higher if there was no noise. Also my HAs need to be reprogrammed for more gain and other features then I should get to like 50% score. I can already get about 75% score for sentences and numbers(1-100) so I consider my speech comphrension to be quite good and itll be even better when my HAs are reprogrammed.

1. JAR(jar)(3)
2. BOIL(body)(2)(I thought my dad mispronounced this one! It sounded like a two syllable word!)
3. TOUGH(hat)(0)
4. TOOTH(cat)(0)
  5. GOOSE(net)(0)
  6. TOAD(pond)(1)
  7. ROUTE(high)(0)
  8. MESS(nets)(1)
  9. KITE(wait)(1)
10. JUG(jug)(3)
11. PAD(held)(1)
12. SALVE(fine)(1)
13. VAN(bait)(1)
14. HOME(hold)(2)
15. CAPE(eight)(0)
16. SHORE(far)(1)
17. WRECK(sight)(0)
18. SHIRT(third)(2)
19. KNIFE(might)(1)
20. HULL(cow)(0)
21. YEARN(girth)(1)
22. SUN(burn)(2)
23. WHEEL(ear)(1)
24. FIT(state)(1)
25. PATCH(fought)(1)

I scored a 35%(max points=75, my score=26)

Friday, April 17, 2009

Im learning more about CIs, her results were good. A good surgeon matters!

I talked to another lady who got CIs(two) and she got lucky, especially in the "worse" ear that had 95-110db loss. She now hears 15-25db thresholds and was so happy she got her better ear implanted. I was worried she would hear worse than her HAs since her better ear had only 85db-95db loss(250Hz to 8000Hz) The Phonak Naida V UP HA's have a max gain of 82db so she would be hearing around 10-15db with those HAs at some frequencies. Yet she says she not only hears speech but also hears environmental sounds better with either of her two CIs! I am trying to understand how that's possible compared to the best HAs. She did say that her "better" ear had some cochlear ossification which was only discovered during surgury. Perhaps this could be a plausible explanation of why she was hearing unusually poor with her HA. I feel I am hearing quite decent with my HAs.

I for one hear a great deal of environmental sounds and my hearing is actually worse than hers except in the low frequencies(75db loss at 250Hz for example) I do know that anyone considering CI should be getting a 90 day trial of the best HAs first. Not to do this is very irresponsible, sadly ive seen a few people get CI without ever trying proper HAs or getting their HAs properly programmed. They have no idea what HAs could have given but with their residual hearing, the results could have been great!

I do know that it's easier to achieve an improvement in speech comphrension since getting the same thresholds with CIs does yield an improvement over HAs but for environmental sounds, it should be the same. My audiologist is going to reprogram my HAs two weeks from now and he should get me down to 10-15db in the low frequencies and around 30db in the mids. Transposition should give me access to the highs by shifting them down to the mids. To be fair, I won't count transposition in any of the math I have done and will do. So therefore ill count it as missing frequencies above 2000Hz entirely.

Transposition will make a 4000Hz sound appear to sound like a 2000Hz sound, one which I can still hear. No HA will give me a real 4000Hz sound since I have no residual hearing in the highs that can be amplified. Oh well ive mentioned before that high frequencies 2000Hz and above only account for 5% of environmental sounds and many people find high pitches annoying to hear. Even my parents say I am not missing out by not hearing high frequencies. I am able to understand 80% of what my dad says without lip reading. It could be 90% after my HAs get reprogrammed. I also mentioned that this profoundly deaf man scored over 90% on speech. I am saying get proper HAs, find an expert audiologist that will program your HAs to the max and give your HAs a chance to shine!

She did tell me that a good surgeon knows how to properly implant the electrodes and won't rush the operation. That could be part of the reason, that and she said she's in the top 2% for CI results. In other words she also got very lucky to have such a good CI result. Her thresholds look impressive as well as her speech comphrension. I am happy for her but caution others to be realistic in their CI expectations. I am realistic and to be honest, I am not expecting CI to give me hearing as good as my HAs so of course im not getting CI till technology improves alot more and my hearing gets worse. You can see my previous posts below for more information and the math ive done.

Wednesday, April 8, 2009

This woman hears worse in some aspects with CI over HA.

I just finished reading another CI blog and this woman's CI journey was a long and difficult one. I am linking you to her blog. Note that she hasn't updated her blog in almost two years and has no further news. Her blog  <------ source

I am providing some excerpts from her blog to save you the time from reading every post. My comments below are shown. The purpose is not to warn you from CIs or decide for you, but only provide information to help you make an informed decision. Today's candidacy criteria is way too lax and there's way too much hype with CI. I am seperating the hype with realistic expectations of what CI can and can't do.

1. Between pressure disguised as “encouragement” from family members and others, and unrealistic overly optimistic expectations from them, I began to resent the implants and even psychologically reject them. I was so tired all the time, it was mentally and physically exhausting. I had enough to deal with, you know, like real life and stuff? I wanted to get on with using the blasted things effortlessly, I wanted to forget they were even there and just have my hearing as it was be a part of my life. 

My comments: I have made this point before that there is way too much pressure and hype surrounding CIs. Many people, even family and friends of CI wearers believe the hype and thus their expectations are unrealistic.

2. Cochlear implants may solve a big problem, but they give you a lot more to solve in it’s place. I’m pretty sure that when someone says “Wow it’s so cool, YOU CAN HEAR!” I am not the only one that thinks “It’s not as great as you think it is. You’re so used to hearing so easily and effortlessly. For me, it’s work. It’s stress. It’s frustrating. It’s not like one day I went from being deaf to being just like you, it’s more like I went from something I knew and was comfortable with to something that I have to work at constantly while I watch everyone else around me get it so easy… just shut up. You don’t know what it’s like.”

My comments: The big problem CI solves is giving the deaf access to sounds and some speech. For over 90% of the profoundly deaf, they still have a measurable amount of residual hearing. Then it becomes a choice vs. HAs. I can't make that choice for you, I can only give you the facts, opinions, risks and numbers and you must decide.

3. And having implants of course causes expectations of those people in your life for you to be able to do things that despite how much hearing the implants have given you, you just. can’t. do. Like for me, hearing on the phone, and being able to comprehend without reading lips. It’s just not going to happen, and I am tired of it being expected to happen. 

My comments: CI results vary. Some people hear just environmental sounds, others will understand a little speech. Still others will have decent hearing. A lucky few will hear as good as normally hearing people. Not everyone can understand speech with CIs.

4.  It’s like they think that each appointment, each surgery, each little thing involved is going to be “THE CURE”. It’s going to make me hear! It’s going to solve all my problems! No it’s not. Why can’t they just be happy with the way things are? I am! As if all that wasn’t bad enough, whenever the results inevitably don’t measure up to their expectations, it’s always my fault somehow. I don’t do enough. I don’t practice enough. I don’t care enough. Oh no, the very idea that maybe I’m NOT going to hear as well as them is just not possible, it’s all my fault!

My comments: CIs are not a cure, they never were and never will be. Scientists are working on a cure that no one knows how far in the future itll become available. But there's no cure now nor will there be a cure in the next several years or longer. Your choice is HAs or take a chance with CIs. Be happy with whatever you decide.

5. What could have been a wonderful experience has been ruined by the invasion of those who think they they own stock in my bionic ears. Somehow it’s become all about THEM and what THEY want. THEY want me to talk on the phone and hear without lipreading. That’s all that seems to be important. Why? Since when did this become about them?

My comments: That also explains why 90% of deaf babies born to hearing parents have CIs forced on them. The parents explain that they aren't happy that their son or daughter is deaf. Maybe the kid doesn't mind being deaf? If the kid has any measurable residual hearing, get the most powerful HAs and max the gain(make sure this much gain doesn't cause any discomfort) and let the kid decide for himself when he's older or an adult. I had 100db HL at 1000Hz and up, yet I did great with HAs. I am 100% oral, speak clearly, read lips and understand some speech.

6. They had planned to declare the implant a failure anyway if it was still messing up after everything we tried (including all new external parts at one point), but finally at the last appointment before declaring it failure, it acted up while Dr. Wolfe had it connected to the computer and he finally saw what it was doing. I was very relieved, but at the same time it was bittersweet, because it was then confirmed that yes, the implant was in fact a failure and I would have to have surgery again to replace it. If you’ve read my accounts of my previous 2 cochlear implants surgeries, you know this was not good news to me by any means.

My comments: When a HA fails, it's easy and safe to replace. If a CI fails, it's difficult and risky to replace, requiring more surgery. She lost all residual hearing so she could not go back to HAs, something she wish was possible. Nowdays a lucky few retain most/all their residual hearing, making it a great plan B option.

7. But that pressure was nothing compared to the pressure I am experiencing with this new technology that the hearing world is misunderstanding as “the cure for deafness”, rather than what it really is which is a tool for attempting to mitigate deafness.

My comments: I see/hear it all the time now. CIs have been hyped so much that many people believe it to be a cure or at least something that restores perfect hearing. CIs are not a cure and very rarely give hearing equal to a hearing person. She does say it's a tool to give access to sounds which is correct.

8.  Once in a rare while I will overhear people’s conversations and catch a word here and there. I still have moments where I am hearing something faint and I can’t figure out what it is, then once I do I am amazed, such as crickets singing outside at night or a bee buzzing around me.

My comments: CIs do work and they give her access to environmenal sounds and some speech.

9. This almost happened to me, I can only imagine what the poor kids are going through with their parents putting so much weight on their child’s ability to use their implants. At least I am aware of this effect and I can say “Back off!” but the children may not realize this and think all sorts of negative things such as it’s their fault or that there’s something wrong with them, that it’s just not gonna work, or even give up, and parents and therapists constantly pushing them just exacerbates the situation. 

My comments: Ive mentioned it above, I will mention it again. Too much forcing, pressure, hype.

10. Everytime I want to listen to music, I get sad. I never realized just how much music really was a part of my life until I couldn’t enjoy it anymore. And it’s all because I willingly gave that ability away. Those who know me well say that I am much better off having implanted my “good ear” instead of continuing to use the hearing aid in that ear, but I’m not so sure anymore.

My comments: This is why it's usually a bad idea to implant the good ear. Implant the bad ear first! If going bilateral, think long and hard if you want to also risk the good ear or "save" it for future technology. Many people do great with one CI and one HA. Many people don't properly hear music after CI and her's is no surprise with only 12 electrodes. Read my earlier post to understand why.

11. It’s been about 2 and a half months since the left side was activated. I know that really isn’t long at all to adjust to an entire new way of hearing, but I was told I would adjust much faster due to having been able to hear with a hearing aid in that ear before. So far, I have been able to hear more stuff with it, but it still doesn’t sound very good. And ironically, my comprehension seems worse than with the hearing aid. I can no longer understand my loved ones without looking at them as I did with the hearing aid, and I can no longer talk on the phone. And the music… The music has ended for me.

My comments: Her CI in the worse ear ended up better than the HA in her better ear, yet a CI in the better ear was worse than the other CI or her HA. This just goes to show that results are a draw of luck. It also goes to show that having more residual hearing doesn't always give better results, in fact there's more to risk because HAs work much better with more residual hearing and when HAs work so well, they could be giving better hearing than CIs as she found out. I have made a post below explaining the math and that id need to get 24db threshold with CI just to match speech comphrension with male voices that I understand up to 80% with HAs. I also made a post of a profoundly deaf man who scores over 90% speech reception with HAs!

Sunday, April 5, 2009

Profoundly deaf man scores over 90% speech recognition with hearing aids!

(Case study, year 2008. He did get a CI eventually in right ear.)

This just goes to show that hearing aids most certainly are not inferior, well unless you happen to have a 115db or 120db hearing loss. My audiologist doesn't recommend CIs for me or anyone hearing equal or better than me, but did say that no HA will ever aid a 120db loss or if there's no residual hearing left, such as with cochlear dead zones.

He didn't mention what HA he was wearing but it's possible he wore the Phonak Naida V UP HAs(and if not, an equivalent from a different brand). I wear those too and got them in 2008. Right now I am able to understand 70% to 80% of what my dad says in the car and that's with much worse aided scores than what ive shown in the chart below(im getting my HAs reprogrammed for max gains and to enable transposition) so it's not too much of a stretch that he could score 90% in noise(and I might be able to match his scores). He did say it took alot of training, but nothing wrong with that and besides a CI would still require alot of training!

His hearing loss is progressive but he held off getting a CI for a very long time, instead doing the right thing by trying all the best HAs and maxing the gains. He did mention that he was taking a big risk getting a CI, but figured that he always has the better left ear and also even if CI was worse than HA, in a few years itll become better than HA because his HL was progressive and HAs won't benefit him after a few years. He probably felt that today's CI technology was "good enough" to risk the worse ear and hope he gets lucky with the CI results.

Well he did get lucky but how much can you improve when you are already hearing great with the best HAs with max gains? His speech recognition improved a few percent and is now over 95% while it was over 90% with both HAs together. He did get the biggest improvement with CNC but CNC doesn't usually reflect real world converstations, HINT would most closely reflect this which he was already over 90% to begin with.

There is way too much hype with CI recently. It is being pushed as the "latest and greatest" by audiologists, ENT and surgeons. They are probably forcing insurance companies to pay at least 80% of the $50,000 tag that CI carries. I really wish insurance companies would pay for HAs and for audiologists to work with the person to program the HA so he or she hears the best. The man who got the CI even mentioned in his case study that everyone should be training themselves to understand speech with HAs first and that it's no different from CI, both are simply tools to give the deaf access to sounds and speech.

Then this begs the question, why take the risk with CI and it's associated surgery? As long as you are getting benefits from HAs, stick with them! Even the profoundly deaf can benefit just fine with today's HA technology. It's simply a matter of choosing the right HA, having a skilled audiologist program and reprogram your HAs and getting speech reception training. This is possible even with unaided hearing as bad as mine and his. Of course if your unaided hearing is something like 115db or 120db at 1000Hz and NR above that and still 90db or worse in the low frequencies, it's going to be very difficult if not impossible to be able to score better than 40% speech reception which is the cutoff for CI candidacy.

I will repeat that I am not against CI, but only advise that you be realistic about what CI can do and can't do. It's not a cure or a miracle, but just another tool to aid the deaf in sounds and speech. Over 90% of the profoundly deaf still have some residual hearing left that would be amplified with HAs and thus provide access to sounds and in most cases, also speech. There's always other options such as lip reading, ASL and writing for anyone that ever has any difficulty understanding others.

Update: I did the math for his audiogram and he's missing alot of low frequencies and all of the highs. I am surprised his speech is around 70% in just his worse ear alone! But this should give the profoundly deaf new hope that with the best HAs on max gains(blue dots) you just might get enough usable aided hearing to have fairly decent speech and hear environmental sounds in the 30db range. A CI would not be much better, but id respect your choice if you had an extra $50,000 to spend.

Doing the math, he has access to about 67% of the lows and 85% of the mids. That's an overall of about 65% so that's great he can understand 70% of speech despite having access to only 65% of the speech banana. With both HAs in, he is able to access over 90% of speech! I should be able to score similar to him, in fact I can understand 70% of what my dad says without lipreading.

Friday, April 3, 2009

Cochlear implants vs. hearing aids. The math behind this!

Deciding if you should "upgrade" your HAs to CI(s)? My math will give you the odds and perspective and make it easier for you to decide. Do note that there is a risk associated with the surgery required for CI, as well as losing most or all your natural residual hearing. There is also a $50,000 cost that you and/or your insurance must pay.

I will do the math for my unaided/aided audiogram. Note that an average CI result is 40db from 250Hz to 8000Hz. If you are hearing 25db threshold, consider yourself lucky! Looking at my unaided red points on audiogram, some of you might think CI would benefit me. But thanks to today's HA technology, I could be aided up to the blue points on my audiogram.

It used to be standard photocol that a CI candidate had to try at least two brands of the best HAs set to max gains for at least 90 days each brand before he got approval for CI. It also used to be that you needed to be profoundly deaf, now I am seeing moderately HOH people somehow being approved by the surgeon and even insurance for CI!

CI used to be taken seriously and only as a last resort for the profoundly deaf with so little(or no) residual hearing that no HA in the world would be much, if any good. Now there's way too much hype and pressure to force or persuade as many people as possible to "upgrade" to CI.  I am not part of any deaf groups but still agree with much of the controversity surrounding CIs as trying to "fix" deaf people, especially when HAs are giving them decent benefit.

Ive read several CI blogs and it's a recent phenomenon that they are approving CI on the moderately HOH. All the older blogs, they had profound HL for the most part with a few in the very severe(near profound) range in the low frequencies sloping well into profound in the high frequencies. They would have a 75db to 90db HL at 250Hz sloping down to 110db to 120db HL at 1000Hz. Most of them had 120db or NR at 2000Hz and above. In short, their hearing was often worse than even mine.


Speech comphrension seems to be overhyped as the only thing that matters but environmental sounds and music is equally important. Anyone considering CI should not have to trade away a range of their hearing for another range. It's like trading ten(10) dimes for four(4) quarters. Different units of value that both add to the same dollar amount. I will first do the math for speech comphrension then for environmental sounds then finally for music.

A man's voice has a 125Hz fundamental frequency and ranges from 100Hz to 1000Hz. My best aided scores should be 5db at 125Hz, 10db at 250Hz, 20db at 500Hz, 30db at 750Hz and 30db at 1000Hz.  5+10+20+30+30=95/5=19. CIs probably give better quality aided hearing so ill add 5db to the CI score and come up with 24db for CI to equal my 19db for HAs regarding speech comphrension for male voices.

A woman's voice has a 250Hz fundamental frequency and ranges from 300Hz to 3000Hz. My best aided scores should be 10db at 250Hz, 20db at 500Hz, 30db at 750Hz, 30db at 1000Hz, 40db at 1500Hz and 50db at 2000Hz.  10+20+30+30+40+50=180/6=30. CIs probably give better quality aided hearing so ill add 5db to the CI score and come up with 35db for CI to equal my 30db for HAs regarding speech comphrension for female voices.

A young child's voice has a 500Hz fundamental frequency and ranges from 450Hz to 4500Hz. My best aided scores should be 20db at 500Hz, 30db at 750Hz, 30db at 1000Hz, 40db at 1500Hz and 50db at 2000Hz. NR at 3000Hz and 4000Hz so ill put 65db as a finite number that resides just outside the speech banana. 20+30+30+40+50+65+65=300/7=43. CIs probably give better quality aided hearing so ill add 5db to the CI score and come up with 48db for CI to equal my 43db for HAs regarding speech comphrension for children voices.

The conclusion is I will be understanding speech from males at a barely normal hearing level but still better than most CI wearers. Ill understand speech from females better than a little more than half the CI wearers. Most CI wearers will understand speech from children better than me.


Now ill do the math for environmental sounds. I am breaking them down into five frequency ranges: very low, low, mids, highs, very high. Like speech, the sound banana(better known as sound spectrum) would be similar. However, the greatest percentage of sound will be lower frequencies. The decibals in the sound spectrum would range from 20db to 70db. The speech banana generally ranges from 30db to 60db in comparsion.

The very low frequency sounds are at 125Hz and below. My unaided hearing loss is moderate at this frequency range. No audiometer tests below 125Hz(and some don't test below 250Hz), however I should be hearing at normal ranges when aided, especially considering I could be hearing aided as good as 5db at 125Hz. Many CI wearers don't hear below 125Hz and some don't even hear below 250Hz. I know a bunch of CI wearers who miss being able to hear and enjoy bass music.

The low frequency sounds are at 125Hz to 500Hz. My best aided scores should be 5db at 125Hz, 10db at 250Hz and 20db at 500Hz. 5+10+20=35/3=12. I round to the nearest whole number. The CI score would be about the same, maybe 1db better than HAs for environmental sounds. It's highly unlikley today's CI technology will come close to my HA aided scores in low frequencies and even more so in very low frequencies. 75% of environmental sounds are 500Hz and below.

The mid frequency sounds are at 500Hz to 2000Hz. My best aided scores should be 20db at 500Hz, 30db at 750Hz, 30db at 1000Hz, 40db at 1500Hz and 50db at 2000Hz. 20+30+30+40+50=170/5=34. The CI score would be about the same, maybe 1db better than HAs for environmental sounds. It's possible today's CI technology will come close to my HA aided scores in mid frequencies. 20% of environmental sounds are 500Hz to 2000Hz.

The high frequency sounds are at 2000Hz to 8000Hz. I don't even need to do the math to know my HL is infinite in the high frequencies. I have a tone generator where I can test my hearing using my computer speakers. I can hear 2000Hz but it's faint. On a good day I can hear up to 2500Hz at threshold levels regardless of how high my speaker volume is at. The problem is I may have less than 1db dynamic range at 2500Hz, by the time I hear this tone, I have already reached the SPL on my HAs. However I am not missing much as only 5% of environmental sounds are 2000Hz and above. This includes very high frequencies at 8000Hz and above.

The conclusion is I will very likley hear low and very low frequencies worse with CI. This means id be missing much of the huge 75% range. I would hear mid frequency sounds better than a little more than half the CI wearers. The mids account for another 20% range. Most CI wearers will hear high and very high frequencies better than me, they would enjoy that 5% range that I am missing pretty much entirely.


Now on to music math. I will break it down into octives and intervals between octives.

I can hear the lowest piano key with my HAs. That's 27.5Hz. One octive above is 55Hz. Then 110Hz, 220Hz, 440Hz, 880Hz, 1760Hz. A quarter octive above that is 2200Hz. So I hear up to 6.25 octives. However I hear 6 octives easily. With CI, the average result is 250Hz to 8000Hz which is 5 octives. Some CI wearers may have their electrodes inserted deeply enough to properly hear down to 125Hz so they'd still hear the same 6 octives I hear easily. A normal hearing ear's cochlea can hear as low as 16Hz to 20Hz and as high as 16KHz to 20KHz. This is 9.6 to 10.2 octives. I hear about 60% the number of octives which honestly isn't bad for a profoundly deaf person.

The CI would then simply be shifting the same 6 octive range a little more than 2 octives higher than what I hear. My range is 27.5Hz to 1760Hz, a CI's range is 125Hz to 8000Hz. Like environmental sounds, most music is in the low frequency range, although more than 20% of music is in the mid frequencies and more than 5% of music is in the high frequencies. I don't yet know the exact percentages.

The real problem is today's CI has up to 22 electrodes and many people are still getting only 8, 12 or 16 electrodes. A normal hearing person can distinguish as many as 20 different puretones between each octive. I can still distinguish 10 different puretones between each octive. CI wearers may be able to distinguish only 3 different puretones between each octive. It's a limitation of so few electrodes. 16 electrodes means you will only hear 16 different puretones. You really need at least 100 electrodes for music to sound like it does to a normal ear and cochlea. If music is important to you, wait for the 128 electrode CI comming in the near future. It will also help in other avenues besides music.

Today's CI wearers complain how bad music sounds and also that they can't hear bass music(just feel the vibrations) even profoundly deaf people appear to hear and enjoy music more than CI wearers. Music can easily be loud enough for me to hear unaided!


The conclusion is that certainly no one who's moderately hard of hearing will benefit from today's CI technology and probably not ever from any of tomorrow's CI technology for the matter. They would be able to be aided to normal hearing without even comming close to maxing out the gains or needing the best HAs.

The severely "deaf" also is unlikley to benefit from today's CI technology, well unless they get extremely lucky and hear down to 15db aided with CI. They still would lose out on music and environmental sounds and possibly speech comphrension with male voices for the matter. Some of them may still be "candidates" due to unusually lax requirements by surgeons and even insurance companies. Unless all that matters is hearing/understanding your children and wife a little better without lip reading, stick with HAs.

The profoundly deaf accounts for only 0.1% of the population and the worst 1% of the hearing impaired, but that group is the most likley to benefit from CI. As bad as my hearing is, the math I have done above shows I would trade off alot of aspects to hearing in exchange for understanding speech better when listening to children and maybe women as well. Thus I will wait for better CI technology and gradually lose more hearing.

For those of you deciding if you should "upgrade" your HAs to CI, please carefully read the above and plug in your own audiogram into my math numbers. I provided my own example and I can help you by doing the math for you. I can't decide for you, only your insurance(if any) your surgeon and you can decide for you. Do not let anyone pressure you into a CI, alot of people have a monetary reason for doing so. I can give you the numbers, the odds and realistic expectations. The worse your hearing is, the better odds you will have, it's that simple.