Monday, May 25, 2009

Take the piano thud test! How high can you hear?

Take the test!

The above is a great test. Test it with your best HAs(left, right, both) with the volume dial or button turned to the max. It should work for those with CI as well, but you won't get to test for cochlear dead zones as it's a moot point. Your CI just bypasses the dead zones and stimulates the auditory nerve directly with electrical pulses. You can test if you can hear the high frequencies with CI. For those with HA, you need enough surviving hair cells to amplify. For those of you who are hearing or have a mild hearing loss, you can test unaided. For those of us who are deaf, we can't hear enough unaided to get a proper assessment of our cochlear dead regions. 

Unaided, I can't properly hear anything but the lows. It's not loud enough even with the speaker cranked to the max. You will want to use a desktop speaker and turn it up to the max. If the speaker distorts terribly, turn it down a couple notches, but make sure it's loud enough for your HA to pick up the sound!

Try it with the speaker 3 feet away then hold the speaker near your HA. For me, the results were the same since my speaker is loud enough to reach my HA's SPL limit either way. Experment in different ways and obtain your best results. Make sure you properly adjust your speaker and try to test in a quiet room, turn off any other sources of noise.

This will both test what your HAs are capable of as well as your ears. It's also great for testing cochlear dead regions. The tone should be loud and clear like a bell and last the full 4 seconds. The pitch should ascend logically with each key(both white and black) sounding different. If you get the following, suspect a cochlear dead region(and possibly a poorly programmed HA)

1. The tone does not last the full 4 seconds, it fades away faster.
2. The tone is very faint or you just hear a thud or nothing.
3. The pitch sounds off or wrong or is the same across keys.
4. The tone sounds garbled, distorted or noiselike and not musical.

The highest I could hear at all for left ear: 967Hz then I hear just a thud.
The highest I could hear at all for right ear: 1046Hz then I hear just a thud.

The highest I could hear for both HA: 
932Hz for the full 4 sec. At 967Hz it was heard for 3 sec. At 1046Hz it was heard for 2 sec. At 1108Hz and 1174Hz I heard it for just a second then silence. Above 1174Hz, I heard just a thud sound. I hear somewhat better with both HAs than with each alone.

I find it odd that I hear up to 932Hz loud and clear but it goes downhill fast from there. Below 932Hz sounds just a bit louder with each descending key. The volume drops off rapidly with each ascending key above 932Hz. Perhaps I don't have enough surviving hair cells at around 1000Hz and none a few dozen Hz above that. Ive always wondered how much of a HL before you get to that point. Perhaps no HA is powerful enough above 110-115db HL.

I will repost my audiogram:

125Hz: 60-65db HL
250Hz: 70-75db HL
375Hz: 80db HL(home test)
500Hz: 90db HL
625Hz: 100db HL(home test)
750Hz: 105-110db HL
875Hz: 110db HL(home test)
1000Hz: 110-115db HL
above 1000Hz: 115db-120db+ HL, possible cochlear dead region.

I will learn more about this from reading around and from your results and explanations. Feel free to leave a comment with your own results and ask questions.

Tuesday, May 19, 2009

I had brief tinnitus a moment ago, it sounded like brrrrrr!

I don't have a problem with tinnitus but do experience it briefly once in a while. Most of the time, the world is silent without HAs. I wasn't wearing HAs when this tinnitus occured. It lasted for about 10 seconds and was heard louder in my left ear(which is the very slightly worse ear) The sound was like two tones, a 750Hz and a 125Hz tone. Ive read that sudden tinnitus or any changes in tinnitus usually means you have lost more hearing. Ive very gradually been losing my mid frequencies. Ill have to scan all my audiograms and post them but ive posted some of my audiograms so far. When my HAs are reprogrammed hopefully next week, ill find out more.

Friday, May 15, 2009

So exactly how good are the best HAs? The facts and my experience.

I will find out more in a few days when my HAs are reprogrammed and will share my experience on that and how much better I hear. What I currently hear is shown below:

250Hz(75db HL) and 500Hz(90db HL): I hear low frequencies up to 500Hz very loud. I can still hear those from the other side of the house!

750Hz(105db HL): I still hear this tone very loud but notice it's half as loud as the 500Hz tone. I can hear this tone from the other room!

1000Hz(110db HL): Much softer than 750Hz, about half as loud and about a quarter as loud as 500Hz. I can still hear 1000Hz from the other end of my room!

1250Hz(115db HL): Less than half as loud as 1000Hz, this tone is quite hard to hear even if I put my ear to the speaker. I can't hear it from more than about 3 feet away.

1500Hz and 2000Hz+(115db-120db+ HL): Most of the time, 1500Hz is inaudible. On a good day, I hear it from a few inches away at threshold levels. 

I am personally surprised by that disparity, once I reach 110db HL, each few db above that quickly fades into nothing. But I hear sounds very loud and well at levels below 110db HL, even the 750Hz tone I can hear very well! I have a piano when when I play it, there is a small difference in loudness between the low(first set) and mid frequency keys(second set). It's when I get to the high frequency keys(third set) that I can tell a noticable volume decrease between each key. My parents do not experience this however for any keys. My dad only experiences this for the last few highest keys since he has a moderate high frequency loss. But for me, the last dozen keys are silent, and the keys before that are very faint.

Some possibilities and theories:

1. Perhaps the dynamics of the ear changes at 110db and up. Below 110db HL, there still is enough functioning hair cells that can be stimulated/amplified. Once you get to 110db and up, there is so few, if any hair cells. Ive read into cochlear dead regions where a very loud sound actually stimulates adjacant hair cells and this does give the person a perception of hearing. The sound may be noiselike, very distorted, off-frequency, felt as a woosh, or simply very faint.

2. I wonder if it's a limitation of HAs but after trying my old HAs from 1998 and comparing my new HAs from 2008 with neither giving me hearing above 1250Hz, but the new HAs making sounds at 1250Hz and below 2-4x louder, yet still not being able to give me anything usable at 1500Hz, I suspect it's my ears.

3. I am able to get a response on the audiometer at 1500Hz, 2000Hz and sometimes even 3000Hz in the 115db to 120db range. But I don't recall hearing any shrill tones or whistles. It's likley I heard a low frequency distortion that came from the audiometer and/or due to the cochlear dead region phenomenon. I also hear the same distortion comming from my speakers at 1500Hz, 2000Hz, 3000Hz, 4000Hz, etc. It sounds like "ehhhh" like humming or static.

4. I will find out more when I ask my audie about this and when he reprograms my HAs. He did say that at 120db, HAs cease to become useful. I can ask him what about at 110db, 115db and in between 110db and 120db.

5. I do know that the pain threshold as well as UCL(uncomfortable level) occurs at or around 120db. Thus even if you could attempt to amplify a 120db loss with an insane amount of gain/SPL, it won't be pratical as there's zero dynamic range, would not be comfortable and might even cause damage to adjacant functioning hair cells.


On another note, given the max SPL of my HAs(Phonak Naida V UP) as well as the UCL/pain threshold, the worst unaided audiogram(assuming no cochlear dead regions) someone can have and still hear anything is as follows:

frequency/db HL/SPL HL/HA max SPL dbA/dynamic range

125Hz: 95/120/123/3
250Hz: 105/121/126/5
500Hz: 115/127/130/3
750Hz: 115/125/135*/5
1000Hz: 115/124/140*/6
1500Hz: 115/125/135*/5
2000Hz: 115/127/130/3
3000Hz: 110/126/128/2
4000Hz: 100/116/119/3
6000Hz**: 85/106/110/4
8000Hz**: 60/86/90/4

Above 4000Hz can't be aided with my HAs, however you can give transposition/soundrecover a try. This shifts the high frequencies down as low as 1500Hz from what I heard.

* My HA is capable of above 130dbA SPL, however for many good and obvious reasons it's not recommended to exceed 130dbA SPL. I assume all SPL figures to be "A" weighed.

** A different HA meant for mild-moderate HOH people is capable of going up to 8000Hz. HAs for profound losses don't go much above 4000Hz for many good and obvious reasons.

I will have to find out what SPL my HAs have been set at. I can tell you right now that I am happy with the SPLs up to 1000Hz. I barely hear anything at 1500Hz and I am going to find out if it's my HA or if my cochlear dead regions start around 1500Hz. Ill also find out what's the min dynamic range required to get usable aided hearing. I do know it's more than 1db, probably at least 5db. If so, subtract about 5db from the worst unaided audiogram.

There are no 120db HL figures above since my audiologist said a 120db loss can't be touched/aided by any HA. For those with 120db HL, it may in reality be 116 or 117db since you didn't respond to a 115db tone so the next increment was 120db which you responded to. You may also have the SPL set to 132-136 dbA. Some people experience discomfort and risk damaging their residual hearing but they feel they have no choice. I do have a choice for the low frequencies and don't need insane amounts of SPL. I would rather not hear 1500Hz than hear that frequency with the SPL turned up to uncomfortable levels. HAs should never be uncomfortable and right now they aren't for me. My audie is going to try for more gains and even SPL and that will depend on comfort levels. Maybe I can get a couple db more, well see.

I would get a CI myself if my low frequency hearing got much worse to the point where HAs ceased to be useful. I have no high frequency hearing and little mid frequency hearing but a decent amount of low frequency hearing and that's where most of my benefits come from. 75% of sounds and 60% of speech takes place at 500Hz and below so I don't feel I am missing that much by not hearing any high frequencies. I still have some mid frequency hearing so I can hear more than 75% of sounds and 60% of speech. I have read some good articles on the usefullness of those with left corner audiograms who have mostly or only low frequency residual hearing. Ill post about that some other day and link to the article.

I am tired now, ill keep you guys updated with any new facts and experiences. Thanks for reading, feel free to comment and I shall respond.

Tuesday, May 12, 2009

Person with no high frequency hearing can hear phones unaided!

I found the below post from a forum. I have bolded the important part. This man hears unaided better than I hear aided! It's likley his cochlear dead zones are around 1500Hz and especially at above 1500Hz. He did reach the pain threshold(120+ db) in the high frequencies. Ive said it before that my audiologist is correct that a 120db HL can't be touched/aided by any HA because you hit the pain threshold among other good reasons. I have learned so much by reading other's experiences with hearing loss and hearing aids.


Subject : HA recommendations for ski slope loss

posted by DAW on Thu Apr 5, 2007 3:36 pm
I'm new to this forum, but have lived with hearing loss since birth (now 47 years old). I tried aids in the past (15 years ago), but they did not help. Latest audiogram (4/2/2007) shows 25 to 30 dB bilateral loss from 250 to 750 Hz, 70 dB at 1000 and 100 dB plus at 1500 and beyond. These numbers shows minor degradation from audiograms in 1992 and 2001. I function fairly well unaided in a business setting and on the phone, but have the typical struggles in noise. Obviously, technology has come a long way in 15 years and I'm ready to give aids another try. I have 2 sisters and a brother with similar loss and we've all made attempts with aids over the years without success, until recently. My oldest sister is participating in the University of Iowa's hybrid cochlear implant trial and is seeing benefit from a Savia 211 BTE in the ear that didn't get the implant. She let me try the Savia (with her mold), but the sound had an obnoxiously loud cheap transistor radio quality. Does anyone have any suggestions for an aid? I have an appointment on 4/12 to select an aid to trial. The audiologist is suggesting GN ReSound Metrix as an alternative to Savia or SaviaArt. I've read in some of the threads here that Phonak MicroPower can be inappropriate if your loss at the low frequencies is not high enough, is this true for other power aids as well. It may not be worth bothering to amplify frequencies above 2000 Hz, since I begin to experience pain with amplification just 5 dB beyond audibility.

Thanks in advance for any help.

Thursday, May 7, 2009

Stem cells as a treatment for deafness. Try best HAs before CI.


Ive been reading many such articles. Here's the most recent one to date. Ive read that there could be over a dozen ways to treat or even cure deafness. Stem cells is probably the best way but it could be as simple as finding a certain protein that will force hair cells to divide/reproduce. Ive also read an article talking about a special laser that when aimed will either repair hair cells or cause them to divide! There even could be a way to take existing hair cells and recruit them to do several jobs at once!

Stem cells can come from several sources. One article talks about taking stem cells from your own skin, using them as master cells to grow hair cells then injecting them into your ears where they attach and your hearing is improved! Another article has found that every ear contains stem cells. They can remove a sample, convert them to hair cells then reinsert them. Other articles say your brain contains stem cells but I probably will not be willing to let them touch my brain, too risky.

As for finding proteins, the article discusses that a deficient in certain proteins are the cause for damaged hair cells. It is possible that if the deficient is remedied, the hair cells could be repaired! It could be as simple as ear drops and the proteins are absorbed into your eardrums and cause some of your hair cells to repair. That would be a very safe, simple, cheap way to improve your hearing! Id do it for any improvement!

There are lasers that reshape the cornea and improve your vision and reduce your dependacy on glasses. The article talks about laser ear surgery, a cousin of laser eye surgery! I personally have no interest in laser eye surgery since glasses do the job fine for me and I am not willing to take the risks. It does not give better vision than what glasses gives. But with laser ear surgery, it should help the deaf hear better with and without hearing aids. I hear pretty good with hearing aids but I could definately achieve a big improvement. If I was only hard of hearing and not deaf, I wouldn't be as interested since id get full benefits from HAs that most deaf people can't achieve as their hearing loss is too deep.

We all know that recruitment is sometimes a bad thing but im now reading that certain chemicals/hormones/proteins could "reprogram" existing hair cells to recruit in a good way and make you hear better. Have great low frequency hearing but missing the highs? Just recruit some of the low frequency hair cells to respond to high frequencies! Don't hear loud enough with HAs? Recruit more hair cells so you hear louder!

Most of the articles put the timeframe at 10 years out into the future. This means we could be looking at 2020 when we see clinical trials but it could be a few years earlier when the first person gets expermented on with the results made public. Other countries may begin their trials before America as their regulations differ. I will let others go first and see what their results are as well as the risks. When results are good enough and it's safe, I am going ahead myself. I am 27 now and I could be 37-40 when it's done on me. Ill have more than half my life to enjoy better hearing.

----------------On another note--------------------

But I understand not everyone has the luxury of time or are willing to wait at least 10 years. What they can do is try the best HAs and have them programmed for maximum amplification/gains so they hear more/louder/better. I am noticing a growing number of CI candidates who haven't tried the best HAs and also have more residual hearing than me. I thought it was a basic requirement that every CI candidate get a 30 to 90 day trial of the best HAs! I know someone who was understanding 20% speech then he tried newer, better HAs and now understands 80% speech!

This is precisely why my audiologist doesn't recommend I get CIs at this time and instead to work with him in reprogramming my HAs for more amplification/gains so I hear more/louder/better. If you look at my audiogram, I have alot of residual low frequency hearing with only 75db loss at 250Hz. 60% of speech and 75% of sounds take place at 500Hz and lower. Thus im still able to hear most sounds and understand some speech. I am learing all I can so I can understand my own deafness, others and to work with my audie to program my HAs to the best potental.

This is the best I will hear aided with my Phonak Naida V UP HAs. I currently hear about 10db worse than that so I am having the gains increased. No guarantee ill get to 10db at 250Hz or 30db at 1000Hz but my audie is going to try for that. Ill be happy to get close though. I am missing the highs but transposition(if it works) will address this. Even if not, only 10% of the speech banana takes place in the high frequencies.

This is about what ill be hearing sometime in 2020 with about 20db improvement. The red dots are my unaided hearing and the blue dots are my aided hearing. You must remember that HAs will be much more advanced a decade from now and they will be capable of aiding me down to 0db except in the high frequencies. Transposition algorithms will be extremely sophiscated by then and will do a great job of shifting the highs down to the mids. Even without transposition, I will already be able to access over 90% of the speech banana. Besides as stem cell technology improves, I can always repeat the procedure and achieve another 20db improvement!

Tuesday, May 5, 2009

Should my speech recognition be over 70% with HAs

See my post below about the profoundly deaf man scoring 90% on HINT. Someone linked me to a blog of a severely deaf man 85db HL, 35db aided whos scoring 100% on HINT! I am going to ask him some questions, maybe I can learn from him then work with my audiologist to have my HAs reprogrammed so I score at least the same as that profoundly deaf man. After all, I have better hearing than him! I am not expecting to score 100% but 80% to 90% is realistic and ive seen other deaf people score in that range.

Im actually not obsessed with high % speech, but it does serve as a barometer of how well im hearing and how well my HAs are programmed. My audie says he can get me down to 15db aided in the low frequencies and up to 30db in the mids. With transposition/soundrecover I should have access to the highs as well(ill hear the highs differently than hearing people). Those aided scores should put me at the top of the speech banana so I should score well.

My audiologist doesn't recommend CI for me as he says my hearing is still too good. He did say I might benefit from a CI but it's risky and if I hear worse with CI, there's no going back to HA in the implanted ear. I did ask him about the deaf cure and he doesn't believe ill see it in my lifetime. Maybe not but I don't need a cure, just some procedure/treatment(stem cells is one example) that will give me 20db more unaided hearing, then I would hear perfect with HAs according to him. Id also hear some sounds unaided as well.