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The unbearable loudness of hearing

Posted Apr 25 2010 11:00am

It has been one month since activation and my world has changed beyond recognition and exploded into a kaleidoscope of sounds. Some are old sounds which sound different, some are completely new. The world sounds different through a cochlear implant and it is starting to sound much better.

Each time I have a mapping, my bionic hearing is adjusted – at the moment we are still focusing on increasing the volume. For the last week I have been listening in awe to the (surprisingly noisy) birds, the crackle and pop of rice krispies, my office clock ticking, the ssss of my perfume atomizer, the jangle of keys and my dog’s clinking collar tag, and all the little sounds my dog makes when he wants something! I am discovering that some things, heretofore silent to me, actually do make a sound. The photocopier touchpad beeps, the door of the room next door squeaks (and now annoys me immensely), my hands rasp when I rub them together and so does moisturiser when rubbed on my skin, running my fingers up my arm makes a soft rasping sound too.

I have been utterly shocked by the cacophonous ssshh of brakes and beeps of doors on public transport, the roar of traffic, people in the street, the sharp crackle of plastic bags and paper, the clatter of crockery, the flushing toilet, the microwave nuking food, and the kill-me-now roar of aeroplanes (unfortunately, I live near Heathrow). Last Saturday was the first day in my life that I was able to hear all the birds so I sat in the garden, in the sunshine, and listened. This also happened to be the first day of the airline stoppages due to the Icelandic volcano eruption and the skies were silent. I only realised how much noise airplanes made this week when the airports re-opened for business. Over the last three days, I have become quite overwhelmed by the loudness of some sounds, now that my implant’s volume is nearing an optimum level.

I went to a social event a few days ago and although noisy, I was able to pick out peoples’ voices more easily which made lipreading easier. I heard this strange sound behind me and turned around to see a woman playing a harp. It sounded totally different from what I expected, like a soft guitar.

The strange thing is that high frequency sounds seem much louder to me than other sounds. A person with a hearing loss cannot screen or ‘filter’ out sounds in the way that hearing people do, so everything seems loud. This is why noisy places are so problematic, as hearing aids and cochlear implants amplify all sounds so that environmental sounds are as loud as voices, and the hearing impaired person is unable to filter out the background noise (the cocktail party effect ). Now that the high frequency sounds are so new to my brain, these seem extra loud to me, my brain is going WOW What’s This?, sitting up and taking notice, and is only now listening to low frequency sounds again. The world is starting to sound more normal. Voices still sound tinny so it’s a struggle to understand speech.

I can now hear the dial tone on the phone. I started off by listening to phone sounds (these work on both pc and Mac) and will next try listening to a script I’ll give to a friend.

There are four levels of auditory skill development according to Erber’s model – awareness of sound (presence v absence), discrimination (same v different), recognition (associating sound/word with meaning) and finally, comprehension (using listening for understanding). As I was born deaf and have been deaf for 40 years, I’m going to struggle harder and for longer to climb up this ladder.

It is a common misconception that we hear with our ears. In fact, the auditory system, from the outer ear to the auditory nerve, merely provides the pathway for sound to travel to the brain. It is in the brain that we hear. If a person developed hearing loss after learning language (postlingual hearing loss), the brain will retain an “imprint” of the sounds of spoken language. The longer a person is deaf, the more challenging it is to recall these sounds. In the case of a person who has never heard (hearing loss at birth), or who has had very limited benefit from hearing aids, sound through a cochlear implant will be almost entirely new. That person will need to develop new auditory pathways, along with the memory skills to retain these new sounds. Whatever a person’s history, rehabilitation can be very useful in optimizing experience with a cochlear implant.

Being able to detect sound, even at quiet levels, does not mean that an individual will be able to understand words. Norman Erber developed a simple hierarchy of listening skills that begins with simple detection: being aware that a sound exists. An audiogram indicates detection thresholds. Although thresholds with a cochlear implant may indicate hearing at 20 dB to 40 dB (the range of a mild hearing loss), the ability to understand words can vary greatly. The next level of auditory skill is that of discrimination; that is, being able to determine if two sounds are the same or different. For example, one may detect the vowels oo and ee but not be able to hear a difference between the two sounds. The third level of auditory skill is identification. At this level, one is able to associate a label with the sound or word that is heard. Key words may be clear, such as cloudy or rainy, within the context of listening to a weather report. Erber’s final level of auditory skill is that of comprehension. Words and phrases provide meaningful information rather than just an auditory exercise. At the level of comprehension, a person is able to follow directions, answer questions, and engage in conversation through listening.

(Source: Advanced Bionics)

I’m still at the stage of detecting sounds and trying to move into the next stage of discriminating between sounds.  Two weeks ago, I was unable to tell the difference between PAT and BAT, TIN and DIN, FAN and VAN. With the practice I have done, I am now able to do this with almost no errors. I am now working on listening for the difference between MACE and MICE, and DEAR and GEAR – which is difficult as D and G sound so similar. I don’t know what to listen for so am hoping the brain kicks in at some point!

My speech perception is improving slowly. I have tried to make discrimination practice fun, by listening to Amanda on Skype. She will give me a colour, or a month, or a day of the week, or a number between 1-10. Maybe next I will try tube stations or football teams, whatever I think I can cope with, to keep it fun. We decide which closed set we will do – using Mac to Mac, the in-built sound (and video, for lipreading) quality is very good, aided by my use of a direct-connect lead to my processor. I am trying to work towards ‘open sets’ – unknown sentences – by asking people to put a hand over their mouth and give me a sentence. Patrice gave me my first sentence this week : “Bob and Kirby are waiting for me in the car park” and I got it correct except for the word “car”. She gave me a second sentence and I got that spot on. With practice, I will improve. We tried a discrimination exercise – I am now able to hear the roadworks behind the office – they had been working there for a year and I had missed it all (lucky me). So when they hammered, drilled, or dug with a spade, Patrice told me and I listened for the different sounds.

Music is improving too. I am finding that rock with vocals louder than music wins hands down. Opera sounds good, piano/flute/guitar sound quite good. There are musical resources specifically for CI users. Advanced Bionics offer Musical Atmospheres (free for AB users) and available online or on CD, where new music is discovered through 3 hours of recorded musical examples, each containing increasing levels of complexity in musical appreciation, helping to establish a firm foundation for musical memory. They also offer A Musical Journey, through the Rainforest and Music Time for children. Med El offer Noise Carriers, a musical composition available on CD from hearf@aol.com – see Listen,Hear! newsletter no.20 for further information. Cochlear don’t seem to have any resources but they do offer tips .

I am finding that I am feeling soooo much better than I did with hearing aids. I used to have headaches almost every day, I was always exhausted from the constant effort of lipreading, reading the palantype (CART), concentrating to make sure I didn’t miss anything, and stressed by the thought of any social event.  Now, I’m not exhausted every evening, I’ve had one headache since activation, lipreading is somehow easier as I’m getting more audio input even though people still sound like Donald Duck, and I feel much more relaxed overall, and more positive about communicating with ducks people.

I’ve finally discovered the noisy world that everyone lives in. This noisy world should get a bit quieter this week when I get ClearVoice , which will automatically reduce background sounds so I can concentrate on voices. It’s almost a magic wand for hearing loss. All I will then need is to be able to comprehend speech, and I’ll do a convincing fake of a Hearing Person.

I’ve lost the clouds but I’m gaining the sky. And the sun will shine. You’ll find me out there, in the Hearing World, shining brightly with happiness. And as the video below nicely demonstrates, I want to kick your butt!


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