Over the past couple of days, I have been gathering information, largely (but not solely) from a Facebook group I belong to, Association of Adult Musicians With Hearing Loss. I have been an active member of the group for quite a while. I will share a post I made to the group yesterday morning and a few selected responses to the post – the ones primarily responsible for my decision, finally made today, to go ahead with a cochlear implant procedure. I’ve been pondering this for a long time, certainly more than just the last two days – but these are the statements that made me finally come to the decision.
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MY POST: Is there a handy-dandy list of CI brands and models that compares features and specs, HAs that communicate with them, best combinations of speech/music options, likes/dislikes, and that sort of thing?
Maybe the landscape changes often enough that such a list is unfeasible.
Everything I have read by CI/HA companies refers to music features specifically for “music appreciation” - that is, LISTENING to music. I appreciate that but know that music performance is a different situation, whether singing or playing an instrument. If I were a CI/HA company officer, I'd be doing everything possible to create hearing devices for performing musicians.
Maybe it’s not possible - if it was, surely it would have already been done. I know that HAs and CIs were developed primarily to assist speech understanding - and that our hearing loss can only be recovered to a certain extent. But it seems like such a device would be ideal for both worlds - speech and music - whereas the current situation is pretty lopsided, requiring tweaks to enable some musicians to function - some, not all.
I’m at the point that I’m ready to commit to a bi-modal CI situation - my only hesitation is that I fear what life could be like if music is taken away from me. I’ve played piano for almost 68 years and I’m not ready to quit. But I’m quickly losing the ability to carry on a conversation with friends, even in small group settings. Honestly, I’m not at all sure which is more important to me - I can’t imagine life without both of them.
Thanks to whoever posted the links (in a recent post) to the ACI Alliance two-part talks about aural rehabilitation for musicians (in their Tuesday Talks, I believe). I also discovered a link to The Hearing Journal, another informative resource I was previously unaware of.
RESPONSE ONE: IMO… The brand hardware is pretty much irrelevant… There are people with great outcomes with all three brands, and there are a few who struggle …
The biggest piece of the CI puzzle is already in place, our brain…the dedication and effort we put into relearning how to hear with these things is where it all happens no matter which brand we choose.
RESPONSE TWO: I certainly empathize with the quandary and agree that the audiology research is poor at addressing music at all, let alone performing music BUT....
When one reaches cochlear implant candidacy, it means that there is no longer the potential for improvement in hearing accuracy with acoustic amplification (hearing aids).
Cochlear implants offer very strongly supported potential for improved word recognition in most cases.
Music improvement/preservation is much more of a “it depends.”
While I really do “get” the trepidation about moving to a CI, it’s important to step back and take a look at things a little less emotionally.
Human spoken language is a pretty closed set of pitch, loudness and harmonic complexity. We know that CIs deliver improvements in functional communication across all spoken human languages.
We also know that most adults who get CIs use spoken language to interact with the world. The negative psychological impacts of losing that interaction is also well documented.
My clinical experience shows that the better you do with speech, the more potential you have with music. We don’t have good data on how to predict that but we do know that the longer you are within criteria before getting implanted and activated, the longer it takes to achieve “step one,” which is optimal speech perception in quiet. It also lowers the potential maximum performance there, which secondarily reduces potential for speech in noise and music perception.
RESPONSE THREE: None of the CIs are better at music. The one shot you have at CI related music perception is if you have residual hearing to preserve such that you can wear a hearing aid and a CI in the same ear.
RESPONSE FROM A DIFFERENT POST: My audi is in Oklahoma City but she has her bachelors in piano performance. She was/is able to help me tremendously with adjustments so I hear everything perfectly. I am bilateral cochlear implant. I switch to electronic hearing at high A, she programmed my processors so it is a seamless transition. She might be worth a trip once or twice a year! [Note: I asked for her audiologist’s name and she responded: “it’s Dr. Sarah Cain at Hearts for Hearing. My CIs are Cochlear. I told her where the pitch was going flat on the piano and she said “oh, I know exactly where that is and how to fix it”. I play every day and even perform a couple of times a year. I never think about it sounding bad or different.” In another reply, she said her first CI was in 2014 and the second in 2021. She is 66 years old, so a few years younger than me].
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My decision is not made lightly, given that it may mean the permanent loss of my ability to function as a musician, both as pianist and as a member of our church choir, and, perhaps, even as a music listener. In recent weeks, I have enjoyed being the ‘semi-regular’ pianist at St. Stephen’s UMC in Norman, Oklahoma, while our regular pianist has been involved with important family matters that required her to miss church for several weeks. That period has ended now and I feel like the time is ripe for me to have this procedure done, so I can get busy with the extensive aural rehabilitation that is necessary to re-learn how to hear.
Based on others’ experiences, the minimum time necessary to retrain the brain to hear again is roughly one year; some report much longer times, as much as five years. I am expecting that I will be working at least two years before I will be able to sing or play piano again with any sense of confidence. All hearing devices focus on speech recognition and understanding as the primary goal. With the higher and lower sound frequencies in music, and the pitch subtleties in wind and string instruments, recovering musical ability after an implant is not guaranteed; it is very much a case by case situation for musicians and nonmusicians alike. Every case is unique.
Today I emailed my audiologist, Dr. Caitlyn Mathews, and requested that she invite Dr. Cain to my next appointment, July 13th, in order to discuss the possibility of her (Dr. Cain) being my CI audiologist post-transplant. I will share the other patient’s name (from the last response, above) with Dr. Mathews and Dr. Cain. In her response, she mentioned that she was implanted with a Cochlear™ device; other brand names are Med-El and Advanced Bionics. Hearts for Hearing does not implant the Advanced Bionics devices. [Correction: they implant all three brands]. Dr. Mathews recommends the Cochlear brand. This person’s CI is a hybrid device, with both a CI and a hearing aid in the same ear. As I understand it, the hearing aid helps boost the lower frequencies, which the CI often can’t do well. She is about two years post-activation on the second CI and reports that she is doing well musically.
Since it’s been more than six months since my initial CI evaluation (it was Aug. 15th, 2022), that series of tests has to be done again, which I expected. Dr. Cain’s schedule is booked through July 13th, so the office will contact me to set up an appointment with her sometime after that. I am hopeful for a date ‘sooner than later.’ Now that I have made the decision, I’m ready to proceed.
