This afternoon I had my fourth hospital appointment. Some interesting things I've found out, to share/note down for my own records.
Firstly, to my great surprise, the audiologist declared that I've finished working my way up through the gains, and now it's time to focus on differentiating between sounds. He said that at the very first switch-on appointment they'd done some tests to measure my response to sounds, which gave them an indication of what gain level I was likely to end up at. I hadn't realised this. Broadly speaking, I've reached these markers (some frequencies I'm a bit higher, and some a bit lower).
I also had a hearing test, and the results are shown below, along with my last test from the 31st May, for comparison. It's a small increase, but basically I'm averaging around 30-35dB, which is pretty much what they expect (I was originally told they are aiming for the window 20-40dB, so I'm nearly in the middle of that). So that's good. These tests results, along with looking at my markers, and my difficulty in moving up any further through the programmes, indicated to the audiologist that I'm pretty much there on the gain levels.
This was unexpected news! And it's good news. But it's taking me time to get my head around it, and to feel pleased about reaching this milestone. I haven't yet had a chance this evening to talk to anyone face to face about this, to help me process this and get my head around it. Writing about it is helping it to sink in though, and I'm starting to feel pleased that the first stage of the CI adjustment process is complete. 😊 I think I feel a little disoriented, because the goalposts have moved, unexpectedly. (I don't embrace change as enthusiastically as my husband does, for sure.) Also, I feel like there's a lot of work yet to do on improving the clarity and my recognition of sounds, so I thought that would be achieved by increasing the gains further. But it seems that will come more with time and practice (doing my homework!). And I knew it would take time, I just didn't know in advance the details of the journey to get there.
I now have three different programmes on my CI, to try out over the next few weeks. The programmes are no longer about increasing the gain, but about adjusting various settings to see what helps me hear most clearly. The three programmes I have this time are:
The only difference between the first two programmes is that the range of soft to loud sounds is changed. So the first has an input ranging from 20dB to 85dB, giving a total range of 65dB. The second one is just slightly smaller (I'm guessing something like 23dB to 83dB), with a range of 60dB. This is called the Input Dynamic Range (IDR). From what the audiologist said, and my online research now, it seems the theory is that a bigger IDR lets more sounds in, with more ambient (background) noises, but a smaller IDR will cut out more of the background noises. I think the IDR for my type of CI is typically in the range 60-80dB. When I was tested with a higher IDR today, I found that the audiologist's voice seemed more echoey and less clear to me. So he reduced the IDR. But if the IDR is reduced too much, I won't hear as many background noises, and I could end up feeling more isolated.
In an online forum for CI users, that I've recently joined, I've seen some people say they prefer to have a large IDR, of 80, and let their brain slowly learn to filter out the unnecessary background noises, rather than have the processor do it for them. Others prefer a smaller IDR so they can more easily focus on speech. Trying it for a few minutes in the audiologists office today wasn't enough for me to really tell the difference between the two IDR settings, let alone express a preference for one or the other. So it's really a matter of trying them out over a period of a week or so, and finding out what my personal preference is.
The third programme, Ultrazoom, switches my CI microphone from omni-directional mode to highly directional (in the direction I'm facing) and is for one-to-one conversations in a noisy environment. Hopefully it will help reduce a lot of the background noise and prioritise the voice of the person directly in front of me. Clearly many meals out in noisy (but classy) restaurants are required to test that one out - Stuart you've been warned... 😉
[With regard to the upper limit of the IDR, I asked what happens if there are noises louder than 85dB? It seems the CI has an Automatic Gain Control (AGC) built into the algorithms, that automatically adjusts the volume control, reducing sounds that are too loud. Apparently in a healthy ear, the middle ear has a ligament that tightens in response to an automatic reflex, to help reduce the intensity of very loud sounds, and thus protect the inner ear. A CI bypasses the middle ear, so the processor has to do this job for me.]
Both the audiologist and the Speech Therapist were surprised to hear about my struggles with low energy and taking a long time to get used to each programme over the last 3.5 weeks since the last hospital appointment. The Speech therapist said that while it's not unheard of, it's pretty unusual to still be this tired, this far along in the process (7 weeks). She recommended I go and visit my GP to see if there are any other health issues. I told her about my history with chronic fatigue, and she wonders if that makes me more susceptible to being overtired. I'll give it a week on this new programme and see how I'm feeling before I go to the effort of making a doctor's appointment, because I really don't feel like there can be any other health issues. Also, I'm not quite as exhausted as I was 2 weeks ago, so I'm hopeful that I'm on an upward trend now.
I have more homework from the Speech Therapist. She was pleased with my paragraph tracking, and she did a fun exercise where I was given a sheet with sentences printed out, but each sentence had a key word missing. She would then read the sentence out loud and I'd have to see if I could hear what the missing word was. She could choose to use a less obvious word in the gap, to make it harder for me, to make sure I wasn't just guessing. For example, one was "The ___ bit the postman". Can you guess what the missing word was? Well, she made it medium hard for me and chose "The cat bit the postman". I did actually get that one right. I'm not sure I'd have got it right if she'd gone for the hardest option and said "The child bit the postman"!! Anyway, she was very pleased with how often I was getting the right word. Sometimes I didn't quite get it (or I'd have two words in my head that might fit), so she'd repeat it until I got it right. Another bit of homework to do at home is to download something called "Angel Sounds" which is the name of some software giving me lots of practice listening to different everyday sounds and trying to identify them. You get given clues, eg. there will be two images showing what the sound could be, and you have to select which one you think it is. We couldn't do it in the office today because her loudspeaker wouldn't work, but she wants me to download it at home and practice with that, and we'll have another go with her at the next appointment, which is 19th July: 3 weeks time.
Sounds do seem a little clearer on my current programme than they did before my hospital appointment, in general it just feels a bit more like having two hearing aids, rather than just one. But it's hard to quantify really. And it's getting late. It's taken me a while to write this blog post, and get the more technical things (like the IDR) straight in my head. I'll no doubt be back online in the next week or two to report on how I'm getting on with my three new programmes...
Firstly, to my great surprise, the audiologist declared that I've finished working my way up through the gains, and now it's time to focus on differentiating between sounds. He said that at the very first switch-on appointment they'd done some tests to measure my response to sounds, which gave them an indication of what gain level I was likely to end up at. I hadn't realised this. Broadly speaking, I've reached these markers (some frequencies I'm a bit higher, and some a bit lower).
I also had a hearing test, and the results are shown below, along with my last test from the 31st May, for comparison. It's a small increase, but basically I'm averaging around 30-35dB, which is pretty much what they expect (I was originally told they are aiming for the window 20-40dB, so I'm nearly in the middle of that). So that's good. These tests results, along with looking at my markers, and my difficulty in moving up any further through the programmes, indicated to the audiologist that I'm pretty much there on the gain levels.
 |
| 26th June 2019 |
 |
| 31st May 2019 |
I now have three different programmes on my CI, to try out over the next few weeks. The programmes are no longer about increasing the gain, but about adjusting various settings to see what helps me hear most clearly. The three programmes I have this time are:
1. IDR of 65dB
2. IDR of 60dB
3. Ultrazoom
The only difference between the first two programmes is that the range of soft to loud sounds is changed. So the first has an input ranging from 20dB to 85dB, giving a total range of 65dB. The second one is just slightly smaller (I'm guessing something like 23dB to 83dB), with a range of 60dB. This is called the Input Dynamic Range (IDR). From what the audiologist said, and my online research now, it seems the theory is that a bigger IDR lets more sounds in, with more ambient (background) noises, but a smaller IDR will cut out more of the background noises. I think the IDR for my type of CI is typically in the range 60-80dB. When I was tested with a higher IDR today, I found that the audiologist's voice seemed more echoey and less clear to me. So he reduced the IDR. But if the IDR is reduced too much, I won't hear as many background noises, and I could end up feeling more isolated.
In an online forum for CI users, that I've recently joined, I've seen some people say they prefer to have a large IDR, of 80, and let their brain slowly learn to filter out the unnecessary background noises, rather than have the processor do it for them. Others prefer a smaller IDR so they can more easily focus on speech. Trying it for a few minutes in the audiologists office today wasn't enough for me to really tell the difference between the two IDR settings, let alone express a preference for one or the other. So it's really a matter of trying them out over a period of a week or so, and finding out what my personal preference is.
The third programme, Ultrazoom, switches my CI microphone from omni-directional mode to highly directional (in the direction I'm facing) and is for one-to-one conversations in a noisy environment. Hopefully it will help reduce a lot of the background noise and prioritise the voice of the person directly in front of me. Clearly many meals out in noisy (but classy) restaurants are required to test that one out - Stuart you've been warned... 😉
[With regard to the upper limit of the IDR, I asked what happens if there are noises louder than 85dB? It seems the CI has an Automatic Gain Control (AGC) built into the algorithms, that automatically adjusts the volume control, reducing sounds that are too loud. Apparently in a healthy ear, the middle ear has a ligament that tightens in response to an automatic reflex, to help reduce the intensity of very loud sounds, and thus protect the inner ear. A CI bypasses the middle ear, so the processor has to do this job for me.]
Both the audiologist and the Speech Therapist were surprised to hear about my struggles with low energy and taking a long time to get used to each programme over the last 3.5 weeks since the last hospital appointment. The Speech therapist said that while it's not unheard of, it's pretty unusual to still be this tired, this far along in the process (7 weeks). She recommended I go and visit my GP to see if there are any other health issues. I told her about my history with chronic fatigue, and she wonders if that makes me more susceptible to being overtired. I'll give it a week on this new programme and see how I'm feeling before I go to the effort of making a doctor's appointment, because I really don't feel like there can be any other health issues. Also, I'm not quite as exhausted as I was 2 weeks ago, so I'm hopeful that I'm on an upward trend now.
I have more homework from the Speech Therapist. She was pleased with my paragraph tracking, and she did a fun exercise where I was given a sheet with sentences printed out, but each sentence had a key word missing. She would then read the sentence out loud and I'd have to see if I could hear what the missing word was. She could choose to use a less obvious word in the gap, to make it harder for me, to make sure I wasn't just guessing. For example, one was "The ___ bit the postman". Can you guess what the missing word was? Well, she made it medium hard for me and chose "The cat bit the postman". I did actually get that one right. I'm not sure I'd have got it right if she'd gone for the hardest option and said "The child bit the postman"!! Anyway, she was very pleased with how often I was getting the right word. Sometimes I didn't quite get it (or I'd have two words in my head that might fit), so she'd repeat it until I got it right. Another bit of homework to do at home is to download something called "Angel Sounds" which is the name of some software giving me lots of practice listening to different everyday sounds and trying to identify them. You get given clues, eg. there will be two images showing what the sound could be, and you have to select which one you think it is. We couldn't do it in the office today because her loudspeaker wouldn't work, but she wants me to download it at home and practice with that, and we'll have another go with her at the next appointment, which is 19th July: 3 weeks time.
Sounds do seem a little clearer on my current programme than they did before my hospital appointment, in general it just feels a bit more like having two hearing aids, rather than just one. But it's hard to quantify really. And it's getting late. It's taken me a while to write this blog post, and get the more technical things (like the IDR) straight in my head. I'll no doubt be back online in the next week or two to report on how I'm getting on with my three new programmes...
Hi Jean, Cathy read your blog to me as I loaded the dishwasher this morning, We're getting a real insight into your progress and the high and not-so-high moments of your journey and we had some fun with the missing words game! Sorry we're a bit far away for the restaurant experiment. Looking forward to the next update.
ReplyDeleteLove from Cathy and Malcolm