Day to Day with My Cochlear Implant.

Many people have told what it is like to receive a cochlear implant and the miracle of hearing again. But what is it like to live with a cochlear implant on a day to day basis?

At age 28 years, I lost the hearing in my left ear following a cold. The doctors thought an autoimmune problem caused the hearing to go out so suddenly. I started wearing bi-cros hearing aids at that time and wore them for the next 19 years.

At age 47, I lost the hearing in my right ear following an auto accident. I was totally deaf. The decision to receive a cochlear implant was made in August of 1997. The ''Nucleus 24'' cochlear implant device was implanted in my left ear.

I had worn hearing aids for almost 20 years, and they were good, but not as good as ''normal'' hearing. A hearing aid amplifies all the sounds that come into it, so the user has to learn what to listen to and what to ignore. When you are hard of hearing you tend to listen very closely to everything for fear of missing something important. With practice, you learn again what needs to be attended to and what can be ignored.

With the cochlear implant, sounds are different from what they were with hearing aids. Hearing with hearing aids is somewhat passive, the sounds are amplified and you hear them. Hearing with a cochlear implant is active, you must learn to hear with the implant.

At first, soon after receiving my cochlear implant, noises were just that -- noise. I was aware people were speaking, but I heard only sounds, not speech. I heard the changes in pitch, intonation and volume that go with speech, but I could not understand words without lipreading.

The cochlear implant is ''mapped'' regularly. The mapping process is essentially a tune-up. The audiologist varies the 22 or so threshold levels (the loudness level at which you are first aware of a sound) and the comfort levels (where sounds become comfortable and/or too loud) with each mapping to determine the ''map'' that provides the best sound. Finally after three months, my hearing was on par with what it is now. There are some 8,000 receptors in the cochlea (the inner ear) and there are 22 channels of stimulation through my cochlear implant, so, of course, the sound quality is much different.

You sleep soundly with a cochlear implant. No more phone calls from telemarketers trying to sell you aluminum siding, newspaper subscriptions or long distance plans. With my speech processor off -- I hear absolutely nothing. Once when fire engines came down the street to let us know the fire hydrants were being checked, I missed the news! My windows were open and they face the street. Now, that's deaf! When the speech processor is off, I have no hearing at all.

When I wake up, I shower and brush my teeth in silence. Although I can remember the sound of water while showering, I no longer hear it. Brushing my teeth is also mainly a silent deal, although bone conduction does allow me to hear when I hit a tooth with the handle of the toothbrush. When I speak with the speech processor off, I talk very loudly because I cannot hear myself and cannot modulate my voice.

Finally, after I prepare myself for the day, I put on my speech processor and join the hearing world. I use the Nucleus Third Generation (3G) behind the ear (BTE) speech processor. This marvel of engineering is smaller than the hearing aids I used to use. I put in 3 disposable batteries, choose a battery cover to coordinate with my outfit, place the magnet section on my head and the processor behind my ear and I am once again, part of the hearing world!

With the 3G I hear most of the sounds that hearing people do. All the everyday sounds of life - birds singing, dogs barking, bacon sizzling in a frying pan, the beep of a microwave oven, water running in the sink and all the noises a hearing person takes for granted. I can even hear the shouts of the grade school children at recess in a school behind my house, even though they are playing seven houses away from my back yard. While many of the sounds I hear can be ignored, it is still nice that I hear them and choose to ignore them. I've saved a lot of money by being able to hear water running. As many deaf people know, we've often left water running in the sink and didn't know it!

Now when the phone rings, I pick up the phone and I can hear and talk. While a telecoil is a common feature in hearing aids, the Nucleus 3G is the only cochlear implant to have a built in telecoil in the speech processor. With a flick of a switch on the bottom of the 3G, the telecoil is engaged, and all I hear is the speech signal from the phone. No interference from background noises. The voice comes through loud and clear. I can carry on a conversation while riding a stationary bicycle, washing dishes, or doing other noisy things.

I really missed the give and take of normal phone conversations before getting my cochlear implant. While the telephone relay system is great, the spontaneity of conversation is lost. It is such a joy to no longer have to use a relay system or a TDD!
I can even use cell phones without any problems.

Meals in a noisy restaurant are no longer something to avoid. I always make certain to seat myself in a location to optimize my hearing. My implanted side will be toward the people I'm with and my deaf side is placed toward the noise. There have been several times where I heard and understood the servers better than my hearing friends. Because I still retain my skill in lipreading, I can often tell my friends the restaurant's specials when they are not able to hear them!

Once I was dining with my cochlear implant surgeon and the discussion turned to roses and the pests that destroy them. He asked me if the name of the bug was A-fid (with a long ''A'' sound) or aff-fid (with a short ''a'' sound). I told him it was A-fid. He said, ''Wait a minute, did you actually HEAR what I said?'' So I repeated both pronunciations and told him which was correct. He was stunned that my hearing was so good in a noisy situation like that. And since both pronunciations look the same, I was indeed, hearing, NOT lipreading.

While driving in my car, I can hear my turn signal, traffic noise, and I can listen to the radio or carry on a conversation with passengers. I can also hear emergency sirens and look for the flashing lights to locate where the vehicle is. So in many respects, I'm no different from most drivers.

Movies, which were something I avoided as my hearing deteriorated, are now something to again enjoy. Live theatre is also accessible, especially if the theatre has a loop or FM system. The same built in telecoil feature that allows me to hear so well on the phone also works with a ''loop'' or ''FM system'' installed in many theatres. When I turn the switch on, the performers' voices appear to be right in my ear.

When I sew, I turn on a CD player and listen to my favorite music. I'm no longer in a silent world.

While every implant system that Nucleus makes comes with various patch cords to use for TVs, stereos, phones, Walkman and other personal listening devices, I have never had to use them. But all the cords and accessories are included with the speech processors.

The ease and convenience of disposable hearing aid batteries can't be overstressed. My 3G behind the ear speech processor runs on regular hearing aid batteries. They are easy to find, change, and disposed of. I put 3 batteries in every morning before I put on the 3G, and remove the batteries every evening. Every 2 weeks or more, when the power runs out, I change them. I average 15 days, or about 176 hours of use between battery changes. My mapping strategy is SPEAK, which is a very low power draw. Average battery life is 50 hours on 3 batteries. Variations in noise levels, skin thickness, and mapping strategies all affect battery life.

If I forget to put extra batteries in my purse, I can pick up size 675 battery at drugstores, discount stores and hearing aid offices. What a relief to know you're never far from batteries if you run out. Every 3G cochlear implant user is supplied with 300 batteries (the usual year's supply) when they get their speech processor.

I started hearing using a body worn processor (BWP) and my first mappings were obtained on that device. The BWP has the advantage of holding 4 programs and allowing the user to control the volume and microphone sensitivity on each program. The programming choices include SPEAK, ACE and CIS. Both processors, the body worn and behind the ear models (BTE) can hold these strategies. The BTE holds 2 programs and the user can control either volume or microphone sensitivity, but not both.

When I know I will be in a very noisy situation, I will use the body worn processor. For instance, when I worked one summer in a day camp setting for children with behavioral problems, I wore the BWP. This let me dampen the constant background noises while still maintaining volume for speech understanding.

Understanding speech from children, or from people who are at a distance, like in a meeting, has always been difficult for hearing impaired people. With the ''Whisper setting'' (a Nucleus 3G setting), I can flick a switch, and the soft voices are enhanced, they come in loud and clear. What an asset this is in a business meeting, or when speaking with a child.

I recently took a tour of Arizona's Canyon de Chelly National Monument. On the tour, we were seated in an open truck and driven around the area. The truck is noisy, and the chains that hold the steps in place clang with every bump in the road. I switched to the Whisper setting and was able to understand the conversations of my fellow tourists. Those sitting behind me and across from me as well as those in front were understandable with Whisper. The noisy background sounds were muted while the speech remained loud and clear. It was incredible. I had not used Whisper much before this trip, but what a blessing it was to have it. On the flight home, I switched to Whisper and was able to converse with my seat mates while flying in the airplane.

I have been asked if there are ever times when I don't wear the speech processor. The answer to that is yes. The processor cannot be immersed in water, so I remove it when bathing, showering, or swimming. I also take it off while sleeping. I see no reason to listen to annoying noises like lawn mowers or vacuum cleaners and so I do remove (or turn off) the processor when I'm around them.

On weekends, I attend craft shows and festivals. Quite often, music is playing in the same room I'm in -- often within a few feet of my table. Even in a noisy situation like that, I can hear and conduct business, thanks to my cochlear implant.

I have had my implant for 5 years now. I am implanted in the left ear. My left ear was without hearing or stimulation of any kind for almost 20 years, starting when I was 28 years old. Because I only have one cochlear implant, I do not have directional hearing. That is, I cannot tell where the sound is coming from. Because I've been without directional hearing for more than half my life, I have learned to adapt to that. Some people have chosen to have cochlear implants on both sides to give them directional hearing.

Getting a cochlear implant was the best decision I ever made. As a deaf person I was constantly frustrated at not being able to understand what was going on around me. Deafness is socially isolating. It becomes easier to just stay home, rather than trying to follow conversations with minimal hearing and lip reading cues. When you no longer hear, it is easy, and perhaps natural, to withdraw from society. Even your friends get tired of having to repeat themselves or write things down so you can understand. The Nucleus 24 allows me to hear again and to participate fully in the hearing world.

What is it like to hear with an implant? While it's not as good as normal hearing, and is very different from hearing aids, it is REAL hearing and it is nothing short of a miracle for those of us who can hear again. Being independent again is such a gift.


Editor's Note: Ms. Jansen is a volunteer member of the Cochlear Corporation Advocacy program. She has presented on this topic many times as a patient and as an advocate for cochlear implants.

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