Middle Ear Implant: My Personal Experience

It has now been three years since I was implanted with the Symphonix Vibrant Soundbridge implantable hearing aid. In my first article, which was featured on AudiologyOnline, (Middle Ear Implant: An Audiologist's First Hand Experience) I discussed my initial experiences with the implantable hearing aid, from surgery to activation and my first hearing experiences with the implant.

In this article, I will update my progress and my impressions of the performance of the implant as a more experienced user. Overall, I have been extremely pleased with the performance of my implant.

I have a bilateral, moderate, sloping to severe, sensorineural hearing loss. My right ear is the implanted ear. The left ear hears slightly better in the low frequencies (250Hz-1000Hz). My 'wear time' is now approximately 16 hours per day, which essentially equates to all my waking hours. Now that I am 'amplified' in a true full-time manner, I am amazed that I was able to function at all without 'full-time' amplification. I was only able to wear conventional hearing aids for my workday.

I have asked my husband to give his impressions of our quality of life prior to implantation, and he simply states that I was not aware of how much I missed, or of how difficult it was to communicate with me. I am told that there were many times when he 'didn't bother' to talk to me because it was an exercise in futility. While I was aware that was happening on some levels, I never truly understood the degree of the problem, until I was implanted. Unless you have experienced hearing loss and the devastating effect it has on your life, and the impact on those closest to you, it is very difficult to appreciate the precious gift of hearing.

This past year has been one of personal trials and new experiences for me, on several levels. For example, in January, I relocated from Florida, back to where I grew up, Denver, Colorado. The move has been very positive and my lifestyle has changed considerably. Most of my immediate family lives in the Denver area and I have had many occasions to interact with them and test the performance of the implant with those who are most important to me. Perhaps the biggest test of performance came in the form of two small children, my 6-year old niece, and my 4-year old nephew. I have spent considerable time with the children over the past 9 months and have had opportunity to assess both acoustic and physical performance of the implant. Interacting with the children has been much easier for me now than it had been previously. Although I wore my hearing aids around them as much as possible, I have found that I now understand them better than I did with hearing aids. This may be due to the increase in high-frequency information that I am able to get with the implant.

Another new experience for me has been the use of the implant during intense physical activity. I have studied ballet for most of my life, but during my years in Florida, I did not have the opportunity to take lessons. Since my return to Colorado, I take lessons two or three times each week. My lessons last anywhere from 1.5 to 2.5 hours. Initially, I was concerned that the intense perspiration combined with lots of spinning and jumping would send the processor flying off of my head, so for the first month of classes, I did not wear it. However, I grew frustrated at missing corrections and not always hearing the subtle nuances of the classical music so important to the lyrical movements of the ballet. I decided I would wear the processor and see what happened. To my great delight, it didn't fall off, and I have had no problems with the internal components as a result of perspiration. It has been such a pleasure to dance and hear simultaneously!

Cold weather was another of the experiences that I encountered with the move. My head did not spend time in winter hats in Florida and I had not been in Colorado in the winter months since being implanted. To my great joy and relief, I can comfortably wear winter headgear with the processor on and I do not have any feedback. I have worn the audio processor ice skating on an outdoor rink, and skiing. These activities have been much harder on my feet than my ears!

During this past year, I also took the opportunity to evaluate the benefits of using a conventional digital hearing aid in my left ear in combination with the implant. I was asked to give a presentation at the annual AAA convention in San Diego, and I became concerned that I might not be able to hear questions addressed to me from the back of a large room without being binaurally amplified. I ordered a digital canal instrument for my left ear, which arrived only two days before the convention. I programmed the hearing aid and proceeded to try and adjust to it as best I could. It was fairly comfortable, but it was difficult to tell whether I was really benefiting from it. There was a significant amount of occlusion effect, despite the large venting and many attempts at programming it out, but I decided I would give it a try.

At the convention, I wore it in the most intense of listening environments - the exhibit hall. While the exhibit hall was intensely noisy, I was able to hold a conversation without much difficulty. A colleague who was with me told me that she thought I performed remarkably well. As far as binaural vs. monaural benefit, I experimented with both conditions, and found very little difference. In fact, due to the occlusion effect, I was more comfortable wearing just the processor. During my presentation, I chose not to wear the hearing aid, and I found I had no difficulty hearing the questions from the back of the room.

I have subsequently returned the hearing aid to the manufacturer, and while I am still interested in pursuing the benefits of binaural hearing, I am very satisfied with the benefit the processor alone provides me.

As far as durability is concerned, I have had only minor problems with the processor, and no problems with the internal components of the implant. I have had the processor knocked off my head on a number of occasions during play -- without damage to the internal components or to the casing. It was explained to me when I was first implanted that there was a possibility that the skin over the internal receiver and magnet would thin, thus causing irritation and perhaps requiring some medical intervention. This has not occurred, nor have I experienced any skin sensitivity to the casing of the processor. In fact, the processor is so comfortable that I forget I am wearing it. I have stepped into the shower while wearing it on several occasions, and I have even gone to bed wearing it.

I have had only minor problems with the processor. On two occasions this past year, I had to return the audio processor to the manufacturer for repair of the casing due to battery door breakage. This appears to be a weak spot. Similar to a conventional hearing aid, the battery door is held in place by hinges. These are actually two small plastic hinges, which are part of the actual external casing, as opposed to a single, replaceable hinge pin. They appear to be susceptible to breakage.

On the first occasion, I believe the hinge pin broke as a result of the processor being knocked off my head and onto a hard surface. I have discovered that there is a negative side to forgetting that the processor is on my head! However, apparently I am not the only implant wearer who has suffered such incidents. To reduce the risk of accidentally knocking the processor off the head, Symphonix developed a small alligator clip attached to a short piece of nylon string that can be attached to the side of the processor. The alligator clip is attached to a small bundle of hair and hidden underneath the remaining hair. If and when the processor gets knocked off, it just hangs loosely at the neck. It is very effective, (although a bit cheesy looking if it is not well hidden) and it has significantly reduced the number of 'accidents' in which my processor has been involved. The reason behind the second hinge pin breakage is unknown. I had not knocked the processor off of my head since it was returned to me after the first repair. I was changing the battery and the hinge broke right in my hand. Importantly, neither incident resulted in any dysfunction of the audio processor. In fact, on both occasions, I wore the processor for several weeks (after it was broken), simply because I was so reluctant to give it up.

During the times that my processor was being repaired, I wore conventional hearing aids. I experimented with ITCs and BTEs. I have drawn several conclusions from the comparison of conventional hearing aids to the Symphonix middle ear implant, and conclusions comparing conventional to 100 percent digital technology.

I have discovered that I am personally much more comfortable binaurally aided with conventional aids, than I am monaurally aided with conventional technology. I believe this is primarily due to the perceived reduction of the occlusion effect and to the reduction (or at least perceived reduction) of background noise.

Secondly, I discovered that I am significantly more affected by background noise (particularly with intense restaurant noise) when wearing binaural conventional hearing aids, than I am when using a monaural digital middle ear implant. In fact, I could not tolerate the noise on several occasions, and simply had to remove one or both of the conventional hearing aids.

I cannot conclusively state that I had less tolerance for noise due to the conventional versus digital issue, or whether it was binaural conventional hearing aids as compared to a monaural middle ear implant, or whether it boils down to a combination of factors. However, I can say, that I am much more comfortable in noise with the digital middle ear implant than I am with binaural conventional hearing aids. I have not experienced any problems either with tolerance or with communicating in an intense noise environment using the digital middle ear implant.

Finally, as a functional comparison between conventional hearing aids and my implant, a colleague who spent considerable time with me in both conditions reported that I asked her to repeat less often when I was wearing the implant. She also reported that I heard better with the implant when she spoke to me at distances and when she was beyond my visual field.

In conclusion, over the past three years, I have had opportunities to experiment with the digital middle ear implant in many different environments, and to compare my functional ability under a variety of amplified conditions. Implantation was the best decision I have ever made regarding my hearing. It has been of enormous benefit in both my professional and personal life.

I have been asked on many occasions whether I would have my left ear implanted. To my knowledge there is only one individual who has been binaurally implanted. However, if and when the opportunity presents itself, and if I am deemed a proper candidate, I will take advantage of it. Hearing is priceless.