First day in 11th grade for Nichole with Bilateral CIs

Today was Nichole's first day in 11th grade after having gone bilateral this summer. I asked her during dinner how school went. She said it was pretty good, but ... her right (older) CI wasn't working for the first two classes. Arggg.

She has Freedom FM receivers for both ears. During the first two classes, her older right ear was not picking up the FM signal, nor was it picking up sounds of the other students using the processor mic. But her newer left ear was working. She said she could hear the teacher clearly through the FM on the new side, and best of all, she understood almost all of what the teacher was saying (though she did say she supplemented with reading their lips). Not bad for just two weeks post-activation! But the point is, if she hadn't had the new implant, she would not have gotten much out of those two classes.

Between her second and third class, she removed the FM receiver from the old ear, and re-installed it. This brought it on-line. She guessed that the FM insert was not properly seated, thus not working. Whew!

So for the rest of the day, she had a clean FM signal to both ears. However, she said she still couldn't hear other students around her in her right ear. It wasn't until she got off the bus after school that it occurred to her that the night before, she had been playing around with the FM-only program her audiologist had put in P4, so she could listen to music from an MP3 player. That setting cuts the mic input to 1/9th the FM or direct audio input. No wonder she couldn't hear her class mates on that side. She will remember to user her regular P1 program from now on.

So all in all, going bilateral was a good thing, since it gave Nichole a "backup" hearing capability over last year. And her brain is re-wiring nicely to utilize the new implant.

First full day with new CI - 8/13/2008

Well, today was the first full day with Nichole's new left implant activated. I was at work most of the day, but saw her at lunch time, and she had not really tried much "listening" yet. We took a family walk after I got home from work, and I told her that it seemed she was much less interested in exploring sounds with this implant than she had been with her first one last year. She agreed. She said that with her old (right) CI, she now knows all the new sounds so it isn't as exciting trying to hear them with the new (left) CI.

She said that in the late afternoon, she did try the different programs which Marilyn had saved in the Freedom processor. Program 1 (P1) is basically what felt comfortable at the end of her activation on Tuesday. P2 and P3 are increasingly louder versions of P1. Marilyn thought that those three would give Nichole enough to work with until her next mapping, which is 9 days after her initial activation. She wasn't even sure Nichole would get to P3, but gave it anyway. Well, Nichole is already comfortable with P2, at volume = 9 (full volume)! She has tried P3, but it is a bit too loud. I reminded her that this isn't a race, and that she shouldn't feel the need to push herself too fast.

As for speech recognition, it didn't seem she was understanding much, if anything, by just observing her during normal conversations. So tonight, at about 11:15pm, after everyone else was asleep, I asked her if she wanted to play the "closed set" game. We pick a category (numbers 1 thru 10, or colors, etc), she faces away from me, and tries to repeat each word I say. I was not too optimistic given it was only day 1, and that I hadn't observed her understanding much earlier in the day. Boy was I in for a wonderful surprise!

I started with the numbers 1 thru 10 in random order. Nichole correctly repeated 8 of the 10 on the first try. For the two she got incorrect, I repeated the number once, and she then got it correct. Yahoo! I moved on to colors. Out of 11, she got eight correct first try, two correct on my first repeat, and one (indigo) she couldn't get. Next was animals. She correctly repeated nine out of 14. She got seven out of 11 sea creatures and five out of six oceans/seas (south china sea, she missed the "china").

So her "first try" success rate was about 80% for most lists, with 65% for the two really hard ones of animals and sea creatures. I have shown her raw results below, so you can get a feel for the difficulty of the words I picked, and so I can keep a record somewhere.

We have her first Listening Therapy session tomorrow afternoon.

Raw Closed-Set Listening Results, I have bolded those items where a mistake was made. Where two percentages are shown, they represent raw score on first try, then with a word repeated if it was wrong the first try. If she had no guess, I put a ????.

Numbers (80%, 100%)

I said	She repeated
5	7, then 5
3	3
4	4
10	10
1	1
7	6, then 7
9	9
6	6
8	8
2	2

Colors (72%, 91%)

I said	She repeated
Blue	Blue
Yellow	Yellow
Red	Red
Black	White, then black
White	White
Pink	Pink
Orange	White, then orange
Green	Green
Brown	Brown
Indigo	????
Violet	Violet

Animals (65%)

I said	She repeated
Cat	Cat
Squirrel	Squirrel
Bird	Bird
Dog	Bird
Snake	Snake
Fox	Smocks
Beaver	????
Robin	Robin
Chickadee	Chickadee
Hawk	????
Bat	Bat
Blue Bird	Little Bird
Great Blue Heron	Great Blue Heron
Owl	Owl

Sea Creatures (63%)

I said	She repeated
Whale	Whale
Dolphin	Dera fin
Tuna	????
Oyster	Oyster
Clam	Clam
Sea Horse	Sea Horse
Skate	Snake
Jelly Fish	Jelly Fish
Shark	Shark
Walrus	Walrus
Seal	Snail

Oceans/Seas (83%)

I said	She repeated
Pacific	Pacific
Atlantic	Atlantic
Arctic	Arctic
Indian	Indian
Red Sea	Red Sea
South China Sea	South ???? Sea

Shapes (88%)

I said	She repeated
Circle	Circle
Oval	Oval
Square	Square
Rectangle	Rectangle
Star	Star
Ellipse	Erect
Octagon	Octagon
Pentagon	Pentagon
Triangle	Triangle

Left CI Activated - 8/12/2008

Early today Nichole had her new left side CI activated. Her audiologist, Marilyn, got her all hooked up to the programmer, and started out setting the T-levels (threshold levels). This is the minimum stimulation which Nichole can detect. Nichole then used the keyboard and software to set the C-levels (comfort levels) herself. This sets the stimulation level where she can hear, and it is comfortable, versus being too loud.

Once all the T and C levels were set, Marilyn turned on the microphone (after reducing the overall volume a bit to avoid Nichole being overwhelmed with sound). Nichole said that it hurt, kind of like an electric shock. Using a little electronic keyboard, Nichole played the notes, and told Marilyn exactly which notes caused discomfort, and which felt ok. Based on this information, Marilyn modified the T and C levels to a point where Nichole could hear sounds, while at the same time feel no pain. In fact, the contour of the new levels (viewed on a graph on the software) closely follow the "telemetry" readings that Marilyn took while Nichole was still on the OR table. I am not 100% sure what these are, but Marilyn said they can predict what her C-levels will probably look like after she gets acclimated to the implant. Nichole was happy with how the new levels felt.

An interesting observation was how Nichole described what she heard when she played a scale on the small electronic keyboard (left to right which would be low to high pitched notes). She said the first 6 or so keys went from high to low pitch (opposite what I hear), then the next bunch of keys went low to high (correct), then the last two were low again. I seem to recall her making the same observation at an earlier mapping session with her right CI. Not quite sure what it means though.

I asked Nichole how it sounded when we spoke (with her other CI turned off). She said that if she looks at our lips, she can make out some of the words we are saying. Wow! That is much better than when her right side was first activated a year ago. At that time, she could hear us talk, but had no idea what we were saying (we sounded like a waterfall or birds chirping). Maybe the fact that that this ear was her better ear helps. Or maybe the fact her brain has had a year with the right side CI will help it decode the new left CI. It could also be that Marilyn is using a slower stimulation rate (720Hz) which is what Nichole eventually settled on with the right side (so we wouldn't sound so "chirpy"). Most likely, it is a combination of all of the above. In any case, all the electrodes are working, and I am confident her brain will re-wire to accommodate the sounds from the new implant. I just hope it happens as quickly as it did last year (see my Day 1 Update post from last year to see how quickly she started understanding speech). She starts junior year of high school in two weeks!