In this post I will try to describe how I experience sounds after receiving my Cochlear Implants (CI). It is extremely difficult to describe as the description depends a lot on my own perspective. Your perception of my descriptions also depends of your perspective in relation to how you hear. In other words the problem is that I try to compare the sound with how I was able to hear before receiving CI – that hearing cannot be directly compared with your hearing. I will therefore compare with my previous hearing but also focus on what I actually hear with CI. Another factor that makes it difficult to describe how CI sounds to me is, that my own perspective changes while getting used to the CI sounds. The changes happen in small steps and that makes it difficult to make a comparison as it is very difficult to remember exactly how my hearing was earlier in the process.
But for a start I want to emphasize that the sound examples on how CI sounds that I heard before receiving my implants does not at all match the experience that I have now. They at least sound as bad now as they did before I received CI. I will therefore strongly suggest not to make a decision towards CI based on those sound examples. I think the simulation that come closest to the sound I hear today is the one I managed to create on my own. By using a program to create these examples I defined that there should be 120 channels. There 120 channels in my processor from Advanced Bionics. But it is a long time ago that I made that example – I cannot remember exactly how it sounded to me, and thereby make a comparison.
It is about 8 months ago that I got my processors hooked up. I have therefore gotten a long way in my rehabilitation process. I still have further adjustments and habituation that may provide me with an even better result than what I have now. I’ve heard that it can take up to a year before the optimal result is achieved — but you can still get even better beyond the first year. In my case it took about half a year to get to the point where I felt that I was able to hear better with my implants than what I could with hearing aids. The process have therefore also been a great test of my patience. It is certainly a relief that some people are beginning to notice that I hear better than previously.
Since my last post
About 3 months ago I had a mapping session. I was supposed to receive the new Naida processor which is more campact and provides a range of other benefits. But the manufacturer was however having difficulties in delivering – I therefore haven’t received it yet. I do however expect to receive it tomorrow. But as I did not want to wait for the new processor in relation to get adjustments for my processors I decided to get a new appointment so we could make a new map for my current processors. It was a great improvement of the sound quality. The adjustment also included an update for my processor so that I could use the new “Optima” processing strategy. The main difference is that I have received a great improvement of battery life (my Harmony processors are now able to stay alive for a whole day on just one battery). I experience that the new programming strategy makes the sound a little more metallic but apart from that there are not so many other differences. But I cannot rule that some of the metallic sound experience may be caused by some of the other adjustments that were made that day.
The main improvement of this adjustment clearly was the improvement of sound quality. When I went to this mapping session I had a bad hearing day as I experienced that the sound was choppy on one of my ears. But when I went home from this mapping session that chopping sound was gone. This was a huge benefit – since that adjustment I have only experienced choppy sound one time and that was caused by a week with too much sound and no breaks. Since this mapping session I have experienced that the sound kept getting better and that I am now able to hear in more situations. There are however still room for improvements. I have for instance noticed that if I hear a frequency of 850hz then it sounds like there are two frequencies at the same time. It does not bother me in the everyday situations, but by getting this adjusted I might probably get a much better sound. But apart from that I generally perceive the sound I get as being normal. I certainly notice that I get much more treble and less bass sounds compared to when I used hearing aids. In addition when concentrating I also notice that the sound is artificial – especially if I take of one of the processors.
In the beginning
In the beginning the sound is without any doubt very surreal. When I was hooked up I experienced that whenever I said something it sounded like I had a flute in my own throat. But during the first day I experienced that the CI sound was aiding my lip-reading skills. Anything sounded strange when I was out in the traffic on the first day. Cars sounded like a flute with vibrato and I experienced the same with wind-noise in the microphones. The next day however I felt that many of these sounds started to sound much more correctly. In the beginning I had a very steep learning curve – I managed to understand more and more sounds every day. It did however take a long time before it started to sound like before. It was a very hard test for me having to accept and get used to the scratchy and unclean sounds that I experienced in the beginning.
In the very first couple of days I was not able to hear any music — I could only sense the rhythm and some very weak vocals in some songs. In the following period more and more details were added to my musical experience. In the beginning I also experienced it like all sounds had the same volume — pretty loud. This was primarily caused by having the CI turned up to the maximum volume that I could bear, and that I had to keep turning the volume up whenever I could manage to do that. It of course meant that it was very difficult for me to access the volume of my surroundings. I could for instance not access if the volume on my TV was too loud or weak. Over time I have however experienced that the difference in volume on weak and loud sounds have become bigger than what I experienced with hearing aids. It is probably one of the explanations as to why it has become easier to discriminate between sounds later in the process.
One of the big challenges has certainly been to find the limit on how much I was able to train. In the beginning I frequently experienced that I hit “the wall”. The problem was that I could not determine when to stop — I could only feel it when I had crossed the limit. It was a very frustrating problem as the result was tiredness, choppy sound and loud tinnitus — it could take 1-3 days before it was normal again. The problem has certainly become smaller over time and the problem with choppy sounds is almost impossible to enforce since my last mapping session.
From bass to treble hearing
If you look at the audio diagram from before I received CI there is no doubt that I was hearing most in the low frequencies (the bass). With CI you get a hearing where the volume of all the frequencies are equal. There is however the difference that with my implants I cannot hear sounds below 150hz (the lowest frequency that can currently be heard with implants from Advanced Bionics). I have therefore experienced that I have been missing the deep bass-sounds that I have been used to and that the low frequency sounds that I can still hear are a much smaller part of the current soundscape that I experience. It is almost impossible for me to explain how this difference is experienced. But I can however emphasize that I have experienced it like I am being bombed with high frequency treble sounds. In the beginning I for instance experienced while watching TV that it was like everyone was whispering instead of talking normally (funny when you watch news and wonder what makes the news so secret that they have to whisper). But as it is now it sound much more normal to me — at times I do however still feel that I miss the low frequency bass sounds. But at least I can still experience these low frequency sounds as long as the volume is so loud that I can feel it — I do however avoid to play music so loud at home for the sake of my neighbors 🙂
In addition to the missing low frequency sounds the CI sound is also shifted in pitch in a way where some sounds get a higher frequency than normal. This is something that you certainly notice in the beginning – some feel like they had come to Duckburg. That was however not my experience – I just experienced that everything sounded more high frequency – but that problem went away rather quickly for most voices. It did however take much more time before sounds had landed at the correct pitch when listening to music…
My ability to listen to and enjoy music is of course a thing that has developed a lot during this process. It is beginning to become stable but there are still developments, and I am therefore very curious about what the end result will be. But if we go back to the start it was without any doubt a very strange experience to listen to music. The sound was very messy and unclean – I for instance experienced that there was a lot of beep-notes when there was many instruments playing. In addition I also experienced it like some of the singers had received something much worse than helium – it sometimes made me laugh loudly through a whole song – poor singers that could not sing. The video below is quite good at illustrating this experience – jump to 0:39 in the video.
When the sound started to become more understandable and correct it was still a problem to discriminate the notes. I could sometimes experience that it was difficult to access what note was played or the pitch of a song if I did not have sounds to compare with. I am convinced that this problem was caused by two things – first of all the CI sound is compressed. That means that the frequencies are played on much fewer frequencies in the ear and secondly the CI electrodes are not stimulating the deepest frequencies in the ear which means that the sounds become more high frequency. It is not a problem as it just required practice and habituation. The missing clarity and the problem of sounds that are compressed and moved has also had the consequence that I for a long time did not like to hum along with the music I heard – it was very difficult to hit the notes and it therefore sounded horrific. I have just started to experiment with singing – it goes fine but I am certainly not ready to sing in a Singstar competition. I recently was in a church where I had to discover that I was not able to sing any of the songs. The reason was that I was not able to hear my own voice at all – and I did not want to sing so loud that I could drown the voice of all the others – what if I was singing false 😛
The most positive experience I have had in relation to music is that I am now able to hear much more details. The difference between weak and loud sounds have become larger which makes it easier to discriminate between sounds. It is not perfect but I am now able to hear details that I have never heard before – I can hear weak details in instrumental music and I also feel that it has become easier to hear what the singers are actually singing. I actually feel that the singers have gained more control of their voices and manage to make much more beautiful details with their voices than what I have heard before 😉 When I recently was in church to hear a christmas concert I almost got tears in my eyes because the voices of the choir had become more clear and that I was able to hear some of the words that they were singing. I cannot remember that I have every enjoyed a church concert this much as I do now did with CI :D… In the video below one of the small details that I am now able to hear is when they are using the violin string on the piano – it is a very weak sound but also a very cool detail suddenly to be able to hear.
I do however not feel that the sound is perfect – some sounds are still a little muddy. I think a primary reason for this problem is the fewer details that a CI can relay. As mentioned earlier I have chosen implants from Advanced Bionics which provide a resolution of 120 “channels”. As far as i understand this means that I should be able to discriminate between 120 different frequencies. But I do not experience this as 120 clear frequencies – if I try to hear one single frequency it might sound a little muddy as the implant might be stimulating multiple frequencies in my ear. But if I push a key on the piano then the sound is very clear. Even though I can discriminate 120 frequencies I am able to hear a lot more sounds which are very clear. In the example of the piano it is also worth mentioning that when you push a key the hammer inside the piano actually hit 3 strings that makes 3 different frequencies. A note on the piano is therefore composed of a range of frequencies – it is the composition of notes/frequencies that makes it possible for me to hear and discriminate between a lot more sounds than just the 120 channels.
In short I experience a soundscape that is similar to what I had before receiving my implants – I have just received many more details, clarity on the vocals, less bass, and a little impurity in the sound. The quality loss that I experience is certainly overshadowed by the joy I experience by the extra details and clarity in the vocals 🙂
My ability to hear and understand speech is my main reason for getting CI. It is also the development of that which has been my greatest fascination. It is not a perfect story but I am not in doubt that I have received a good improvement of the ability to hear speech. At times I have found it hard to notice the improvements and compare them to what I have previously been able to hear. But I am now able to participate in conversations in calm situations without having to ask people to repeat as often as I did when using hearing aids. This change is something that people around me notice. This is also something I have to get used to. I sometimes notice that there is a small detail that I do no hear – this automatically makes me ask for a repetition but I often experience that I shortly after hear the rest of the sentence and therefore become able to guess what was said. It is actually a very hard balance to navigate – in one perspective I have to ask people to repeat what I don’t hear, but I also have to avoid waiting too long about asking people to repeat – if I do not figure it out on my own I can easily get too far behind in a conversation if I do not ask for a repetition quickly. This is definitely a balance that I have to keep training 😉
My biggest challenge is to hear speech in background noise – the sounds easily get muddy – but I still haven’t received programs with noise cancellation on my CI. I therefore expect that this will become better with the upcoming mapping sessions. But as it is now I experience that my ability to hear in noise have become slightly better than when I had hearing aids with noise cancellation. I am impressed that I am able to hear better with CI without noise cancellation like I had with my hearing aids.
I believe the main change I have received in relation to speech is that I have received a much greater volume on the high frequencies which makes it possible to hear much more of the consonants. I am now able to hear the TV-news and similar programs without using subtitles – as long as there are not too much background noises. But I still prefer to have subtitles if they are available. Even though I can hear the sounds it can be difficult for my brain to discriminate between them – especially if there are other noises. I recently watched 5½ hours of live TV about the election for local municipalities here in Denmark without subtitles but a few days later I watched a documentary where I could almost not hear what the narrator said because of the background music. But when I recently was in church for a christmas concert I experienced that I could hear what the priest said without lip-reading and additional aids in a church with a lot of reverb.
A very positive effect about my better speech discrimination is that I am less dependent on lip-reading. This means that I can look people in the eyes during a conversation. I am however accustomed to use lip-reading – I therefore feel like I am leaving my comfort zone when I have to look people into the eyes 😉
There are many CI users that describe how they experience a lot of new sounds that they do not know where come from and which can be frightening. I have not had that experience. I have however experienced that there are many sounds that get a new life – I can easily figure out what makes the sounds and I therefore just become fascinated about those sounds which has become so clear. I can almost describe it like if the small sounds have gotten a new life – that is fascinating.
But there has of course been certain sounds that have gotten me to stop up and wonder before I figure out what made a specific sound. In one occasion I for instance heard a strange hammering sound in my kitchen. It turned out to be the church bells that I could hear from an open window – and when I discovered that I could clearly hear that it was in fact church bells. I felt that I initially just heard a part of the sounds, and therefore could not understand what it was. Another sound that has really fascinated me is the sound of boiling water. I have always been able to hear boiling water, but the sound that comes when the air bubbles reach the surface of the water is new to me – I could stand watching a pot of boiling water for minutes. I also have had the same experience when pouring soda or beer into a glass where I can now hear the roaring sound.
The sound experiences can also be a little overwhelming. In the beginning I was for instance very surprised about how much birdsong that I could hear during spring, and that it was actually possible to hear the birds inside when the windows were closed. I have been able to hear birds before – but not this much. Another thing that have felt overwhelming is that I am sometimes able to hear other people breathing – that can be really frustrating. The fun thing however is that all these small sounds suddenly get more volume and focus but as times goes by they actually goes into the background so that I no longer notice them. I therefore get used to having a long range of small constant roaring sounds in calm environments – it is actually quite nice to have a constant input of sound – at times I wish that I did not have to take off the sound when going to bed.
It is not everything that is perfect – I also experience that some distant sounds are not so clear as I remember them. I have for instance noticed that when my neighbor is watching TV then the sound is choppy, humming and unclear. This can of course be caused by many things – but I guess that it might be caused by the division of the sound made by CI and the fact that the lowest frequencies are missing. It is after all the lowest frequencies that are best at traveling through floors and walls. So if the sounds are at the lowest frequency limit of my CI then it can explain why I hear the sound as choppy – The sounds below the limit is removed. But I do feel that these distant ambient sounds are getting better 🙂
Volume is a fun phenomenon when you are getting used to hearing with CI. In the beginning you keep turning the volume up as soon as possible. It is therefore difficult to access the volume of sounds. In the beginning I experienced that almost all sounds I heard were just loud – either there was silence or there were loud sounds. Over time this issue faded – but it took a long time before I could access if the volume of my TV was too loud or too weak.
Later in the process I experienced another problem as I gradually turned up the volume of my CI. When I hit the maximum volume of my CI – I could of course turn up the volume on the stereo. But my CI was already on the max, and it therefore turned down the volume in a way that made me feel like it did not change anything when i adjusted the volume on the stereo. This problem is not so big anymore.
Another strange phenomenon in relation to volume is the increasing difference between weak and loud sounds. If you look at my ability to hear with hearing aids, then the sound had to amplified a lot before I could hear it. But even though the sound was amplified there was also a limit on how much it could be amplified and how loud I could bear having it amplified. The result of this was that I had a sound where the difference between the loudest and weakest sound that I could hear was reduced. With CI that has changed a lot and I therefore needed to get accustomed to a much bigger difference in volume between weak and loud sounds. It is fascinating but also a big transformation to get used to. An example of this issue is from when I got my implants activated – here I experienced at that if I said something myself then the volume was very loud – but if anybody else in the room said something then it was very difficult to hear that they was saying anything. This problem has clearly gone away over time but I also think that this is a great explanation as to why it has become easier to understand and discriminate speech – the difference between sounds become bigger.
Back to life
In a large part of this process I have felt that I really wanted to get it over with as soon as possible in order to return to a normal everyday life. During the clarification process and the adaptation process I have spent a lot time and energy on thinking and evaluating my own hearing. It is nice to think constructively about your own ability to hear in order to find solutions that can make it easier to hear – but it is tough to relate to your own ability to hear for several hours a day for such a long time.
One should almost think that the need to relate to your own hearing on a daily base would be reduced after the initial rehabilitation process. I have however experienced that my need to focus on my ability to hear continued for a much longer time. I think the main reason for this is related to how the sound is perceived but also when you feel that your goal has been reached. I have for instance experienced that I was able to hear more in some situations while I still felt that some sounds were sounding wrong. This process is therefore also about having to accept that the sound is sounding in a new way – even though a lot of the frustrating things will get solved during mapping sessions and the adaptation process. Another aspect is that you can easily get the expectation that anything will become great for you even though you have read all the facts that states that CI does not provide a normal hearing. The process therefore also is about having to mentally accept that you have gotten a better sound but that you will never be able to hear perfectly by the use of CI. But even though the sound will never be like a normal hearing I experience that it sounds “normal” to me. It reminds me of the hearing I had before with the main difference that there are more sounds that I can discriminate and hear.
The biggest challenge for me have however been that I had to accept that the surgery has given me tinnitus which is always there. In the beginning it was very annoying and I found it hard to imagine how I could ever return to a normal life with all that noise. But after having read a lot about tinnitus and getting my CI adjusted it has started to fade into the background. It can still be annoying but I am now convinced that I can return to a normal life without being limited by my tinnitus. I just have to avoid focussing on it and get stressed – as that can make it much more difficult to ignore its presence.
Another challenge has definitely been to keep my energy up. In the beginning I “hit the wall” frequently – this meant that I became extremely tired and had choppy sound. I therefore experienced that it could be difficult to pull myself together for anything that meant that I would be exposed to sound. I have for instance felt that it was overwhelming to talk on the phone as that meant that I had to concentrate a lot and that I after a conversation felt that I heard worse on the ear that I had used for the phone conversation – it could take half an hour before the sound was back to normal on that ear… Now however I feel that I am getting my energy and courage back so that I can face more challenging sound environments 🙂
Exactly how CI sounds is a very a subjective experience to describe. In this post I have described a lot experiences about how I think CI sounds – but my description is extremely limited by my own perspective – I can only compare with the hearing I had before getting CI, and even that comparison is very difficult to make as it is difficult to remember exactly how I heard before I got CI.
But it is my experience that CI can provide a good hearing that is similar to a normal hearing. There are however some limitations in relation to the ability to hear in noise. There are also some quality loss in relation to music – but in my case I certainly feel that I can hear more details in music with CI than what I could when using hearing aids – There are some things that are lost – but I get a lot of other things.
Have I described how CI sounds? NO! I have described some aspects in relation to what I can hear and how that has developed over time. I cannot make a real description of exactly how it sounds in a way that makes people without an implant understand how it sounds – it has to be experienced. I actually feel that I have experiences of how CI sounds that I cannot describe – it has therefore been a very frustrating process to write this post. But if you are a good CI-candidate I certainly think that you should considering getting an implant as there are good possibilities for getting a better hearing. Remember to ask yourself if you are satisfied with your current ability to hear – the doctors will not offer you CI if they determine that you have a sufficient or better hearing with an hearing aid.
I know that a lot of other CI-users are reading this blog – I will therefore encourage you to start a debate about how CI sounds in the comments below this post. This debate may be of great interest to potential CI-users and relatives.
Finally I want to wish everyone of you all a merry Christmas 🙂