Post CT for otoplan program-follow up

[Carol D]

Hello all,

I started a discussion when I had the CT for otoplan adjustments back in January. It took awhile to get it all done, sent to Medel, and for them to get the result to my audio.  She made the recommended adjustments to the mapping. I noticed an immediate change to a much lower pitch, especially my own voice. Everyone sounded like they were in a TRON movie. 

I tried for a couple weeks, and then switched back to the old program.  Today I put it back to the new mapping to give it another try. My husband thinks my hearing is 20 times worse than ever.  I have CI on one side, HA on the other. Use different audio for each device. My hearing aid Dr. does not know anything about CI.

So, my questions are as follows

Should I keep trying the new mapping until I see Dr. for next appt? Does it take a really long time to adapt to changes?

Should I find a hearing professional who can attempt to adjust the hearing aid to better complement the CI? 

Thank you in advance for your insights! 

[Mary Beth]

@Carol D

The frequency shift of the anatomy based fitting MAP will take time to get used to and if you choose to go that route, I would suggest staying in it and training it like it is a newly activated side.

@Roy has experience with frequency shifting of electrodes so maybe he will jump in and let you know how long it took for him to adjust.

Whichever MAP you choose to stick with, it will be helpful to put the CI ear through aural rehab activities.  Check out our section on rehab for members’ tips.

A few people are fortunate to work with CI audiologists who also will make changes to their HA.  Most of us seem to not have that benefit.  The CI audiologist will make an adjustment to the Sonnet 2 or Rondo 3 to match the timing of the HA but that is actually a CI setting adjustment and not any change to the HA settings.

[Carol D]

Thank you! I was not told to train like it was a new implant.  Just to give it time.. I will try some of my apps and see if that helps. 

[Roy]

@Carol D- I had my CIs remapped by the UNC research team a bit more than 2 years ago. This had the effect of pushing more low frequencies to the apical electrodes, which made male voices sound unnaturally deep. Female voices remained mostly the same for me.

I stuck to the new mapping and it resolved itself through normal listening, but I’d say it took me about three months before things sounded normal again.

On the upside, I feel like I’m hearing music much more transparently now. The brain has an amazing ability to adapt to these things!

[jcech344]

I was going to start a new topic on the role of ABF and the acceptance of both audis and patients.  But this looked like an appropriate thread.

I selected MED-EL for several reasons (Use of arrays that cover more of the cochlea, Otoplan for array selection and with post operative CT for ABF as part of their FineHearing strategy). I am now 10 days past my activation and have discovered that my hospital team did not use the post operative CT scan and the Otoplan output to set the initial mapping.  

I discovered this almost by accident researching a secondary source of sound distortion i am experiencing.  I also noticed that I kept failing the pitch portion of Hearos with low % correct. An article on sound distortion made reference to pitch reversal which occurs when a primary frequency falls between channels and its harmonic does, creating the sensation that the sound is actually higher in pitch. Keeping track of the trend I noticed that I most frequently thought the second note was higher when in fact it was lower. What I was hearing sounded higher than what the actual note was.  With the aid of my daughter, we checked this out on the piano and through 2 octaves, found that the best match to an initial note heard by my unimplanted ear was one 2 or sometimes 3 notes lower than what I perceived it in my implanted ear. In otherwords some notes sounded higher with my CI than they actually were. 

When I asked the audi I am working with at the implant group about whether the initial mapping had been done with ABF from the Otoplan, she told that it had not! It was their practice to set the mapping at "default" levels focusing solely on comfort (too lout and soft) and that if that there were still issue after I got use to this, they could upload the ABF settings and make adjustments.

I am honestly stunned that this would not have been done right at the beginning. If this tool has value (and I think it does) why would we not do it from the beginning?  Why adjust your hearing to different (in this cases) higher frequency than natural only to relearn more natural ones later. I am planning to ask that this mapping be changed to use ABF now, not at some point in the future. What have others experienced?

[Lauren]

My left side learned to hear with defaults, and briefly my right ear too. At the time my ABF map was switched on I was seven months adjusted to the map at the time. It was rough going as it was enough of a map change to scramble my brain. It took one month for my brain to unscramble, a second month to get used to it, and by/around month three I was starting to catch up to where I was prior to the ABF map change. 

Suggestion: I’d get the ABF map done ASAP if you’re wanting that. 

[Mary Beth]

If you want to the the frequency allocation of anatomy based fitting, I suggest you get it done now.  Ideally a new user would be activated with it.  

[Tim]

Somehow I missed @Carol D's thread when it was originally posted - hope her ABF is working out for her.  

@jcech344 I totally agree with what Mary Beth and Lauren said about getting the ABF as early as possible.  If you already had a post-op CT imaging done, getting an ABF interpretation seems like it should not get a lot of resistance.  The cost of post-op CT imaging and needing to justify the medical necessity to insurance was the reason that my clinic did not support doing the ABF earlier.  In your case, being able to point to pitch reversal might be justification. 

As Lauren points out, not doing at activation doesn't keep you from being able to make use of it but it makes for a presumably longer road of re-adjustment.

I finally was able to get ABF around 7-8 months post activation, worked at it for about the same number of weeks and still was far behind my pre-ABF word recognition scores (WRS).  Switched back to the original frequency allocation and in the same appointment my WRS improved to be better than ever.  In my case, the ABF detour didn't cost me anything in terms of progress.  (Discussed in more detail elsewhere.)  I'm glad that I did it even though it didn't really work out for me. 

By the way, I like your frequency testing!  I've been "geeking out" on a lot of stuff with my CIs but haven't done much actual frequency testing myself.  I found some of Meludia's rising/declining frequency pitch exercises very hard - perhaps also due to "pitch reversal."  I'll need to do a little experimenting. 

[jcech344]

Tim,

Here is the study done by Barry Jacobson of MIT/Harvard on the source and potential solutions of sound distortion.

https://www.biorxiv.org/content/10.1101/003244v3.full.pdf

It is a fascinating study done as part of his thesis 10 years ago after receiving an ME CI.  While much of this is over my  head (i'm a chemist not an engineer), I found his explanations and theses quite credible.  It is interesting to see his inquiries supported by ME, and I wonder 10 yrs in what became of his work and recommendations to them. 

[Mary Beth]

Clarity of sound and music changed significantly as I acclimatized to my CI and reached a stable MAP.  The way things sounded to me at one month, three months, 6 months, one year were significantly different.

The neuroplasticity of our brains is amazing.