Frustrated by Sound Quality of Hybrid CI

[Shirsee]

Last week I had a very frustrating day and I'm still reacting to it. I am 3 months activated today. It seems like my progress is slow but my audiologist thinks I'm doing fine. I have a MedEl hybrid CI. I wear a hearing aid in one ear but I've not been wearing it while I get use to the CI. Some of the things that I'm struggling with follow:

I hear two voices at once. One sounds more natural and the other is under and lower than the natural voice and seems to trail a little behind. It's sort of like an echo but I don't hear it on single words usually. I hear it more in sentences and especially when I am streaming directly to my Hybrid/CI ear. I also hear two voices when listening to TV but the second voice I hear sounds more mechanical, tinny and garbled.

I do very well with Angel Sound word tests and other apps like that but the real world is a different story. I saw a technician last week who was doing a knee treatment on me and I could barely understand anything she was saying. After her, I saw the doctor who was hard to understand also, easier than the technician but still hard. I understand my husband and my son pretty well. With the technician, the problem seemed to be distortion. With the doctor it seemed he was too soft.

I get frustrated that the audiologists where I was implanted seem to want to keep you on a schedule where you are seen about every 2 months. Is that normal? My first mapping of course was when I was activated. I returned two weeks later to have the acoustic part added (EAS) and I got my second map. I didn't like how things were sounding so I went in again early a few weeks later but that mapping was sort of a wash because I got my appointment mixed up and missed most of it. We only had about 45 minutes but the audi tried to help me. I've had one mapping since then which would have been about 2 and a half months out from activation. I'm not scheduled to return until March. To me, this seems like not enough mappings for someone who is having issues.

I still feel like my ear is plugged up but my ear has been examined and I know that the fluid in my middle ear is gone. I think it's my eustachian tube that's the problem now. I can't seem to get it to open like I can the other side. I hear my heartbeat especially in the morning and almost any little noise I make from moving my head in my CI ear. It feels like there is still something in that ear somewhere that shouldn't be there. 

Car noise and fan noise sound like a waterfall or a public square fountain. It's a higher pitched sound and I sometimes describe it as a rice crispy sound. Drives me crazy.

For those of you who wear a hearing aid in one ear, how long did they tell you not to wear it while learning to hear with the CI?

Does any of this sound normal to any of you and will I ever hear well with this thing? It hard not to feel discouraged sometimes. I'm at one of the best centers for MedEl in the country, UNC.

Thanks all. I know that was a lot but I thought I'd just reach out and see if some of you could relate or have suggestions.

[Mary Beth]

Hi @Shirsee

 

I am sorry you are having a frustrating time.  I do not have the Sonnet EAS - I have bilateral Sonnets but I will try to answer some of your questions the best I can.

I did experience the perception of hearing two voices at once.  It was not like an echo....more like two voices layered on top of each other.  One was a natural sounding voice and the other was more mechanical sounding.  What happened for me was that slowly the mechanical sounding voice peeled away and I was left only with the natural sounding voice.  I hope this happens to you as well.

I did a lot of aural rehab and I found that I needed to do the aural rehab different ways.  Training with a DAI cable or BT neckloop or Roger System is great practice but those inputs sound different than speech sounds over our Sonnet mics.  So I also trained with live voices.  To help me with different types of voices and accents I listened to TedTalk podcasts.

The Roger Pen/Roger 21 Sonnet receiver or the Artone Mic/Artone 3 MAX BT neckloop may help you when trying to understand a therapist or doctor.  It’s worth a try to see if it helps.

If you have an iPad,  I highly recommend running all the way through the ABCLIX app in addition to Angel Sounds.  It covers a lot of easily mixed up speech sounds in a very repetitive way.  Just search the App Store for Advanced Bionics and it will show up.  It is free.

Every audiologist has her own way to activate and move us through the early progressive MAPs until we stabilize.  I like the way my CI center does it but there is a lot of variation on this between centers.  And in the end, most of us end up in good places.

If your CI center bills separately for each MAPping, instead of including a group of MAPpings in your surgery package, maybe you can schedule additional MAPpings when needed?

Sometimes, quality of speech sounds can be improved by turning off an electrode.  We turned off an electrode on my right side at the three month point when a quality of sustained speech (not individual words) was bothersome.  It helped a lot.

I have been extremely fortunate on my CI journeys to work with an awesome audiologist.  A great working relationship with a highly skilled audiologist makes a big difference in my opinion.

I am glad you are at a large, well respected CI center.  I hope as you continue to talk with your audiologist there, you can reach some answers that will make your listening experience more enjoyable.

My audiologist told me to listen with my CI only for at least several hours a day.  I was allowed to wear my HA in my other ear as much as needed.  I wore my HA in my other ear for work and at home and on weekends went CI only.  Before too long I was CI only at work too.  Again, this varies from audiologist to audiologist.

 

Good luck to you.  Hang in there.  Things do get better.

[Mary Beth]

Oh, I almost forgot....check out the free app AVA to see if that helps when trying to understand a therapist or doctor face to face.  It captions via software so makes errors, but it can be very helpful.

[Shirsee]

Thanks Mary Beth. Maybe I'm doing better than I think. It helps to get a broader perspective. I wish I did have an ipad. I have an iphone and a MacBook but no ipads in the family. I'm not around a lot of real people to practice with. There is my husband and my son who will take time to read to me if I ask. Somehow, your response was encouraging and calming. Thank you for that. 

 

[Mary Beth]

I’m glad it helped a bit @Shirsee.

I hope you stick around here and keep us posted on how your journey is going.

[Mary Beth]

@Shirsee

I had another thought that may help you in difficult listening environments too.

When our audiologists create our MAPs, each MAP is saved as either omni, adaptive or natural mic setting.

omni-is one mic that picks up sound from all around us

adaptive- is dual mics that focus in on where the sound is coming from (the best setting for in noise)

natural- is dual mics with a fixed focus to the front (keep your head facing the speaker)

Switching into a program that uses adaptive may help you too.  Chat with your audiologist about your mic settings.

[Shirsee]

Thanks again Mary Beth, I will talk with her about that. I would like a program or map that senses when something is too loud and adjusts to that. Thanks for this tip and I will be back to let you know how things are going. 

 

[Kara of Canada]

I had some similar troubles at the beginning of my journey too. These programs really do help and there is so much play within them the Audi can adjust. 

[Shirsee]

14 minutes ago, Kara of Canada said:

I had some similar troubles at the beginning of my journey too. These programs really do help and there is so much play within them the Audi can adjust. 

Kara, you are speaking of the programs Mary Beth told me about, right?

 

[Mary Beth]

@Shirsee  Ideally after everything stabilizes and we have gotten used to sounds we haven’t heard in a long long time, nothing will be too loud.  If anything is too loud, be sure to tell your audiologist so that your MCL (most comfortable loudness) settings can be adjusted.

 

Even before the mic setting options became available in the US (They have only been available since May 2017.) things were never too loud for me even when I attended concerts in huge stadiums.  I never had to adjust my volume setting.  

The MCLs set the max loudness our CIs will get no matter what the input level is.

Now with a Sonnet EAS, and residual hearing in the low frequencies, there are times that those lows may become too loud perhaps.  I guess that depends on how much acoustic hearing you have in the lows.  A good question for your audiologist.  Smile.

[Kara of Canada]

13 minutes ago, Shirsee said:

Kara, you are speaking of the programs Mary Beth told me about, right?

 

Yes it is amazing. I use adaptive now. It keeps getting better and better. Don’t give up! 

[Mary Beth]

@Kara of Canada...so you switched out of omni?  You are staying in adaptive all of the time now?

[Kara of Canada]

Yes. I did back in October. I need some tweaking to you mapping and didn’t want to go see theaudi I don’t like. I do have an appt with my regular Audi. In February but I’m seeing the one I don’t like for my lresurgery appointment on Wednesday. I’ll ask her for some adjustments. I love it. It keeps getting better and better. The other night I heard some dogs that were far away. I actually had to stop and figure out what the sound was. It was cool! Slightly muffled because they were far away. 

[Mary Beth]

There is quite a group of adults who are preferring to stay in adaptive all of the time.  I did that for awhile.

[Cara Mia]

On 1/27/2018 at 5:44 PM, Shirsee said:

Last week I had a very frustrating day and I'm still reacting to it. I am 3 months activated today. It seems like my progress is slow but my audiologist thinks I'm doing fine. I have a MedEl hybrid CI. I wear a hearing aid in one ear but I've not been wearing it while I get use to the CI. Some of the things that I'm struggling with follow:

I hear two voices at once. One sounds more natural and the other is under and lower than the natural voice and seems to trail a little behind. It's sort of like an echo but I don't hear it on single words usually. I hear it more in sentences and especially when I am streaming directly to my Hybrid/CI ear. I also hear two voices when listening to TV but the second voice I hear sounds more mechanical, tinny and garbled........

 

For those of you who wear a hearing aid in one ear, how long did they tell you not to wear it while learning to hear with the CI?

Does any of this sound normal to any of you and will I ever hear well with this thing? It hard not to feel discouraged sometimes. I'm at one of the best centers for MedEl in the country, UNC.....

 

@Shirsee, sorry about that frustration that adjusting to CI/EAS can give us sometimes.

I had that  double layered sounds in my early days with CI. And I had to deal with this twice. The first time I experienced this effect around 3 month mark when the sound volume of my processor was adjusted to the higher level (close to my optimal). It took some time for my brain to get use to this. The second time I got this two channel hearing when my EAS unit was activated at 6 moths mark (after it was approved by FDA). This time that double layered sound was different if compare how it sounded for the first time.

It took much less time until it started sounds like "normal".

I hope, your period of uncomfortable hearing will end soon. I want to think that you are just in an early stage of adjusting to a new mode of hearing that includes two forms of stimulation (electrical and acoustical) which can make things a little bit complicated at the beginning.

Regarding the recommendation how much time to without HA while training a newly implanted ear. My audiologists suggested to use only CI for at least 2 hours per day. But I spent as much as I could without HA to be able to use CI independently sooner. But my HA helped me not so much by the time of implantation and I stopped to use it completely about 6 months after my first surgery.

I am glad that you use Angel Sounds app. It helped me a lot in many aspects of my CI journey.

What else helped me to overcome all challenges of learning to hear with CI -  exposing myself to many different sounds from the different sources, and staying positive and relaxing as much as possible. I tried to work on my speech understanding without setting any strict deadlines and goals. I did all that I could and accepted the flow of my life, appreciated any gains and improvements CI gave me for each day.  I analyzed what areas I need to explore and work on to advance my hearing skills. 

Good luck and all the best!

 

[Jdashiell]

I experienced the "echo" too with my second CI (Left) - which is being reimplanted March 13 - Most of the sounds on the Left are very high pitched because the electrode array is only at the outer part of the cochlea. The "echo" is lesser now but at times I think I hear it. When listening to music I will hear high notes of a guitar solo, that cause me to turn my head to the left, wondering where that sound came from. Weird.

I am Soooo ready to get this implant done - its been all year, 1st Left side surgery, March 1017, then reimplanted in June 2017, now a 3rd attempt in March 2018.

[Shirsee]

On 1/28/2018 at 4:38 PM, Mary Beth said:

@Shirsee

I had another thought that may help you in difficult listening environments too.

When our audiologists create our MAPs, each MAP is saved as either omni, adaptive or natural mic setting.

omni-is one mic that picks up sound from all around us

adaptive- is dual mics that focus in on where the sound is coming from (the best setting for in noise)

natural- is dual mics with a fixed focus to the front (keep your head facing the speaker)

Switching into a program that uses adaptive may help you too.  Chat with your audiologist about your mic settings.

How do those settings relate to ASM 2.0? And what of those settings do you find most helpful? Thanks. I know programs 3 and 4 are set to pick up sounds mainly in front of me. 4 is louder than 3. I was playing with those today at a restaurant and I liked 3, 4 was too loud. But then I didn't know how much volume up or down or sensitivity could be played with in that setting or should be played with. Another question, If you are sitting at a long table for 8 or 10 with people on either side of you and across from you, what program is best?

I'm not sure how Programs 1 and 2 are set but they don't seem to change or adjust to loudness around me. 1 is my everyday and 2 is louder and that's about all I know about them. Thanks.

 

[Shirsee]

19 hours ago, Mary Beth said:

@Shirsee  Ideally after everything stabilizes and we have gotten used to sounds we haven’t heard in a long long time, nothing will be too loud.  If anything is too loud, be sure to tell your audiologist so that your MCL (most comfortable loudness) settings can be adjusted.

 

Even before the mic setting options became available in the US (They have only been available since May 2017.) things were never too loud for me even when I attended concerts in huge stadiums.  I never had to adjust my volume setting.  

The MCLs set the max loudness our CIs will get no matter what the input level is.

Now with a Sonnet EAS, and residual hearing in the low frequencies, there are times that those lows may become too loud perhaps.  I guess that depends on how much acoustic hearing you have in the lows.  A good question for your audiologist.  Smile.

Another question Mary Beth, I hope you don't mind. I find myself turning the volume down a lot in noisy restaurants so that I can hear the people closest to me better. I also turn the sensitivity setting down. No one has ever really explained to me what the sensitivity setting is all about but I've gathered that it either enlarges your circle of hearing or makes your circle of hearing smaller. I'm impressed that you never had to adjust the volume. I'm just 3 months in from activation so maybe I haven't adjusted to all the "new" sounds yet but it's hard to say. So, say I'm in the natural setting but things around me are still too loud and interfering with speech perception. Would the best thing to do be to lower my sensitivity or change to adaptive and maybe still lower my sensitivity? 

 

 

[Shirsee]

Just wondering about this. I was in a room yesterday where I did pretty well with just the CI when I was talking with someone one on one or one person was talking at a time but when more than one person was talking or the group broke out in laughter and someone added a comment while people were laughing, I was very flustered and couldn't keep up. Does that sound pretty normal with where I am in this CI journey? Thanks everyone so much here. 

[Mary Beth]

Hi @Shirsee

 

Everyone’s journey is so unique and even my own right and left sides took very different journeys.  

 

The mic setting that is designed to work best in noise is adaptive.  It kind of aims at the direction the speech is coming from and keeps adjusting.

 

Some people use different programs for different settings.  One for regular.  One for noise.  One for music.  Etc.  I tend to stay in one program for everything.  Sometimes I move into adaptive for noisy places.  Many times I don’t.  I actually no longer carry the Fine Tuner around.  So I stay in one program all of the time.

 

Hearing lots of people sitting around a long rectangular table can be difficult.  I would suggest trying the different mic settings to see which worked best for you.

 

I do not adjust volume nor sensitivity.  But your understanding of sensitivity is correct.  It controls the size of the sound bubble.

 

You are still early in your journey so things will keep improving as you train and spend time listening in different settings.  There are always assistive tech options to help too, like the Roger System.

[Kara of Canada]

So I got a better understanding of my maps. I had an adaptive program that was actually the same as an omni program so I could hear all a round until the sound became louder than 55db then the program changed to:straight ahead hearing. I really liked it. I have actually gone back to omni with my new mapping and I am seeing how it goes. In the beginning I didn’t like the natural program. It since then I have had so much change in my hearing! I have again opted to try it. So I’ll let you all now how it goes. 

[Mary Beth]

Yes that is called auto adaptive.  It stays in omni and automatically switches to adaptive when sounds hit the trigger level (55 or 60 dB are the trigger level choices our audiologists can select).  

I used auto adaptive for awhile.  Then I found I preferred either true omni or true adaptive.  Not the version that switches between them.

Here is a link to good info on the 4 mic setting options on the Sonnets.

https://blog.medel.pro/sonnet-microphone-directionality/

 

I would add that omni delivers the fullest tones for music, especially in bass notes.  And is especially good for when using headphones.

 

 

[Kara of Canada]

Yes your quite right. But I do like the auto adaptive. It works for me. Loud sounds tend to overwhelm me sometimes so I like the ability to automatically adapt. True adaptive is the best for loud situations though. 

[Mary Beth]

I am happy we have various choices so people can find which settings work best for them.  Just wait until you are bilateral!  Many new WOW moments coming your way soon!

[Kara of Canada]

I sure hope so. Before you went bilateral @Mary Beth did you worry about future replacements adnhow you would afford them? It’s just one of those small things on my mind. I know to be in the here and now, but it lingers in my mind. We don’t have insurance in Canada like you guys down there do. We have to pay for future replacements out of pocket. I do want all the bells and whistles of bilateral hearing though!