Will the implant give more volume on the side it's on?

[funky]

Hi, I'm a candidate for an implant. I think the choices are between Cochlear Baha, Oticon Ponto and the Bonebridge. As far as I can tell, the Bonebridge would be the safest, and I suspect it can produce louder or clearer sound as well since the amplifier/vibrator is under the skin.

One thing I haven't figured out yet, though, is whether the effect will be louder on the side it's on. I'm not completely deaf on my left ear and I think my cochlea is pretty much intact. But will the sound travelling through bone be equally strong on both sides, or will there be a sense of direction?

[Mary Beth]

Welcome @funky

I will tag @Ivana Marinac as she has BoneBridge and loves it!

Wishing you the best!

[Ivana Marinac]

11 hours ago, funky said:

Hi, I'm a candidate for an implant. I think the choices are between Cochlear Baha, Oticon Ponto and the Bonebridge. As far as I can tell, the Bonebridge would be the safest, and I suspect it can produce louder or clearer sound as well since the amplifier/vibrator is under the skin.

One thing I haven't figured out yet, though, is whether the effect will be louder on the side it's on. I'm not completely deaf on my left ear and I think my cochlea is pretty much intact. But will the sound travelling through bone be equally strong on both sides, or will there be a sense of direction?

Hello Funky!

can you be more specific about the type of your hearing loss? Sensorineural, conductive or mixed? Also, if you know any value of your hearing loss threshold - it would help enormously to tailor the best answer for you.

in short, don’t worry - it is even louder than it is in a technical details of the device. There said up to 45dB, I have used it for a five full years with a bilateral conductive hearing loss of 65dB average.

you don’t worry it will be louder since fittings are superb, also after a period of getting use - your brain will adapt both on the quality of sound as well as on the intensity.

if you have a healthy other ear and without significant damage of the ear which is intended for an implantation - yes, you will be able to tegain directionality. 

If the other ear is damaged, or this is has a dignose of single-sided deafness - than no: one side-hearing is not enough. 

[funky]

Thanks for replying! I had a lot of surgeries when I was young, because of repeated infections. I'm not sure what they did, but they made me a new eardrum made of skin taken from behind my ear, I think. There's a hole in it but apparently it's nothing they want to try and fix (I can blow air right through it). I'm pretty sure they removed part of the bones in the middle ear. I hear mostly bass on that ear (left) and it's pretty useless for hearing speech. I *think* the cochlea is pretty much intact. Regular hearing aids haven't been of much help, especially with background noise which is when I have the most trouble hearing people.

I'll be trying a Ponto headband for a month or so. I tried it on for a few minutes, and it seemed to work OK but the sounds seemed to be in the center of my skull. It obviously wasn't programmed for me, but it made me wonder if the sounds would just be louder but harder to hear where they're coming from. But maybe that'll get better with time?

I'll see if I can upload an image of my last audiogram. I think the audiogram is for the headphone test. They usually do a test with a bone conductor thing too.

edit: I found this pdf that explains audiograms: https://www.chimehealth.co.uk/web/data/audiogram-hearing-loss-examples-2.pdf

If my translation from Norwegian is correct, this is from the last doctor's note: On the left side mixed mechanical [I suppose that means conductive] and neurogenic loss from bass to middle frequencies with PTA 35 dB. More pronounced treble loss below 80 dB. Audiogram shows good hearing on the right side below 20 dB hearing threshold at all frequencies execpt 25 dB 3000 Hz.

I think I can get either the Ponto or the BB. I don't think they have Cochlear aids. I don't know if Soundbridge is an option, but I guess that would be better for directional hearing since it doesn't send the sound through the whole skull?

Thanks again!

 

[funky]

Oh, and another question maybe you can answer. I can hear noticably better with my left ear when I hold my nose and blow, like when you're trying to equalize the pressure when flying. If I blow pretty hard, but not so hard that air passes through the eardrum. I guess maybe the eardrum is a little loose or flappy normally, and when I apply pressure it tightens up. I do it sometimes when I listen to Beethoven and the music peaks

Anyway, does that mean that maybe my eardrum could be "tightened up" surgically?

[Ivana Marinac]

On 11/13/2018 at 12:27 PM, funky said:

Thanks for replying! I had a lot of surgeries when I was young, because of repeated infections. I'm not sure what they did, but they made me a new eardrum made of skin taken from behind my ear, I think. There's a hole in it but apparently it's nothing they want to try and fix (I can blow air right through it). I'm pretty sure they removed part of the bones in the middle ear. I hear mostly bass on that ear (left) and it's pretty useless for hearing speech. I *think* the cochlea is pretty much intact. Regular hearing aids haven't been of much help, especially with background noise which is when I have the most trouble hearing people.

I'll be trying a Ponto headband for a month or so. I tried it on for a few minutes, and it seemed to work OK but the sounds seemed to be in the center of my skull. It obviously wasn't programmed for me, but it made me wonder if the sounds would just be louder but harder to hear where they're coming from. But maybe that'll get better with time?

I'll see if I can upload an image of my last audiogram. I think the audiogram is for the headphone test. They usually do a test with a bone conductor thing too.

edit: I found this pdf that explains audiograms: https://www.chimehealth.co.uk/web/data/audiogram-hearing-loss-examples-2.pdf

If my translation from Norwegian is correct, this is from the last doctor's note: On the left side mixed mechanical [I suppose that means conductive] and neurogenic loss from bass to middle frequencies with PTA 35 dB. More pronounced treble loss below 80 dB. Audiogram shows good hearing on the right side below 20 dB hearing threshold at all frequencies execpt 25 dB 3000 Hz.

I think I can get either the Ponto or the BB. I don't think they have Cochlear aids. I don't know if Soundbridge is an option, but I guess that would be better for directional hearing since it doesn't send the sound through the whole skull?

Thanks again!

 

 

Hi Funky,

they tried to repair your eardrum but not from skin.

Actually, watching your audiogram reveals that your hearing on your left ear is pretty much decent up to 2 kHz, but what strucked ny mind is your hearing loss further which is quite significant, at 4 kHz it suits into the category of deafness. So, you’re wrong - part of your cochlea or outer hearing cells hardly work in one significant area, so there is a disproportional hearing due to the insufficient higher band - we’ll get back to this stuff.

Your audiogram looks like a typical hearing loss threshold caused by acoustic trauma, not much as the result of chronic otitis media on that side.

Looking at your situation, maybe your test with Ponto revealed you thruth - bone conduction nor active middle ear implant will not regain your wish for full directionality; only one implant can do with your type of hearing loss - EAS because the rest of threshold is more or less functional. 

Soundbridge do well up to 80 dB but no more than of that, and you have a significant loss between 3 and 8 kHz.

Higher freqencies tend to be more directional and therefore help with a sound localisation. Physics behind it is described here: https://knowingneurons.com/2013/03/15/how-does-the-brain-locate-sound-sources/

 

 

[Ivana Marinac]

On 11/13/2018 at 1:03 PM, funky said:

Oh, and another question maybe you can answer. I can hear noticably better with my left ear when I hold my nose and blow, like when you're trying to equalize the pressure when flying. If I blow pretty hard, but not so hard that air passes through the eardrum. I guess maybe the eardrum is a little loose or flappy normally, and when I apply pressure it tightens up. I do it sometimes when I listen to Beethoven and the music peaks

Anyway, does that mean that maybe my eardrum could be "tightened up" surgically?

It’s a typical situation with people who have a mixed hearing loss - you tend to insuflate E. tube and middle ear, maybe some effusion there accumulate through years and it improves sound transfer. 

Eardrum can be repaired in any way, even the ossicle chain can be build out of artificial prosthesis, but - hearing cells (if this is a real situation at the audiogram) are nit vampires or zombies: once heavy damaged - can’t be replaced. Only partially substituted with internal cochlea electrode which would bypass them.

[funky]

Thanks. I haven't had any acoustic trauma that I can remember, but I know I had infections for a long time before they were discovered. If I remember correctly some bone in the middle ear was replaced with a prosthesis, but was removed again later. I also have a cholesteatoma that the doctors have left alone - I guess it's either benign or complicated to remove. I also had encephalitis as a kid, but if my understanding is correct that rarely leads to hearing loss on only one side.

A question about the audiogram - the bone conduction test seems to cover fewer frequencies than the regular sound tests. Is that because bone conduction can only transfer certain frequencies (not the very high or very low tones)?

I can live with the poor directionality I have today, but I'm a little worried that bone conduction will make it harder to distinguish where the sounds are coming from. But my main problem is hearing speech on my left side, and on both sides in noisy environments.

I asked about CI once and I wasn't a candidate but they didn't say why. I guess it's a complex operation with a risk of damaging the hearing cells that work.