Hello, Naida!

With all the buzz about bilateral Cochlear Implants, I often feel that our bi-modal kids are forgotten about. Yes, bilateral hearing is best. Of course 2 ears is better than one. We've found over the past 3.5 years that Christian receives GREAT benefit from his aided ear (that measures severe on aided testing) and sometimes folks are surprised that we aren't pursuing a 2nd Cochlear Implant for him. Just yesterday at school he scored 37/49 correct using his aided ear alone in speech perception testing. That is pretty darn good. We know that his aided ear provides much of the enjoyment for his love of music. We know that it also has helped him with sound location and articulation. For now, a hearing aid is working. We'll always keep close tabs on that ear. Maximizing his aided ear is ALWAYS on the forefront of our minds, so when he came home yesterday with a Phonak Naida on his left ear, I couldn't help but be giddy with excitement.

I'll leave the ins and outs of exactly what the Naida does to the pros--check out the video below from Dr. Seewald, a leader in pediatric audiology. In Mommy terms, the Naida uses this amazing software called SoundRecover. It will take the high-frequency sounds that Christian has a hard time hearing with his aided ear and compress them into lower level frequencies, making them accessible and heard. This will help with his speech discrimination and production. Christian will use the demo provided by the school for a couple of weeks, we'll evaluate his progress and decide if we'll order one.

Questions Answered

Most of my friends, family, and loyal readers of this blog know that I've been worrying, ok more like stressing, about what to do with Christian's other ear. On Christian's 1st Hearing Birthday, our questions were answered.

In addition to tweaking his MAPs a bit, Christian also had two audiograms done. One measured his hearing with his CI ear only, and the other measured his hearing with his hearing aid ear only. We learned that with his CI, he was hearing between 25-20db across all frequencies (remember, this kid has a PROFOUND hearing loss in that ear!!!) With his aid, we showed responses in the lower frequencies at 35 and in the high frequencies at 50.

Wow.

Christian then had some speech perception testing done. With his CI ear only, he tested at 96% accuracy (go buddy go!) and with his hearing aid ear only, he tested at 75% accuracy.

Wow.

So, what do all these numbers mean? Well, ends up that Christian's aid is doing much more than we thought it was. We know that he has a considerable amount of residual hearing in his aided ear, and it now performs in a moderate hearing loss range. We now know that Christian's left ear, with these test results, is too good to be implanted with a CI.

Here's what the experts say on staying bimodal:

"Specifically, the lower frequencies provided by the hearing aid can provide information about the fundamental frequencies
of a talker’s voice and vowel information, while the mid- and high-frequency information from the cochlear implant can
provide information needed on manner and place of articulation of consonants.It has also been suggested that localization ability, sound quality, and music perception may be enhanced by bimodal devices compared with bilateral cochlear implants." (Hearing aids plus cochlear implants: Optimizing the bimodal pediatric fitting, Steven A. Huart and Carol A. Sammeth, The Hearing Journal, NOVEMBER 2008 • VOL. 61 • NO. 11)

Can you tell I've spent countless hours trolling the internet for information on this?

While I am so happy to finally have some answers and a clearer picture of where we will be going with Christian these next couple of years, I still feel a bit unsettled. I have been inundated with information on the benefits of bilateral cochlear implants, and see how well both pediatric and adult patients do with them. On the flip-side, I've also collected some first-hand stories from bimodal users and know that model works as well. I know that Christian will do well regardless of what he has in his left ear. He is my superstar, and he is amazed all of us with just how well he is doing.

Bilateral On My Mind

We're almost a year post-activation, and not a day goes by where I am thank God for the miracle of Christian's CI. I never thought in my wildest dreams that he would be doing as well as he is. I've learned over this year that Christian's progress is not typical. I've learned that he has surpassed many people's expectations. Geez, I went into this whole thing just hoping he would be able to hear things for safety's sake, and he's in my backyard pointing to his ear saying "Mommy, do you hear that fire engine", as it blows it's sirens at least 5 miles away. And while I am so happy, and so proud, it makes a difficult decision, even harder.

We're currently exploring possibly going bilateral with Christian (implanting his left ear). Currently, Christian is bimodal. He wears a hearing aid in his left ear, and his Cochlear Implant on his left. Christian was an exceptional hearing aid user, and his aided results get him into the 50-45db level. Over the past year, we've learned that his hearing aid complements his CI quite well, giving him some acoustic hearing along with the electrical hearing that he receives with his CI. We are absolutely certain that Christian has functional residual hearing in that ear, as he does respond to very loud voices/noises when just aided. We've also learned, that Christian hears in the 25-20db with his CI. That gives him full access to speech sounds. 25dbs makes a big difference when it comes to spoken language.

I can't help but wonder that if Christian is doing this well as a bimodal user, how would he do with both ears hearing in the 25-20db level? Surely having two ears with full access to speech sounds is better than just one, right? And, I have this recurring nightmare of Christian coming home from school with his hand over his right ear telling me it's broken. What happens when his right CI fails? I know it will. Maybe it will happen in 5th grade. Maybe it won't. What if it happens in college, during finals? Or on the baseball field in high school when he's on 2nd base? The reality is that something WILL happen to it within the next 18 years, and the fact that he doesn't have a back-up ear terrifies me. We use ASL in our home as a back-up language, something for the bath, for reinforcing concepts, and for times when his CI is off. We are committed to being an oral family, and our ASL use was never meant to be our primary form of communication. We use all of our energy to teach Christian his first language: spoken English. Christian will attend a mainstream school, thanks to his CI. If that fails, there is no way that he would be able to succeed in a mainstream classroom. I would have to pull my child out of school to deal with a failed implant.

There's not much research out there regarding situations like ours. I've read everything there is out there regarding bimodal vs. bilateral. I know the pros and cons. I know that for folks who don't get benefit out of their aid, that bilateral is the way to go. But what to do about my boy? My boy who does get SOMETHING out of his aid?

We have Christian's audiology team at both his implant center and his school on the case. We're working on speech perception testing. We're examining his localization abilities, and we're looking at all of his test scores. We're trying to compile everything we can to make an educated decision. While we know we don't have to rush, we also know that if we do chose to get the second implant, the sooner the better.

Just one more thing on my list of worries.