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An Octogenarian’s CI Journey
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We are pleased to share Bruce Sloane's blog, An Octogenarian’s CI Journey, detailing his passage to improve his quality of life with a cochlear implant. His story began more than thirty years ago when he noticed a change in his hearing. It is typical of an adult who has progressive hearing loss. He was fit with his first hearing aids. He continued to experience loss of hearing acuity. As his hearing deteriorated, he experienced further changes in his ability to communicate in various settings. He was fit with stronger hearing aids with limited benefit. Finally, a turning point occurred that helped him move forward his decision for a CI—thanks to an accidental meeting with a CI recipient in a supermarket. This meeting changed the course of his hearing loss journey dramatically. The blog will focus on Bruce's decision to pursue a cochlear implant, the medical and audiological evaluations, the surgery, and the early outcomes. Please join us in following Bruce’s warm-hearted story.

 

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Part 3. The Scan

Posted By Naama Tsach, PhD, Monday, January 1, 2018

 

Several weeks after my evaluation (Part 2), I received an email from the audiologist saying that I was scheduled for a CT scan of the skull followed by an appointment with the doctor. (A CT scan is a special X-ray that produces cross-sectional images of a part of the body.) This meant more waiting, but at least it seemed like good news. It seemed to me that ordering the scan meant that the doctor thought that I was medically fit for the surgery.

I emailed my audiologist asking if I would be scheduled for surgery at that appointment or if there were any more “hoops” that I would need to jump through. She replied that I should expect to receive a date for surgery at the time of the CT scan and that she thought I was finished “hoop jumping.”

As we drove to the clinic for the CT scan, I endured jokes by Joy and my daughter Amy about what the CT scan would find in my skull—no brains, but a big empty space. Of course, the real purpose of the scan was to examine both the cochlea and adjacent mastoid bones and provide guidance for the surgeon to install the implant.

The scan took just a few minutes. Then, at the surgeon’s office, a resident told us that the surgery was scheduled in seven weeks. He explained some of the hospital procedures and the operation. I might have to remain overnight after the surgery, depending on how I felt and reacted. Because cochlear implantation requires anesthesia and may disturb fluids in the inner ear, some patients feel dizzy and nauseous for a while after the procedure. This typically resolves quickly.

We then talked with the surgeon. I had expected him to recommend that I have the left ear implanted because the audiogram showed that I have a greater hearing loss in that ear. To my surprise, he recommended an implant in the right ear. Although my left ear did have a greater loss, the word and sentence recognition tests indicated that my right ear had better clarity (and better sentence understanding) than the left. He recommended that we implant the right ear.

A week after surgery I was to return for a post-op checkup. About a month later would be turn-on day when the audiologist would hook me up and turn on my cochlear implant.

Bruce Sloane, M.S., M.A.

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Cochlear Implants—Pay It Forward*

Posted By Naama Tsach, PhD, Monday, December 18, 2017
Updated: Thursday, December 14, 2017

The following is an excerpt taken from the December 2017 issue of ACI Alliance Calling.

Everyone remembers certain events that were major landmarks in their life: marriage, a new job, birth of a baby, or—not so happy—death of a loved one. For me, after watching my hearing deteriorate for almost half my life (I’m 82), getting a cochlear implant was one of those major landmarks.

With my new CI, I was no longer isolated. I could converse easily with Joy, my wife. I could talk on the phone. Family get-togethers were once more enjoyable instead of being an onerous ritual. I became more active again in the community; to the surprise of some of my acquaintances, I no longer sat there quietly at meetings but talked up and joined in discussions.

When I decided to get a CI, I kept notes about my experiences and feelings. I wasn’t sure what I planned to do with these memoirs. Maybe it could help others with hearing loss considering hearing aids or cochlear implants.

With that in mind, I contacted Donna Sorkin and Naama Tsach of ACI Alliance to see if they were interested in what I wrote. Yes, they were. In fact, they wanted to publish it as part of Naama’s Blog on the organization’s website. They felt that we should use my musings as a way to tell older folks that you’re never too old to get a cochlear implant. (And you aren’t. Just ask me.) 

After some editing by the ACI Alliance staff, my first segment— The Decision—was ready for publication. I am so appreciative for their wonderful job!

Many people have expressed interest in my CI. A doctor I visited had no idea what it was. When I explained how a CI works, he thought the device might help his father who is getting little benefit from hearing aids. My audiologist asked me if I’d mind answering some questions from a patient who is thinking of getting a CI and I have exchanged several emails with the man.

I’ve since met with others who have questions about hearing, hearing loss, hearing aids, and cochlear implants. A friend who is president of the local Lions Club asked me to give a talk to the Club next month. He says he knows several members who might benefit from cochlear implants as they have great difficulty hearing, even with hearing aids.

I also put a note about my CI on my college class website with a link to the ACI Alliance blog, and will have a short article in the next class newsletter.

What else can I do? Well, our local county has an adult education program. Anyone can suggest a class on a topic they want to teach. We’ve had classes on everything from fly-fishing to geology to French literature. Spring term is coming up soon. It’s about time there was a class on hearing, hearing loss, and technology that can help— including cochlear implants!

Bruce Sloane, M.S., M.A.

*Editor added the title for Bruce’s article. Pay it forward—a goodwill movement popularized by the movie of the same name starring Kevin Spacey and Helen Hunt. The movie concept was that the recipient of a favor did a favor for others, spreading out good deeds. We think Bruce Sloane is “paying it forward.”

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Part 2. The Evaluation

Posted By Naama Tsach, PhD, Tuesday, November 28, 2017

After years of struggling with progressive hearing loss, the decision has been made and Bruce has set off on his journey. The first step is a meeting at the CI center to determine whether Bruce would be a good candidate for cochlear implantation, collect more information, and meet with the audiologists and the surgeon. Learn more about his evaluation in Part 2 of Bruce’s story.

Part 2. The Evaluation

A few days after I contacted the ENT clinic, they sent a packet of information and forms to fill out and return. This covered my medical history, operations, medications, allergies, family physician, and so forth. I already had much of it assembled so it wasn’t difficult to fill in the blanks.

What took more time was the “essay exam” asking me why I wanted a CI and what I expected, both of which were good questions. My answer was straightforward. My hearing had deteriorated so much that I could barely talk on the phone. Understanding anything in a group was impossible, and even holding a conversation with my wife was difficult. To understand the TV, I turned up the sound so loud it drove everyone else from the room.

Evaluation Process
The materials from the clinic also included a flow chart of the step-by-step Adult Cochlear Implant Candidacy Process. (You can view a similar version on the ACI Alliance website https://www.acialliance.org/page/CICareProcess) It stressed that this was a team effort. The first step was to contact the CI program and begin the evaluation process. I’d done that! Next was the audiological evaluation followed by a medical evaluation. After that came a CT scan and maybe an MRI. Finally came the team meeting and recommendation. Three outcomes were possible from that meeting: Yes, No, Wait. I did not want to fall into the last two categories.

It was hard to sleep the night before evaluation day. My daughter picked up my wife Joy and me and we headed to the clinic, which is a few miles from the hospital. I checked in and was met by an audiologist.

The first task was a typical hearing test in a soundproof booth. Without hearing aids and wearing headphones on both ears, I was prompted to push a button when I heard a tone. We then did some testing that wasn’t usually part of a hearing exam that I had previously experienced. I put my hearing aids back on and we repeated the tone testing. This was followed by word and sentence recognition tests. With earphones on and at an adequate volume, I repeated back the words and sentences that I thought I heard. I knew this word recognition test was part of my being considered an appropriate CI candidate. I also received a bone conduction test and testing for any middle ear problems. (There weren’t any.)

Test Outcome—I was a candidate!
Testing took about an hour and then the audiologist provided the outcome. “The tests clearly show that you meet both the FDA and Medicare guidelines for a cochlear implant.” I was astounded. I looked at the paperwork. The audiogram was no surprise. I knew I had limited hearing beyond the low frequencies. Later I compared this audiogram with the previous one. Today’s testing showed I had lost 5 to 10 decibels on practically every frequency in just over a year. Testing wearing my hearing aids showed a moderate to severe loss. Despite their steep price, those things in my ears weren’t helping very much.

Word and sentence recognition tests revealed that I recognized just 12 percent of the words on one test and 32 percent on another—with no visual clues. Seeing someone’s face and filling in the blanks was how I was figuring out what people said. Gradually it dawned on me that I was deaf—not deaf as a post, mind you—but deaf enough that I could barely converse in a meaningful manner.

Another audiologist came in, carrying literature and models of cochlear implants from the three CI manufacturers. We looked them over. I was interested but I was still mulling over the test results. I said that I was not ready to decide which company to go with.

We then left to meet with the surgeon and head of the department. He spoke slowly and deliberately, pausing after every word. (“It’s. Important. To. Understand. Not. Just. Hear.”) Four years earlier, I had open heart surgery to replace a defective aortic valve. The surgeon said he wanted an okay from my cardiologist that I was healthy enough to have the surgery.

I wasn’t worried about what the cardiologist would say. My last visit with him had been several months earlier; he had said then that I was in good shape. I had no doubts that he would report that I was healthy enough for cochlear implant surgery. The CI surgeon said he would write my cardiologist a letter and get in touch with me later. That was the end of the visit and evaluation. I had passed a crucial step and was on the way to a cochlear implant. All I had to do now was to wait for the cardiologist’s letter and we could proceed. I hoped it would not be a long wait.

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Join an Octogenarian’s CI Journey

Posted By Naama Tsach, PhD, Monday, October 9, 2017
Updated: Wednesday, October 4, 2017

Part 1. The Decision

My name is Bruce Sloane. I am an 82-year-old man and live in a small town in Virginia about 80 miles west of Washington, DC. I started wearing hearing aids more than 30 years ago after I went to an ENT because of mild but continual ringing in my ears. The doctor examined me, said there was nothing wrong with my external ears and said that the ringing was called “tinnitus.” He said not much could be done about it and that tinnitus often was accompanied by some loss in hearing. With that, he sent me down the hall to an audiologist who gave me my first hearing test. The test showed mild hearing loss in some higher frequencies—not enough to need hearing aids, but enough so that my hearing should be retested yearly. The retest one year later showed more hearing loss. And the test the next year showed even more. It was time to get hearing aids. 

My Hearing History
I've been wearing bilateral hearing aids for more than 30 years. I have owned about 10 pairs, each one more powerful (and expensive) than the last. As I needed more amplification, I switched to behind-the ear (BTE) aids. I didn’t mind this, as I felt that my poor hearing was nothing to hide; the BTE aids made it more visible and alerted people that I had a hearing problem. At yearly hearing tests, I've watched my hearing slowly deteriorate, decibel by decibel. 

Two years ago, after testing and getting new hearing aids, my audiologist said, "Have you ever considered getting a cochlear implant?" I replied, "I thought you had to be deaf as a post to get a cochlear implant." My audiogram showed severe to profound hearing loss—60 decibels to no hearing at all--in both ears in the middle and upper frequencies, where most speech occurs. In the very low frequencies, there was a mild loss. 

An Attentive Audiologist
She then explained that the standards have changed, and that I probably met both Medicare and Food and Drug Administration (FDA) guidelines for cochlear implant candidates. I thought it was unlikely that I would meet these guidelines. I had new HAs, and I could function OK. Who needs such a contraption, to say nothing of an operation. And cochlear implants were for deaf children and adults who had lost their hearing for one reason or another. I wasn’t deaf—I could still hear, I thought—or could I?

What the audiologist said stuck in my mind. I had trouble understanding my wife’s speech. It often sounded garbled. We both missed the comfortable conversation and easy back and forth talk we once shared. I could rarely understand anyone on the phone and was always asking the caller to talk louder. Even when they did, it just sounded like they were mumbling. In groups I usually understood little, and the comments I made were often "off the wall" and out of context. I belonged to several organizations but usually sat quietly in meetings because I could not understand most of what was said. I stopped driving the ambulance as a volunteer for the local rescue squad because I couldn't understand what was being said on the radio, and often did not understand the EMT’s instructions. 

Could a cochlear implant help? I didn’t know. 

A Chance Supermarket Interaction
A few days after that, my wife and I were waiting in the checkout line at the supermarket. My wife was talking to the woman in line behind us. Somebody said something to me that I didn’t understand and my wife said, “Oh, he’s hard of hearing.” 

The woman she was talking with said, “So am I. In fact, I’m totally deaf and have a cochlear implant.” The woman and I started talking. She lost her hearing suddenly and completely several years ago after taking antibiotics and had a cochlear implant a year after that. She took off the processor behind her ear and showed it to me. I asked her where she had it done and who did it. The doctor and clinic were about an hour’s drive from my house. I wondered why my audiologist didn’t know of this resource. The woman thought her CIs were life savers and her doctor was fantastic. I asked for his name and phone number, which she was delighted to give me—in fact, she had his number memorized. 

The checkout clerk was listening to us and holding up the line of shoppers (who didn’t seem to mind, they were listening, too) joined the conversation, saying that a few minutes ago, a woman came by with young twin boys and both had an implant. I was amazed. I’m surrounded by cochlear implants, I thought.

When I got home I looked up the doctor on the Internet. His credentials were impeccable, and he received high marks from his patients. I went to his website and left a brief note describing my condition and requesting an appointment. A day later I received an email telling me I was scheduled for a CI evaluation in two months. The office wanted a copy of my last hearing evaluation from my current audiologist and they would be sending me some forms and information. 

The next day I visited my audiologist and asked them to send the doctor the requested information. I also told them that the next time someone asks about a cochlear implant, that he was the person to contact.

I was on the way! Two months seemed like a long time to wait. But when I considered I had been wearing hearing aids for 30 years, I figured I could wait a little bit longer.

 

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