Cash, granola and more as a cochlear-research subject

I don’t mind being a guinea pig. In the two-plus years since I received my cochlear implant, I have volunteered to be the subject for a variety of research into hearing and related technology.

On a hot summer’s day during the 2020 lockdown, I got a new request by email:

Good Morning Ian,

My name is Emmanuel Chan, not sure if you remember me, but I am a research assistant from the Cochlear implant lab at Sunnybrook Health Sciences Center.

I remember you well, Emmanuel, I thought. The last time we met, you used a gooey gel to attach about 50 electrodes to my scalp and made me listen to musical duets. How could I forget? I was frustrated that it was so hard to distinguish between the sound of different classical instruments playing simultaneously.

Ian with electrodes

“We are not amused”

But you had a great attitude, explained everything carefully, and at the end of the session, you gave me some shampoo to wash my hair, a granola bar, a parking pass, and twenty bucks. You were doing important work to help cochlear implant recipients. I drove away from the hospital parking lot in my minivan with a smile on my face.

Maybe this guinea pig could help other people who share my journey.

Hearing and quality of life

Emmanuel continued his latest e-message: I am emailing you to let you know about an opportunity to participate in research with us. As a reminder, our lab focuses on cochlear implant populations, investigating a variety of aspects including cognition, perception as well as quality of life.​

At the moment, we are conducting some online tests investigating speech perception and the quality of life of people living with, and without cochlear implant(s). This data in turn will be used by clinicians to optimize rehabilitation for patients with cochlear implant(s). There will be a total of 4 online questionnaires and 1 online speech test. The questionnaires and speech test should take a total of 30 minutes to complete.

Aha — optimizing rehab for patients with cochlear implants. That is one area where I could have used more help a couple of years ago. I had done homework to get used to my hearing system, using programs such as Speech Banana, but felt bewildered by all of the potential programs and technologies. I sometimes wished I had a hearing-rehab guardian angel.

Cash and granola bars

So I replied by email: “Thanks Emmanuel, I should be able to get to it this week.  Will keep you posted. In addition to the $20, I would not turn down a granola bar, like the one you gave me last time.  (:”

Emmanuel sealed the deal:

Hey, your participation is very much appreciated. And if I am around the next time you are in the clinic, feel free to stop by for a snack, haha.

Best,

Emmanuel Chan
Research Assistant
Department of Otolaryngology
Sunnybrook Health Sciences Centre

Emmanuel provided links to the online questionnaires and speech test.

I sat down with my laptop to tackle the first two questionnaires. One focused on elements of sound such as speech, environmental sounds, and qualities of hearing. The second looked at the quality of life for a person who has a cochlear implant and/or hearing aid.

I was providing answers using a sliding scale, or multiple choice, that would hopefully help the research group identify trends and issues around cochlear implant rehab. At the same time, a few of the questions got me thinking. So I decided to answer them in my own words:

You are in a group of five people, sitting around a table in a quiet place. You can see everyone. Can you follow the conversation?

This question took me back to the feeling of dread that would creep up as I walked into our small team meeting at the office a few years ago. Over time, as my hearing worsened, I began to “lose” certain colleagues who spoke softly or quickly.  When my hearing was at its worst, it took all of my energy just to focus on our director. I would sit across the table from her to ensure I got the key messages, and any take-aways. My manager was aware of the problem and would often sit next to me to help out if I missed something. The workarounds helped, but I was no longer fully part of the give-and-take discussion of the team. It felt more like survival.

Today, with new hearing technology including my cochlear device, I have more confidence in a small group. Besides just functioning, I can enjoy the people, personalities, humour, banter. Hopefully, I can engage and contribute. It’s not perfect. My hearing sometimes gets overwhelmed by too many voices, and I have to ask somebody to repeat themselves. But that’s a good problem to have compared to survival mode.

Can you tell how far away a bus or truck is, from the sound?

I’m doing better. When I walk down a country road, I can hear the vehicles approaching behind and in front of me. On a busy city street, I feel more tuned in to the sounds.

The Medel cochlear implant in my right ear is sensitive and can pick up a distant sound. The Bernafon hearing aid in my left ear has been tuned up and improves my directional hearing. My meniere’s disease — which causes inner ear fluid, balance and hearing to go haywire — has given me a break for the past year, so while the hearing in my left ear is poor, it is stable.

My directional hearing improved but sometimes plays tricks on me, so if I am walking with Nadine, she still shouts “Car!!!!” when a vehicle approaches.

I feel more confident these days that I will not accidentally throw myself under the bus, so to speak.

Can you distinguish voices on the radio? Are you able to enjoy music?

For several years, I had turned off the radio and CD player in our car.  I might try listening to the news at the top of the hour, or a song, but I would often shut off the player in frustration. The sound felt chaotic to listen to. Singer Huey Lewis, who also has meniere’s, has described how he had to stop performing after he could not reliably hear the pitch of the music.

This past summer, I realized I could listen to CBC radio for longer stretches — let’s say the news plus a current affairs show. And “get” about 75% of what I heard.  More than enough to enjoy radio again. With my new hearing technology, I sometimes even find myself feeling happy listening to the radio. With a little concentration, I could once again lock onto a familiar song.

Do you feel anxious talking to strangers?

During the covid era, masks have complicated things for people with hearing impairment. I have had some whacky situations recently in which I could not understand a word that a stranger said. But overall, my hearing tech puts me in a much better spot than a few years ago.  I don’t feel that creeping dread — or avoid discussions with strangers like I used to do. In simple one-on-one situations, like a person asking directions, or going into a bank to speak to a teller, I feel more relaxed and confident.

A friend and fellow cochlear implant recipient has been taking more assertive action during the lockdown — advocating for masks that allow us to see the person’s lips.

Read my lips — with the covid virus not going away anytime soon, it is important to look at mask options that will allow us to see your lips.

When communication is difficult, let’s be patient and kind to each other!

ian and stone

“Can you see my hearing technology?”

************************************

And thanks Emmanuel to you and your colleagues — I hope your research goes well. The questions you are asking have made me think about the hearing journey in a new light. I will get you those completed questionnaires back this week.

I am good with my gig as a hearing-research guinea pig.

 

 

 

 

Bilateral meniere’s and my cochlear implant — two years on

In fall 2017, the team at Toronto’s Sunnybrook Hospital gave me a new sound system, replacing the impaired natural hearing in my right ear with a cochlear implant.

After hearing some mysterious beeps when the device was first activated at the clinic, I could suddenly sense my spouse, Nadine, speaking next to me on my right side, without swivelling around to look. “You’re hearing me better already,” she told me.

A couple of nights later, I went out with some friends to have a beer and shoot pool. The conversation felt easier. I could sit back and understand perhaps 75 per cent of a free-flowing conversation. Before the surgery, I would have been straining to catch even 40 per cent, using a combination of bad hearing in my left ear, some lip reading, guess work, and bluffing.

I now had a clunky sound processor perched on my right ear, delivering sound to my inner ear via cables, magnets and electrodes. But vanity be damned. Any sheepishness I felt about the apparatus was eclipsed by a sense of ease and wonder at the new sounds — even simple environmental sounds, like drips from the coffee maker.

Ian processor

Later that week I went into the bank and chatted with the teller — something that would have been intimidating before the implant.

The new sound was different — people’s voices sounded distorted, sometimes Darth Vader-ish. Certain musical sounds, especially percussion, sounded crisp and pure; however I was having trouble absorbing the full mix of most music. Meanwhile, I retained some limited and slightly distorted hearing in my left ear, using a conventional hearing aid. My brain was slowly adapting to this strange fusion.

Two years on, life with the cochlear implant has become the new normal. And sometimes we take good things for granted. So it’s important for me to look at the big picture of my journey — including some wins and continuing challenges. Here are a few:

One-on-one conversations

This had been my biggest challenge in the year or two before the implant. At work, my managers and colleagues helped with some workarounds. For example, my colleague Mike volunteered to join me to interview a patient with schizophrenia who was about to make the big leap to community care.  Mike’s notes from that meeting filled in huge gaps related to my hearing trouble, and allowed me to tell the story. Still, each day I had less confidence speaking one-on-one. I approached some conversations with dread, wondering if I could function.

Following the implant, that simple act became easier, starting with the first time I could hear Nadine in my right ear. Or skyping with our daughters Ali and Colleen.  Life’s simple pleasures were sometimes simpler again.

“Deaf mode”

When I had the implant surgery in 2017, it took away almost all of the natural hearing remaining in my right ear.  The good news: when my new cochlear processor was operating, things were much better. But in situations where my processor was turned off — bedtime, sports or swimming, for example — I had to get used to an almost full-deaf mode.

I am still not used to it. I wake up in the morning in a fog of deafness. I start to feel better once my hearing devices are turned on. The coffee helps too.

At my weekly hockey game, I remove both devices — my implant processor, and the Bernafon hearing aid in my left ear — so they don’t get wet when I play. As a result, I am not much of a conversationalist on the bench. Most of the players know, and it’s okay. But I still miss the ease and fun of chatting during a game.

I could learn from a friend of mine who also has a cochlear implant — he takes out his hearing devices and meditates, fully accepting his deaf self.

New learning

After retiring early from my communications career from stress related to my hearing dysfunction, I am trying to restructure my life and purpose. Learning is lifelong and I am taking new directions in learning and teaching. Lectures in subjects ranging from architecture to politics, offered by University of Toronto’s Continuing Education, made me put on my thinking cap. Using stone-craft techniques learned at Haliburton’s School of the Arts, I built a series of dry-stone terraces at our cottage.

I took tentative steps towards teaching.  The best result has been a new tutor role at East York Learning Experience. My student — who is just a year or two younger than me — is learning computer basics such as email and web navigation, and also brushing up on his reading and writing. We learn together. He reads slowly but understands deeply; we have some amazing discussions about books he is reading. The other week I had a big smile on my face when I received my student’s first email to me.

In another small foray into teaching, I was able to share some of my corporate communications experience with professional-writing students at York University.

Meniere’s disease

Meniere’s involves a fluid build-up that causes periods of vertigo, hearing distortion, hearing variability, and a steady overall hearing loss. I have this condition in both ears. Meniere’s is said to take its own course, and treatment is focused mostly on relieving symptoms such as nausea from the vertigo. Meniere’s took away my hearing to the point where conventional hearing aid technology was not cutting it, and I qualified for a cochlear implant.

Since the implant two years ago, I’ve had several bouts of Meniere’s-related vertigo in my left ear, but have had little or no symptoms in my right ear — the one with the cochlear implant.  So that’s been a blessing, and it implies that if I ever have cochlear implant surgery in my left ear, it should reduce Meniere’s symptoms there too.

Music

Playing and listening to music were a big part of my life. When my hearing became distorted and muted before the implant, I gave up both. Some favourite songs sounded like garbage — it was too painful to try to listen.

I’ve taken some tentative steps to play and listen again.  I’m giving myself a homework assignment this winter to get back into it with more vigour.  When it comes to familiar music, I have a magic triad going for me — the three-way links between my brain’s memory, my new cochlear sound system, and my remaining distorted natural hearing. That combination means I can at least make progress on music that is familiar.

The biggest challenge with unfamiliar music is locking on to the musical key, and interpreting the musical mix. I’ll give you an example: I went to see a saxophone quartet recently at an event hosted by the Don Mills Public Library, back in my old suburban stomping grounds. The quartet — Sidecar 78 — channels a range of classical, pop, jazz and seasonal music in a tight style. At this concert, I found that when I knew the tune and could lock on to the melody, the complete musical picture came into focus — like a big inky blob on a Rorschach test suddenly revealing a familiar face.

Favourite songs like Stevie Wonder’s Sir Duke — a tribute to Duke Ellington — and Henry Mancini’s theme to the Pink Panther — came into sharp focus for me. At the same time, I struggled to find the key signature and melody in songs I did not know.

At Sunnybrook Hospital, researchers are studying the ability of cochlear implant recipients to listen to music.  Next week, I will have 50 electrodes attached to my head while I listen to classical music duets, and focus on just one instrument. I hope that research like this will continue to improve the precision and effectiveness of hearing devices such as cochlear implants and hearing aids.

The final part of my musical homework this winter will be learning some classic snare drum solos. Wish me luck.

Ian1

 

 

 

 

 

 

 

 

 

Cochlear implant is a new dawn for a person with bilateral Meniere’s disease

Sunnybrook Hospital in Toronto has completed almost 2,000 cochlear implants to restore hearing in adults affected by severe or profound hearing loss — people like me. Of those, about 50 share my condition of bilateral Meniere’s Disease. It’s a condition that puts the inner ear through repeated wash cycles, triggering vertigo and progressive hearing distortion and loss. In some people, like me, both ears are affected.

Gael Kennedy Hannan asked me to write about my experience with Meniere’s and my cochlear implant for her blog: Hearing Health Matters. Gael is also author of The Way I Hear It: A Life with Hearing Loss. After having my cochlear implant surgery at Sunnybrook in fall 2017, it’s a new chapter for me as I get used to a brand new sound pattern in  my right ear and the possibilities of better hearing, better engagement – and even the sound of music.

I was on a deadline for a news story for the Addiction Research Foundation, when the words started falling off the screen of my little Macintosh computer. I was hustling to put the story together, but the words appeared to be jumping off the page like ducks to water. My eyes jerked back and forth but could not catch them.

Pretty soon I was in the hard spin of vertigo – the world whirling around me. My eyes could not control the messages my inner ears were sending to my brain. Hanging on to the wall, I stumbled out of the office, lurched along the sidewalk and caught the bus and subway home.

I was young and strong and could tough it out – the hours of spinning, nausea, vomiting, and finally, a peaceful sleep.

I was back at the office the next day and wrapped up the story. After my morning coffee, life was good. I was working with a great team. Together, we were telling the story of an organization committed to helping people — through addiction treatment and research. (ARF is now part of CAMH, the Toronto-based Centre for Addiction and Mental Health).

At home, in the early 1990s, my wife Nadine and I were raising two beautiful daughters, Alison and Colleen. We tried to appreciate all of the magical moments, the sights and sounds of family life, along with our busy careers.

Changing sound patterns

After the vertigo attacks, I did notice that the hearing in my right ear was becoming distorted. In fact, the sound pattern was changing day to day – from a normal but tinny sound, to a garbled effect, like the sound from a stereo speaker that had a big rip in its woofer.

As the episodes recurred, I sought help from my family doctor, who referred me to the ENT team at Mount Sinai Hospital in Toronto. I was diagnosed with Meniere’s Disease, a condition affecting my right inner ear and consequently my balance and hearing. I was told Meniere’s “took its own course.” There was no cure, but symptoms like nausea could be treated with medication. Vertigo episodes in some cases could be prevented or mediated by a diuretic and other medications.  The condition certainly was not life-threatening and I had otherwise good health to be thankful for. “You are a young man with bad hearing,” the ENT doc told me. I was given a diuretic to take during vertigo episodes and encouraged to consider a hearing aid for my right ear.

Fast forward to 2012. I had taken on an exciting career challenge at the Royal Bank of Canada (RBC) as senior communicator on the bank’s largest enterprise project – tackling an emerging global tax law that targeted tax havens.

One Sunday morning, I woke up practically deaf in my “good ear” – the left ear I had relied on for functional hearing for most of my career. We had a family event that day and I faked my way through it, at the same time worrying about how to face work the next day. As is the case with Meniere’s, some hearing returned the next day. It was distorted, but I got by. After seeing my audiologist, I started wearing two hearing aids as the Meniere’s was now bilateral — affecting both ears.

I was no longer young, but I was still strong and could tough it out. RBC became a leader in engaging the new global regulations, and I was proud to be a big part of the team that made it happen.

Finding allies

I found an ally in an unexpected place. Tech guru Guy Kawasaki was speaking at a communications conference I attended. He told the keynote audience that he was using a cane that day and wearing a large hearing aid to deal with his Meniere’s disease.  It was the first time I had heard someone mention “my” condition in public.  Guy took a refreshing approach to his health challenge.  He used humor to create awareness about Meniere’s – for example, claiming that he was getting deaf and dizzy from listening to too many bad pitches for new high-tech businesses.

I reached out to Guy by email and we had a great virtual conversation. I discovered he was a hockey player, like me, who noticed that the body mechanics of ice skating – its different ballet of angles and gravity – were positive for people like us who had balance problems.

Another ally was Don Lynch, a retired high school teacher who started a support group for Meniere’s patients in Toronto. The words from Don that stuck with me are about making the choice to “stand up” to face the challenge of Meniere’s – or any life challenge for that matter. Don also created a forum for people to share their experiences, fears and hopes.

A moving target

As my audiologist – now at St. Michael’s Hospital – told me, my hearing was a moving target. It could be tested conventionally, but the sound pattern changed daily in both ears. On paper, based on conventional testing at different sound tones, I was a good candidate for hearing aids. And they had helped me. But each day, I was finding it harder and harder to function at work with tasks we all take for granted – speaking on the phone, participating in a small meeting, or having coffee conversation with colleagues.

My hearing loss was in the 60-70 decibel range in each ear, (human speech is about 50 DB). To complicate matters, my hearing aids were amplifying sounds distorted by Meniere’s disease in my inner ear.

With family and friends, I was beginning to withdraw from events and avoid conversations. I was missing the intimacy and humor of being with the people I loved.

In 2015, I returned to CAMH to take on some communications projects in the hospital’s Public Affairs group. I think I did some of the best work of my career in a 2 ½ year stint with CAMH, a world-class hospital integrating mental health care and research.

As my Meniere’s progressed, I became more assertive to disclose my condition to my team and colleagues. I also found some workarounds to be able to continue to function as a hospital reporter and photographer, telling the CAMH story. The organization and my colleagues stepped up to help. In a couple of cases, for example, colleagues joined me at important interviews with patients, to ensure that, as a team, we got the story right. In other cases, I took care of photography first and filled in the gaps on a story with follow-up interviews by email. Especially for a hearing impaired person, it’s hard to imagine a world without the ease of text messaging, bbm, email and social media.

From surviving to thriving

Still, my hearing function – and some recurring vertigo episodes – were making it harder to get the job done. I often felt was surviving when I should have been thriving at work. I had been referred by St. Mike’s to Sunnybrook’s Cochlear Implant program. After extensive testing of my hearing with and without aids by Audiologist and Program Coordinator David Shipp, I qualified and was put on a 12-18 month wait list for the surgery.

I was strong, but not willing to tough it out this time. I needed a change. I took a personal sabbatical from working life to focus on some new challenges and adventures, like home improvements, and learning the ancient craft of dry stone wall building.

At home, my wife, daughters, family and friends were incredibly supportive. I recognized the impact of my condition – and my response to it – had on them. At home the four of us always made a point of eating dinner together and sharing the day. When the kids were in their teens, I was often “out of it” at dinner conversations due to the hearing problem, and to my own lack of focus. I would sometimes retreat into my own zone and miss the buzz and beauty of family life. My mood was affected and I know I was sometimes miserable to my family and others.

Through ups and downs my wife and kids were there for me. I’ve had to lean on them, and I want them to be able to lean on me going forward.

A new hearing system

In October, 2017, Sunnybrook’s Dr. Vincent Lin successfully completed my 90-minute surgery to implant the device. In November, Audiologist Anna Leung activated it for the first time, and started the process to fine-tune it at different tone levels. I had a new hearing system in my right ear, and continued to wear the conventional aid in my left ear.

Sunnybrook Hospital has completed close to 2,000 cochlear implants in adults. About 50 of those patients have my condition: bilateral Meniere’s. I’ve met several of them, either in person or virtually. What I’ve heard anecdotally matches my own experience to date with the cochlear implant:

  • There is likely to be a good result early on following surgery – this may be because people with Meniere’s have already coped with variable hearing patterns. Perhaps our brains can pick up the new pattern quicker. I noticed right away how the implant was filling in high-pitched components of speech, like the letter “S”, and this made conversation easier.
  • The ability to hear in noise may be improved. One of my fellow Meniere’s patients said this was the top benefit from his implant. I’ve personally noticed better discrimination of voices in a noisy environment – specifically the pool hall where I meet some neighborhood friends to have a pint and shoot pool. With my cochlear implant, conversation seems easier and more spontaneous. At the same time, certain environments are challenging and I am starting to experiment with a directional option for noise control on my implant processor.
  • There may be a reduction in symptoms of vertigo. In the first six weeks following my surgery, I thankfully have not experienced vertigo symptoms, apart from surgery-related dizziness that went away quickly. I will continue to track this. A Meniere’s patient I spoke to reported a reduction in the problems he had with balance and vertigo.

These potential benefits deserve further research as cochlear implant programs grow and continue to assist more patients like me who have Meniere’s Disease.

These days, I complete daily homework to improve my new hearing system and my brain’s ability to adapt to it. I’m told this will take some time. My homework includes word recognition exercises, audiobooks, and coffee chats with friends. The chats help me get used to different voice patterns, and to reconnect. To keep things fun, I sometimes stream monologues from Jimmy Kimmel, Jimmy Fallon, Seth Mayers and others directly into my new right-ear hearing system.

Nadine has attended audiologist appointments with me and jumped into the tech side of my new tools – helping set up my new remote microphone pen, and sorting through the pieces of the puzzle of my cochlear implant processor.

Personal allies keep popping out of the woodwork, including cochlear implant patients and friends who have offered support. In turn, I can also help others who are now on the wait list, or who want to share their experience with hearing loss or Meniere’s. I also have learned more about a thriving deaf culture, and the challenges deaf people face in a hearing world. I took my hearing for granted when it was normal, and am still catching up on some of the current issues of advocacy and human rights.

After giving up music a few years ago due to hearing distortion, I am slowly rediscovering it again. I’ve been playing some Elton John songs on our 1920 Heintzman. I am a hacker on the piano – my background is percussion – but I’m appreciating the chords and notes that I am hearing again. I find it a bit easier to hear and “get” music on the radio too.

It’s early days for me as I adjust to the new hearing system. There are steps forward and back. But as the song goes: “It’s a new dawn, it’s a new day, it’s a new life….”

And I’m starting to feel good.