Listen Up

The essentials: glasses, iPhone, CIs.

I said before that I have been impressed with the way Laynie has used her CIs all day everyday since getting them (February and August). It's especially impressive considering that she hasn't really benefitted from them since June.

In May, Laynie began having problems with her first CI, the one on the left side. She had pain during a mapping, and it caused problems after that with tingling, discomfort, and sometimes jabs of pain. Not really knowing what the problem was but assuming it was related to the amount of stimulation, her audiologist turned her down. When I say "stimulation" and "turned her down," I'm talking about electricity running through her cochlea, in close proximity to sensitive nerve endings. People are bound to run into problems with this sometimes.

The audiologist kept turning her down more and more, hoping that would solve the problem. It didn't. But things got quieter and quieter for Laynie. She was missing many speech and environmental sounds. She could no longer hear birds or bugs. She lost S, F, TH, and more. We stopped doing therapy in August, because it was just an exercise in frustration. And then, about two weeks ago, the tingling and discomfort stopped, pretty much overnight. A day or two after that, Laynie had a mapping session, her one-month mapping for her new CI. Her new CI was also quiet, because the audiologist wanted to keep them equal. It turned out that she had been hearing at about 60-65 dB. No wonder she was missing so many sounds!

At that mapping (about two weeks ago), she asked for more sound. She missed all the things she was able to hear a few months ago but had not heard all summer. She got her wish, with hearing levels at about 30 dB. But she feels like she started hearing even better a few days ago (funny that things will change a week or so after mapping). She still wants to hear MORE, especially on the right side. Her next mapping will be the first week in December.

See? Better.

Just for kicks, this is what fun, colored coils look like. I love that she chose blue for the left and red for the right. An audiologist's dream come true.

Now you see them...

Now you don't!

She definitely is hearing better since this past mapping. I can use a normal voice and she turns to me. And she hates my cough again, ha. Yesterday, she was asking why I-695 is so much quieter than I-795. I had honestly never even noticed. As we drove to Target this morning, I realized that she is absolutely right. The only thing I could think of was that it might be because I-795 is made of concrete, while I-695 is paved with asphalt. Her speech is improving again, as well. She's using more final consonants, making nicer vowels, and her /s/ blends are sounding quite good. She told me to STop today, which was dah or dop preimplant. It's so nice to see her making progress and hearing new things again, after her four-month plateau. I guess it's time to get back on the horse with listening therapy.

Yesterday, I saw Laynie checking out the Phonak website, comparing the different FM transmitters. She liked the ZoomLink:

Of course, she wouldn't wear that, so I don't know why she cares about the transmitter. That's for the person speaking to her. She would use the little plug in MicroMLxS or MLxi or whatever. I've been thinking about FM systems since playing around with one with Laynie a few days ago. It seems like it would be perfect for her, because she doesn't need to hear a lot of people at home, just me. It would be nice to have one while out, so that she would be able to hear despite wind, crowds of people, noisy traffic, etc. The world is just full of challenging listening environments.

Too bad those things are so stinking expensive!

Thoughts on FM Systems

Many deaf students use FM systems, and many parents and professionals take it as a given that FM systems are always a good thing. I don't know. First, for the uninitiated, this is how it works:

A receiver like this one is plugged into the hearing aid or cochlear implant.

This is the transmitter. You wear it clipped to your belt or in a pouch worn with a sash, pageant-style. PE teachers often are not too into that look. Anyway, the microphone clips to the sash or to your shirt. The transmitter sends your voice directly to the implant (or hearing aid) via radio waves. You can set the receiver so that it only receives info from the FM transmitter (FM-only), which greatly reduces background noise and helps the child hear you better. You can also set the receiver so that it receives info half from the FM transmitter and half from the microphone on the implant (FM+mic), so that the child can hear others in the classroom, such as peers and paraeducators. The transmitters I use at work can work together, so that the child can hear two people teaching in the same room.

The benefits are obvious. Noise levels in classrooms can be excessive for hearing children, and it's even more difficult for deaf children to hear (that seems like an oxymoron anyway). Anything that helps the child hear better has to be good. But here are some potential pitfalls with FM systems:

- The whole "hearing two people teaching in the same room" thing is great... when they are both teaching the deaf child or children (by the way, I'm using deaf to mean deaf or hard of hearing here). If the class splits into groups and one teacher is with the deaf child and the other is with another group, the other teacher has to be conscious of her FM transmitter and switch it off. If you have more than one deaf child in the classroom and they are in different groups, the teachers would need to remember to change channels (each transmitter has several channels available) and resync. And if you have literacy or math centers with no adult facilitating, you would also want to turn off the FM. Teachers constantly have to be monitoring what the child might be hearing and whether the FM should be used during various times of the day. Keep in mind that teachers often have 15-25 children in a class, all of whom have needs.

- The child often needs to be on the FM-only setting to benefit from it, but that blocks out the other children's questions and comments. Teachers would need to repeat what the other children say.

- If the FM is not working properly or getting interference, the child might not tell you. My students certainly don't. They could be wasting instructional time.

- Teachers have to wear the device properly. This seems like a no brainer, but some people might put the sash/pouch on backwards, with the microphone on their back. Not kidding. Or wear it for an hour before realizing that it was never turned on. I'm not even talking about incompetent people (um, except maybe the microphone on the back), but people who are human and busy and overlook things.

- FM systems cannot help little kids during lunch, recess, and "centers" (free time)--the social times of the day. And trust me, the deaf child will not be able to hear during lunch or centers. Or indoor recess, which is often insanity. And even if an FM system could be used by many talkers at once and might be considered in a lunch or play situation, there's no way I would trust a 6-year-old with a $1000 device (yes, that is how much the transmitters cost). Especially not with food in the vicinity.

I do think that FM systems are good and often helpful, but they do not provide deaf children with the kind of access that many people think they do.

I had an opportunity to play around with an FM system with Laynie, which was fun. And informative. For example, she told me that when the microphone was in the middle of the chest (where people often wear it), she heard much less than when it was up near the collarbone. Laynie heard my voice quality, which was tending to go into fry, especially at the ends of my sentences. It was also scratchy, which I hope is just a regular sore throat and not from aspirating refluxate.. sigh. Anyway, that was interesting, because she could not hear that with her implants only.

When we did the Ling sounds, she said that /s/ was a little different, but "sh" was VERY different. The vowels and /m/ were the same.

Laynie thought that the sound through the FM was choppy, not smooth. As she used it more, she realized that she was hearing the stop-and-release-air sounds more (p, t, k, etc.). She also heard the high fricative sounds better (s, f, th). She especially noticed /s/. Probably because we say /s/ so often in English. ;) When I said "goals," while signing, she said, "You said goals, not goal!" This happened a few times with plural nouns. That was interesting and made me want to have an FM at home for her. I want her to have as perfect an auditory representation of English as possible.

Laynie said that having both implants on FM-only was much louder (better) than one on FM-only and the other on mic or FM+mic. FM-only on both implants was much louder than FM+mic on both implants, as well. When she was on FM-only and I put the transmitter several feet away and came up and spoke loudly near her implants, she could barely hear me.

We played Go Fish with animal cards, which we often do, and her pattern perception was better than normal. She was guessing words with the correct number of syllables and the correct kinds of sounds.

We read books and she did much worse with speech tracking than normal. She was hearing more syllables than she usually does, I think. It was messing her up.

FM systems are pretty cool technology. I wish they weren't so expensive, though. Receivers and transmitters are each around $1000, so a bilateral set-up with a single transmitter would run about $3000. Ouch. I do wish Laynie could afford it, though, because it would probably help her learn spoken English.