Envoy Acclaim – 6 Month Program Update

Hi everyone, thought I’d post myEnvoy Acclaim 6 month program update after my 6 month post-activation visit with Dr. Kara at MUSC. The Envoy Director of Audiology was also on hand, Dr. Caroline Arnedt (I think she’s a Dr. but I don’t have her card on hand so not 100% sure).

I always enjoy my visits with Dr. Kara and whomever else happens to be part of the meeting. Everyone is so nice and very attentive.

We started with the usual 3 “cochlear implant quality of life” surveys. Some of the answers provided as options are a little too general as far as I am concerned. I can’t think of one right now, maybe next time I’ll take some pics with my cell phone (maybe that isn’t allowed).

After that I gave an update on what I had been experiencing / finding with my implant and hearing more generally. From what I am hearing, my experience is not atypical. For example, for the past month the tone of what I am hearing seems to be more toward the implant. I do keep my implant cranked up to just below causing physical sensations / discomfort, so one would expect it to overpower my left ear and hearing aid. That has not been the case but over the past four weeks the tone, as I said, appears to have become “brighter”, or that the implant is now overpowering my left ear hearing. I explained to Dr. Kara that I wasn’t sure if the hearing in my left ear had deteriorated, or if my hearing aid was faulty if it is just my brain adjusting and relying more on the implant in my right ear now.

As I was explaining to Dr. Kara she said this is quite normal and it’s usually a sign that my brain is drawing more information from the implant although it could also be coupled with a deterioration of my left ear hearing and I should probably go to my local audiologist and get that checked.

So we did the tympanometry (pressure) test, which took a while because initially it looked like I had a problem in my right ear. That got straightened out with cleaning the tympanometer. I’ve seen the graphs and the right graph does not look like the left, but it’s close. I guess it’s OK, as they say so.

After that we did the tone test to make sure the frequencies were as balanced as they could be for my hearing. Some of my electrodes are turned off. The Envoy Acclaim has 19 electrodes, I presume these are what Advanced Bionics refers to as probes. My understanding is that the AB device has 32 but it seems not to matter much as I am told that even with the more traditional implants that electrodes are often turned off because the patient’s brain does not “hear” them. The frequencies that would normally be carried by those electrodes are spread over the remaining electrodes that are being recognized by the brain, so you’re not losing anything in reality.

One of the things I discovered last Sunday was that my implant ear doesn’t hear the notes on a bass guitar at all. I play bass in a worship team and had accidentally not charged my hearing aid the night before. I did manage to get it partially charged before sound check but I thought I may as well take the opportunity to see if I can hear the bass without my left ear and the answer is a very definite no. Dr. Kara tells me that’s to be expected as the implants cutoff is around 200Hz while the bass guitar is tuned well below that with the bottom E at 40.xHz and I play a 5 string which low B is about half that. This revelation made me go home and test a range of frequencies with my left ear plugged. I just made a quick scan and I found I can actually hear some tone around 17.5Khz and 18.x Khz. I am going to spend a little more time on making a hearing map but not too much as it won’t really make any difference to daily life.

Well, after the tweaking Dr. Kara did we headed over to the sound booth to do the word recognition tests. I was very pleased with my improvement in speech comprehension. I don’t think I’m outstanding in improvement, my understanding is I’m somewhere around “average” but average or not, I am very pleased with the results.

First we did just the word recognition, then the sentence comprehension followed by the sentence with background noise. These were all done with my left ear hearing aid removed and my left ear plugged.

My last appointment and programming was in the middle of April, so this is 2 months later. Here is a table that compares the results. Bear in mind these are with my left hearing aid removed and my left ear plugged, so this is comprehension of the implant only.

TEST	APRIL	JUNE
WORDS	20%	52%
SENTENCES	28%	67%
WITH NOISE	5%	38%

I am actually not 100% sure if the April 28% measure was for words or sentences but the “with noise” is definitely correct.

As you can see, it’s a tremendous improvement…and perhaps more importantly my wife thinks I can hear better.

When we reprogrammed the implant back in April we also did an audiometric sound field comprehension test of my hearing with both ears with my left hearing aid on. My comprehension at that time was 80%) up from 62% when I was evaluated for the implant study.

Clearly, with the test scores improvement this week, my overall comprehension must now be well into the 80% or low 90% range, although we did not test that again.

We also then tested what Dr. Kara refered to as Acclaim Plus, which is really just the implant plus a hearing aid in the implanted ear with a specific filtering programming for the hearing aid. As I do not have any natural hearing in my right ear now I did not expect the hearing aid to help, but I figured may as well test.

To Kara’s surprise, my comprehension dropped to 45% (from 52% as it was a no-noise test).

I’m fine with that result. The whole point of having a totally embedded implant is the convenience of not having to attach and detach a hearing aid.

Summary

If you don’t know yet, I am ecstatic about my Envoy Acclaim implant. One of the new benefits I have gained from having the implant is that I have now regained the confidence / ability to tune my guitar with my ear and not having to rely on a digital tuner. That’s a real confidence booster for me.

I’m not naive enough to believe that my hearing will ever be “natural”, not in this life, but it is sooo much better than it has been for years. I can hear sounds and instruments that I simply had lost completely. It’s weird sometimes thinking “I don’t remember hearing that”, particularly on a track from an old album.

There are some conveniences and improvements that I understand Envoy is working on but, as I have said, I am ecstatic about the improvement I have experienced so far. One of the things I wanted to confirm with Envoy was that I can’t destroy the sensor / mic with loud noises, like destroying my hearing with loud noises, and I am pleased that I don’t need to be concerned about that.

That’s my update for now. No doubt there will be more to come. My next appointment will be at the 12 month mark unless I decide I’d like one at 9 months. Right now I just want my brain to work with what I have and try to see where that takes me.

I hope this is helpful for you.

God bless.