Currently, there are two very important pieces of legislation awaiting approval in the United States Senate:
The Early Hearing Detection and Intervention Act of 2010 (S. 3199) aka “Newborn Hearing Screening” passed in the House of Representatives but also needs to pass in the Senate so that screening and early intervention programs for newborns continue to be funded across the United States
The Hearing Aid Tax Credit Act (S. 1019) proposes that people purchasing hearing aids, regardless of age, receive a $500 tax credit per device every five years
If you believe that these issues are important, MAKE YOUR VOICE HEARD! Share your personal story with your Senators to let them know the real, human impact of this legislation and why it is so crucial that it is passed. Was your child identified with hearing loss as a result of newborn hearing screening, allowing you and your family to make the best possible early intervention choice while your child was still in the critical period for language development? Tell your Senators! Do you struggle to purchase hearing aids that will give you or your child access to sound as well as social, educational, and employment opportunities? Tell your Senators! Are you an advocate for hearing loss and listening and spoken language awareness? Tell your Senators!
Find your Senators’ contact information HERE or, do as I did, and send them a Tweet about it!
What do these three have in common? They’re all times when wearing a hearing device can be difficult, if not impossible and not allowed at all! Though there are some great solutions for “water-proofing” a CI, there are always going to be times when your child is “off the air”. Not surprisingly, because of this temporary gap in hearing, children are sometimes missing the language and vocabulary associated with these everyday experiences.
For example, I once had a four-year-old student, a very, very bright boy. He had profound hearing loss and used cochlear implants bilaterally. His mother did a fantastic job as his first teacher, filling his days with rich language experiences, and he was right on track to enter kindergarten in his local public school with his hearing peers. One day, when I was working with him on a standardized test of vocabulary, he was blowing me out of the water, getting card after card correct… until we got to “toothbrush”. TOOTHBRUSH!?! His mother and I were both in shock. How did he not know this simple word? Well, we brainstormed about it a little, and realized that he always brushed his teeth at night right after getting out of the bathtub… without his cochlear implants on! No wonder he knew great words like cauliflower and cotton — those were words he’d been exposed to during the day, with his “ears” on. But for bath time words, he was at a loss!
This was a huge wake-up call for me. Logically, I had always known that there were some times that wearing a CI would just not be possible (even more so with the older generations of CIs that were in existence years ago), but I had always assumed that children would learn the vocabulary and language associated with those “off air” times incidentally during other “on air” times. I still think this incidental learning occurs and it is vital, but I also think that we, as parents and professionals, need to informally assess children to make sure that this learning really is happening, and to consciously plan some opportunities for feeding it into children while they are in their best hearing condition.
For example, I now buy almost every book I see about bath and bedtime routines and water activities. You can use baby dolls and practice bathing them and putting them to bed. Keep your child’s devices on for as much of the experience as possible, or as much as you feel comfortable (e.g. keep the CIs on while washing the child’s tummy, and take them off for shampooing the hair, keep the HAs on for wading in the water, but not for splashing or swimming time). Teach songs for bedtime and bath time so your child can vocally participate in a familiar routine even if he/she cannot hear you singing, too. Have good bath time toys for creative play — cognitive growth is good, too, even if it is not tied to language every single second. If you’ve got a hearing child handy, give him a bath and think of all the different words and phrases you use — make a list! Does your child with hearing loss know how to use and understand all of those words, too? Parents naturally use a lot of good “parentese” talking during these routine bonding times, and your deaf child deserves this as well, just at a time when he or she can actually hear you!
Being able to use the telephone represents both independence and connection for people with hearing loss. It means being able to make calls for work without assistance, being able to give and receive information, and being able to make emotional connections with friends and family from miles away. Learning, or re-learning, to use the phone with a CI may be difficult, but it is not an impossible task. With practice, many cochlear implant recipients report success in using the telephone. Here are some ways you can, too!
Enlist a patient friend or family member to be your first telephone practice partner. Make multiple calls to this person using the suggestions below until you become more comfortable listening to different or unfamiliar speakers.
Some CI users prefer to start out listening to the telephone on a speakerphone setting with a hearing friend or family member listening in the background to help with any misunderstandings or clarifications as needed.
Experiment with different MAPs, settings (i.e. T-coil), and accessories (direct connect cables, amplified phones, etc.) until you find the best combination for you to listen to the telephone.
Start off conversing in quiet, with a familiar speaker (a voice you already know and understand face-to-face) on a topic that you decide beforehand. Once you know the topic, you can narrow down vocabulary and more easily predict what is said.
Practice your repair and clarification strategies — just asking “What?” is tiresome and unspecific. Try saying things like, “I heard you mention the name of a store, but I didn’t quite get it, could you please say the store name again?” or “Did you say Smith or Schmitt?” Don’t give up and don’t be afraid to admit that you didn’t hear something correctly. No bluffing!
When you’re ready, practice making short calls for information, like calling a movie theatre to check show times, or calling a restaurant to ask about their hours of operation. Yes… I know you can find almost all of this information online without ever picking up a phone, but if you’re focused on telephone practice, you can go out of your way to find little opportunities like this to use the phone every day.
One of the most difficult telephone listening tasks is when the person on the other end of the line spells something, or gives you a string of letters. Don’t be discouraged! Remember that even people with “perfect” hearing ask for clarification in these situations and use aids like “B as in boy” etc.
Telephone with Confidence is a program presented by Cochlear that can be accessed for free by users of all types of CIs (or HAs). The program provides a number that participants can call and each week there are word lists and passages read aloud as a recording. PDF files of the word lists/passages are available on the website, so you can check your comprehension as you listen. Give it a try!
Also see THIS post by Rachel on her and her sister’s experiences using the telephone as bilateral CI users.
Here’s the quick answer: There’s no way to know for sure.
Due to the unique nature of each person with hearing loss, their individual anatomy, their prior auditory experiences and auditory development in their brain, and differences in electrode placement in each particular person’s cochlea (in the case of cochlear implant users), there is no one answer for how hearing loss sounds. It’s like asking someone, “What does red look like to you?” Well… it looks like… red. Understanding others’ perceptions of any sensation (sound, sight, taste, etc.) can be described but never quite pinpointed by an outside observer.
That said, there are some great simulations of what we think a hearing loss and various amplification systems might sound like out there on the Internet.
Hearing loss simulations include the Better Hearing Institute’s variety of sounds with normal, mild, and moderate hearing loss factors and this Hearing Loss Sampler which demonstrates speech in both quiet and noise as well as other phenomena like recruitment.
This site demonstrates how FM Systems help listeners in noisy environments by increasing the signal (important stuff, voices) to noise (background distraction) ratio, especially helpful for listeners with hearing loss (but good for everyone else, too!) (See THIS post for more information on FM and Soundfield Systems)
The closest I'll ever get to inside someone else's brain!
While simulation sites are great and manipulating the parameters provides for some fun (and challenging) listening experiences, I encourage you to take all of this with a grain of salt. Remember that:
We can never really know what things sound like to each individual user.
Saying that this is how music would sound with a “mild” hearing loss is somewhat deceptive because ten different people can have completely different audiograms which all qualify as “mild” hearing loss — things will sound different based on each person’s individual configuration of hearing loss.
What sounds “natural” or “normal” to a person who has lived a lifetime with typical hearing is not “normal” to a person with hearing loss. Our brains mold themselves around the input that they receive. For a CI user, the CI sound is optimum and normal. Their brains learn to take in this input and use it — as is proven when CI/HA/Baha users perform well in auditory only tasks, listen to speech in noise, or differentiated between minimal pairs (words that are similar in all but one sounds, like pan-man, pin-pan, etc.)
Ultimately, the proof is in the output — people speak what they hear, and cochlear implant/hearing aid/Baha users are able to achieve very natural, melodic vocal quality, and even learn to play instruments or sing. Though the voices on the simulations sound robotic, this is not how the voices of CI users sound.
Many CI candidates (or their parents) worry about the ability to enjoy music through their electronic “ears”. Like anything, appreciating music with cochlear implants (or hearing aids) is a process that requires appropriate expectations and lots of practice. Here are some resources to help you optimize your music listening experience with your CIs.
In "Ellie's Ears", Ellie, a cochlear implant user, listens to an MP3 player using a direct connect cable to one of her processors. (Illustration from "Ellie's Ears" by Rachel Chaikof)
How can I use headphones with my CI(s)?
Some CI companies offer “direct connect” cables which plug into your CI processor directly from the sound source (MP3 player, stereo, etc.). Others have earhooks designed for in-the-ear headphone use. All CIs and HAs can be used with over-the-ear headphones placed over the microphone(s). In THIS post, you can see Rachel looping regular iPod earbuds around her processors so that they “hit” her mics to deliver music to her ears. You can also use Music Links to induce the t-coil setting on your CI/HA. These “skeleton” earhooks fit like behind your processor(s) and plug into a music player like regular headphones. They are available in both unilateral and bilateral models.
What are some tips for listening to music with my CI(s)?
In “Music and Implants: Piecing the Puzzle Together”, Dr. Kate Gfeller explains the many factors that can impact each individual CI user’s experience with music (re)habilitation. She suggests optimizing the listening environment (quiet, good headphones or other player-to-CI connection) and choosing simple, familiar music at first and moving up to more complex, challenging pieces. This eLearning Library has many wonderful recorded seminars on the topic of “Bringing Music to Life”. Unfortunately, they do not come with transcripts, but may be helpful for hearing parents of children with CIs or professionals (or advanced CI listeners who are up to the challenge!). This “Turn the Music On” guide shows different accessories that can be used with CI processors for listening to music (see page 2). Talk to your audiologist about specific programming changes s/he can make to optimize your MAP for music listening. Click HERE to access all of the past Cochlear Implant Online posts about music.
Where can I practice listening to music with my CI(s) online?
Try to identify the Instruments of the Orchestra by sound with four answer choices. Then, move on to identifying different instruments without choices, different music styles, and popular tunes in these Music Appreciation Exercises. Download lyrics to songs in your iTunes library and match the words to what you hear using applications like GimmeSomeTune. You can also find many popular music videos with lyrics on YouTube.
I want to start this post by saying that BOTH FM Systems and Soundfield Systems can be excellent options for students with hearing loss. Both devices function to increase the signal-to-noise ratio, making the relevant signal (i.e. the teacher’s voice) louder than the noise and distraction (i.e. other children talking, chairs scraping the floor, etc.). There are differences, however.
FM System with Hearing Aid
An ear-level FM System transmits sound directly from the teacher’s microphone (worn as a headset, lapel, or lavaliere… more on this below) to a “boot” or “shoe” attached to the child’s hearing aid, cochlear implant, or Baha. Other receiver types include a lavaliere-style neckloop or a separate FM earmold system (the former is not so commonly used anymore).
Soundfield System with Portable Speaker
A soundfield system uses the same types of microphones, but transmits instead to speakers placed around the room or a portable speaker (about the size of a brick — but not as heavy!) that can be placed on the child’s desk and travel around the classroom with him.
I have used, and had success with, both types of systems for a variety of students with hearing loss. However, I think one of the greatest issues to consider when deciding between the two systems is, “IS THE CHILD A GOOD REPORTER?” With FM systems that connect to hearing aids, it is possible for adults to listen to the FM+HA signal through the stetheset test headphones. For a CI, however, parents/teachers/therapists are only able to test the microphone quality (and even that’s not what the child actually “hears”), NOT the FM+CI condition. If you are considering an FM system for a child with cochlear implants, especially a very young child or a child who, for multiple disabilities, newness of implant, or any other reason, is not yet a reliable reporter of sound quality, adults must be extra vigilant to note any changes in the child’s hearing. If the FM signal is weak or static-y, a “poor reporter” will not be able to tell you this, which could lead to hours or days of reduced sound input with no one even knowing. Objective measures, such as testing the child’s hearing in noise in a soundbooth in the unaided, CI, and CI+FM conditions, can yield data that indicate whether or not the child is benefitting from the FM system, but on a day-to-day basis, a child who cannot reliably report the sound quality coming through the FM presents an extra challenge for parents and professionals. With a soundfield, the sound from the microphone is broadcast through speakers that anyone so anyone can hear and monitor quality without extra equipment. This might be a better choice for a young/new cochlear implant user who is not yet ready to troubleshoot her own device.
MICROPHONE TYPES
Lapel: the microphone clips to the speaker’s lapel
Lavaliere/Pendant: the microphone is worn like a necklace and hangs from the speaker’s neck
Headset/ Boom (aka “The Madonna” or “The Britney Spears” — a real generation gap test!): the microphone is worn around the head/ears and projects out over the mouth
Pass-Around (aka “The Oprah”): a wireless, typical microphone to be passed around for class discussions, usually used in addition to one of the three microphone types above, for secondary speaker(s)
Lapel Mic
Lavaliere/Pendant Microphone
Headset/Boom Microphone
Pass Around Microphone
Of all of these microphones, the Headset/ Boom Microphone option gets the mic closest to the speaker’s voice. In addition, this type of microphone moves with the speaker’s face, whereas the other microphone types remain in place. When the teacher turns her head, her voice is directed away from the lapel or lavaliere microphone, and the student temporarily loses the signal. By placing the mic right by the teacher’s lips, as in the headset/boom mic option, you ensure constant access to sound. For older children in seminar-style courses or classes with lots of group discussion, adding a pass-around microphone may help a student with hearing loss follow dialogue from multiple speakers as the mic is passed back and forth around the room.
TIPS AND THINGS TO REMEMBER
Make sure the transmitter (worn by the speaker) is on the same channel as the child’s receiver (attached to his device).
Teachers can wear the transmitter in a pocket, attached to a belt loop or waistband, or worn in a special pack — careful not to let it fall to the ground when bending over!
Teachers should be sure to turn off the FM/Soundfield system when leaving the classroom or having private discussions.
Ling checks should be performed with and without the FM systems multiple times EVERY DAY to ensure clarity of signal.
Remember that classroom amplification can benefit ALL children, not just those with severe-profound hearing losses. Other groups shown to benefit from amplification include: children with minimal or unilateral hearing loss, children with transient hearing loss due to ear infections, children with ADD/ADHD, English language learners, and more!
The FM/Soundfield is only useful when it’s being used! Spot-checks in the classroom by the parent, SLP, or TOD can help to “encourage” teacher compliance with assistive technology use and serve as resources for troubleshooting. Remember, if it’s in the IEP, it’s mandated by law that the child’s teacher comply with its use!
A while ago, I posted THIS about decorating hearing devices, and how adding flair to your “ears” can increase acceptance and awareness of hearing loss every day. Well, the world of hearing devices changes quickly, so here are some of the original ideas of that post with even more ideas of how to decorate your hearing devices.
Stickers are available from nearly all HA and CI manufacturers, but you can also buy any regular stickers from a craft store and cut them down to size.
Val at Cochlear Kidshas some great suggestions for adding flowers and other decorative touches to CI coils. See parts ONE, TWO, and THREE!
CICircle parent Eva runs My Magic Fairy, on online boutique that sells cochlea-inspired jewelryas well as many HA/CI accessories, including BTE clips, which connect the CI to a child’s head with a barrette for an extra layer of protection — and style! On her site, you can also see great examples of wrapping the CI cable with embroidery floss and beads.
Tube Ridersare small plastic figurines in a variety of designs that slide onto HA or CI earhooks.
Tube Riders
Ask your audiologist about specialty earmolds — I’ve seen all different colors, swirl, camo, glitter, even glow in the dark!
Ear Gearcovers help to secure HAs/CIs and also add decorative covers to the BTE portion of the device.
OtoClipsattach HAs/CIs to a child’s shirt so they’re not easily lost, even if they fall of small ears! The clips come in a variety of colors and fun animal shapes.
OtoClip "CritterClip"
Nail decals can be rubbed onto the plastic portion of HAs/CIs and are just as easy to scratch off when you’re ready for a new style.
Stick-on rhinestones (like the kind made for decorating cell phones) can add sparkle to your hearing devices!
Super Sealsprotect HAs/CIs from moisture and also come in fun colors. (For a cheaper, but less moisture-reducing option, stretch a balloon over the BTE portion of the HA/CI.)
Advanced Bionics has partnered with Skin-It to make customized covers for their CI processors. Upload your own design and customize your CI.
Med-El has recently come out with even better CI colors. They are currently available only in international markets, but look for these great shades coming to the US soon.
NOTE: It is important to make sure that all decorative touches are “acoustically transparent” — that is, they do not cover up the HA/CI microphone(s) and prevent the device from doing what it’s supposed to do — help you hear! No matter how pretty it looks, it’s got to work as your ears before it serves as a fashion accessory! Also, various HA/CI companies have different regulations as to what modifications you can/cannot make and still keep your device under warranty. So read the small print, and decorate at your own risk!
Cochlear Implant Online and its contributors are not affiliated with any of the products or services mentioned in this post. Mention of a product or service on this website does not constitute an endorsement.
A few months ago, I posted THIS asking for reader opinions and feedback on the subject of children with hearing loss and additional disabilities. This spurred an independent learning project, and I promised to share with you all what I learned. Here is what I found…
STATISTICS: WHO ARE THESE CHILDREN?
Approximately 40% of children with hearing loss have an additional disability
6.3% Attention Deficit Disorder
8.2% Mental Retardation
1.9% Emotional Disturbance
1% Autism
6.9% Other
5.6% Not Reported
2004-2005 Regional and National Summary, Gallaudet Research Institute
PREDICTION: HOW WILL THESE CHILDREN LEARN TO COMMUNICATE?
How do we “predict” which children with hearing loss and additional disabilities will have good listening and spoken language outcomes? COGNITION… however, having good cognitive abilities is a predictor of language and literacy abilities in typically developing children, so perhaps the question we need to ask ourselves is: Are the child’s speech, language, and listening abilities commensurate with their overall cognitive profile? Is the child performing to the best of his or her abilities, regardless of how far from the norm they may be? A child should NOT be counted out of a listening and spoken language approach just because he or she has below-typical cognitive abilities.
INTERVENTION: WHAT TECHNIQUES SHOULD WE USE WITH THESE CHILDREN?
Unfortunately, there is very little about differentiated instruction in listening and spoken language for each additional disability area. Many of these children benefit from the same listening and spoken language techniques we use for children who are “just” deaf, with modifications based on their unique needs. For children with multiple disabilities, Listening and Spoken Language Specialists and other intervention professionals should use teamwork with professionals from other disability fields and professionals development/continuing education to further their knowledge of hearing loss as well as other challenges these children may face. Collaboration is crucial.
For some children with hearing loss and other disabilities, the child’s receptive (output) and expressive (input) modes of communication may be different. A child who does not have the anatomy to produce speech may use an alternative/augmentative communication device to express himself, but may be able to comprehend speech through listening. For some children with limited fine motor movement, especially in the hands, sign language may not be the best choice of expressive communication. Other children/families may use a variety of approaches. THIS post is my report of a presentation from this year’s AG Bell Convention, ”AVT Model for Families Transitioning from Visual Language”, part of which discusses considerations for “Special Needs Signers” (scroll down, it’s the second session in the post).
BENEFITS: WHAT DO WE CONSIDER TO BE “SUCCESS”?
While open-set speech recognition in noise is the “gold standard” for many CI recipients, for severely impaired children, this may not be a realistic goal. Are CIs still beneficial or worthwhile? You’d better believe it. In fact, in a study of severely disabled children who had received cochlear implants, numerous benefits were demonstrated, including, “Moreover, most of the parents, when asked what they would choose if they had to make the decision for a CI for their child again, answered that they would choose a CI again” (Berrettini et al., 2008). This conclusion was supported by the interviews from parents that were reported in one of this year’s AG Bell Convention sessions, “The Auditory-Verbal Lives of Children with Multiple Challenges”, my report on this session can be seen HERE (scroll down, it’s the third session in the post).
THINGS TO CONSIDER
For children who are ventilator-dependent or require other equipment at all times, measuring accurate behavioral hearing thresholds may be complicated by the background noise of their “gear” – use NRT, ABR, OAE? Measure background noise and factor this into presentation level equations?
Progress may be slower due to missed rehabilitation appointments/school days for other medical complications, not necessarily due to innate child factors
Receptive vs. expressive communication modes – can the child hear and understand spoken language, but is physically unable to produce spoken language? AAC? Manual communication?
Is manual communication appropriate for a child with poor gross/fine motor skills? For children with low vision/blindness?
Facial nerve paralysis/stimulation issues during surgery/MAPping of children with abnormal anatomy?
Is the additional disability identified pre-implant (congenital or perinatally acquired) or later (i.e. when the child has difficulty learning to read ? dyslexia)
Who decides what is “benefit”? Who decides who can and cannot receive a cochlear implant? Cost? Who pays?
Are these children included in AO schools? If not, is it because the school truly cannot provide the necessary support services, or because it lowers outcome data?
So, that’s what I found… but it’s just the beginning! As medical technology improves, more and more children are being kept alive with multiple disabilities who may not have lived to make it into our clinics and classrooms decades ago. The population of children with hearing loss and additional disabilities is growing, and I believe that they (and their parents) deserve the same shot at a listening and spoken language outcome as their “vanilla deaf” peers. As professionals, we need to increase our skills and knowledge base to help them achieve this goal.
*On the last post, one reader commented that she did not like the term Deaf+, as people do not use Hearing+ for people with other disabilities. Though I disagree with her evaluation of my use of the term, I’d like to thank her for expressing her concerns respectfully. She certainly led me to think more about terminology and, while I have concluded that Deaf+ works for me and is not intended to be disparaging in any way, I respect peoples’ rights to define themselves however they wish. What do YOU think about the term Deaf+ Kids?
There was recent news on a child’s processor being stolen at a recreation center. This is an ordeal that NO cochlear implant recipients want to live through because it’s tough to live without hearing, and it’s not cheap to replace the processor. There are several ways to secure the processor while we’re on vacation to ensure it is not stolen:
1. Even if the area is deemed safe, it is highly unadvisable to leave the processor in an unlocked locker. Make sure the locker is completely locked. Bring a lock in case if lockers do not provide locks.
2. If you’re at a beach where there is no place to leave your processor in a secured location, you can use AquaPac. When I use AquaPac, I place the processors in the pouch when I have to remove the processors and place AquaPac on my arm. It stays well secured on my arm.
3. If you have a friend or a family member with you and will not be swimming in the water, have one of them hold the processor(s) for you and keep an eye on them.
Continue to enjoy your summer and please keep your processors safe!
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Cochlear Implant Online is not endorsed by nor is it written by anyone affiliated with Cochlear, Med-El, Advanced Bionics, and AGBell. This website was created by Rachel Chaikof, who just happens to be a bilateral cochlear implant user, to create an awareness about cochlear implants and listening and spoken language.
Contact Your Senators!
Securing Your Processor On Vacations
