man feeling hopeful during cochlear implant adjustment period

No Sugarcoating it — Adjusting Is Hard

After reading my previous chapter, you might wonder if I ever started to hear speech or anything other than buzzy weird sounds. The answer is yes! And quickly — I’m happy to report that within two weeks of activation I started to recognize big, positive changes in both my hearing and my general demeanor.

The implant mapping has to be adjusted frequently in the beginning since there are changes happening both physiologically and cognitively. The trauma of inserting an electrode into the cochlear causes inflammation and, as that settles down, the implant will adjust and settle into a new home inside my ear. The healing occurring in my cochlea continues for many months. Also, the brain is adjusting and what sounded weird and overwhelming on day one became quiet or even disappeared by day seven. This is due to my brain accepting electrical input as a new form of hearing and “relaxing” if you will. So, by the time I arrived a week later for map No. 2, I was in a much better position to undergo the procedure. I knew what mapping was, that buzzy, weird sounds were “normal” sounds, and I was familiar with how much can change in a matter of days.

Since I wore my implant every day, all day, I had adjusted to the sound so much I was turning the volume all the way up trying to hear more. My audiologist was visibly relieved and stated that this was a good sign and showed that I had accepted electrical input. We went through all the loudness levels again and added some progressive maps (maps I can use if I start maxing out the volume again) and reviewed my progress. We then set up my new right hearing aid and matched it up with my processor. I am what we in the business call bimodal. This means I use an implant on the left and a hearing aid on the right. The new hearing aid was specially made to work with my implant and be its buddy. They are designed to share data and work in tandem to help optimize my hearing. We accomplished so much at this appointment that my audiologist stated that this was more like an “activation” day and she expected things to be much more positive going forward.

After this appointment, I was hearing so much better that I experienced four days of elation. I experienced usable hearing. I was hearing speech! I wasn’t constantly lipreading! I was able to hear in the car as a passenger! I was getting used to the sound quality and I was starting to like it. The endorphins were high. I began to experience renewed hope and I found myself more chatty and ready to take on the world. I was using my implant for long hours, doing auditory exercises an hour or more nightly, and just immersing myself in as much sound as possible.

I blogged in 2018 about renewed hope and how it can change a person and now I am experiencing it. It’s an amazing mindset. I found myself eager to skip ahead and impatient to reach the best outcome.

The excitement was palpable and even my husband could see that I was happier. I don’t think I’ve ever before been so chatty in my life. Sadly, I wore myself out and did not pace myself. I became so tired so quickly I was forced to stop auditory training exercises for several weeks. I focused instead on getting through the workday and resting.

It is difficult to explain why the process is so tiring… you may wonder what I’m doing that is sapping my energy. Here’s my best explanation. When it comes to hearing with electricity, everyday sounds like dogs barking and traffic outside normalize quickly but speech and music do not. The brain is prioritizing sounds and everyday sounds are not “important” and therefore are not highly mapped in the brain, meaning the brain could easily replace those sounds with new sounds. It’s an easy transition for my brain to learn a dog bark or a microwave beep since those sounds were never given much priority in my brain to begin with.

Speech, however, is of the highest importance and possibly the most important sound the brain receives, and it has created a very large network of “maps” for speech. Furthermore, this neural network is intertwined with other parts of my brain giving speech “meaning” — memory and emotion, for example, are pulled into this scheme. Speech and music are much more than mere collections of sounds — they provide sensations of complexity beyond hearing.

I imagine it takes a great deal of energy to do all this neural networking. I am actively forcing my brain to relearn everything about speech and music when I push myself to use the implant for long hours and to listen to my auditory exercises. My brain is working overtime and is not only relearning sound but destroying a lifetime of neural mappings and replacing them with new ones. No wonder I experienced fatigue and no wonder speech is so strange sounding. When I think about how the brain has literally been mapping speech since I was an infant and now I’m tearing that all down, it makes sense to me that it would and should be a long road to rehabilitation.

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