Electroded Droid Ear

After anxiously waiting all day April 9, 2009, at 12:45PM, I was wheeled into the operating room. The anesthesiologist showed me the vials of the medication and gave me a thumbs up. I returned a thumbs up. Getting comfortable, I stared up at the ceiling. It started to dance a bit as I started to feel tingly. That is the last moment I remember. In the next hour, the surgeon created an incision behind my ear, milled out a pocket in my skull for placing the magnet, antenna, and computer chip, and threaded the electrode array delicately into my pea-sized cochlea, an inch and a half into my skull, deftly maneuvering between several critical nerves and blood vessels.

My first memory afterwards is of the nurse gently shaking me awake. My mouth felt horribly dry and she brought me a Sprite. I kept forgetting that the surgery was over in the first hazy half hour after coming to. I kept discovering Brian by my side. I greeted him several times before finally getting deja vu. I recall shared tears of joy that it was over, that my face was not paralyzed, and that I could taste the sweetness of the Sprite on both sides of my tongue just fine. The biggest aftereffect by far was the nausea and dizziness. I could not move very quickly without my head spinning in a swirl of eddies.

The nurse asked me how my ear felt. It felt fine... no real pain at all. That meant that I needed no further painkiller injections, and no further hospital care. I could go. Very slowly and carefully, I got dressed, and left the hospital via wheelchair. The two hour ride home to Tucson loomed as an impossibly long trek, but thankfully it went quickly. Residual effects of the anesthesia left me loopy enough to just ride it out with my eyes shut, nibbling on a sandwich Brian picked up at Paradise Cafe. At home, I got far too enthusiastic about moving around and promptly hurled everything I had eaten. I decided to play it safe then and reclined for the rest of the night, nibbling very slowly on dry, flavorless crackers, and sleeping with my head upright. For the next couple of days, the dizziness and nausea stayed at bay as long as I didn't move around too much. By the time Easter rolled around, 3 days after the surgery, dizziness was no longer a problem.

I woke the first morning after the surgery feeling a tender spot, high on the side of my head. Could that be where the magnet goes? It seemed really high. At the pre-op a couple of weeks prior, I brought my bike helmet to see how it would affect the magnet location. In order to completely fit within the helmet area, the doctor said the magnet placement would be a little higher on the head than usual. I wanted to minimize this effect, so I bought a new helmet with lower straps and better head coverage. The doctor said it did allow for a lower position. Feeling the tender spot, and comparing the bumps to the smoothness of the other side of my head, I guessed that was where the magnet was. It didn't seem like getting a new helmet mattered, the magnet was so high on my head. I have to be glad for the custom installation, though, because otherwise the implant would have been under a bike helmet strap and possibly had issues. As it is, it fits perfectly within the helmet, and had no issues on a test ride.

My organic ear gave its life for its bionic future. Sometimes, recipients are able to hear still after implantation, but my implanted ear lost all of its residual hearing. I noticed that the dogs barking no longer registered in the implanted ear. I tested further by banging a hammer against some wood with my ear right by it. Absolutely nothing. Soon, its bionic transformation would be complete.

Monday, April 13, 2009, I woke up excited for what lay in store. I roused Brian enthusiastically. Today's the day! Today's the day! We allowed plenty of traffic time, and had enough time to stop at a Starbucks before showing up at the Ear Center just before 8:00, with my device kit. The surgeon had given me the device kit before the surgery. We were able to look through it before the activation. I was able to stick the magnet on and confirm high placement. We just had to remember to bring it to the activation.

The expectant mood was palpable. Checking in and taking care of the co-pay, it felt so routine, but I was going through one of the biggest days of my life. After taking a seat in the waiting room for just a few moments, the audiologist, Linda, called me back. We went to a spacious office and I took a seat. A specialist from Advanced Bionics was also in the room, Lalita. Linda set up a processor and hooked it to my head. The headpiece would not stay on well, so she replaced the magnet with a stronger one. She commented that my hair was cut so short it was standing up. Longer hair works better because it can be laid flat against the skull, allowing the magnet to nestle more snugly against the receiver inside my head.

Then it was time to activate me. First, I turned off my hearing aid so I could focus on sounds coming in from the implant. Linda conditioned my electrodes, which took about 30 seconds. I tried to listen for sounds during this 'boot up' phase, but could hear none. She said my impedance values were "Beautiful." That's something to brag about. I have good impedance values.

They did a live speech activation, which means all they did was turn up the volume until I could hear it. After she turned it up a couple of times, I could hear her voice. It sounded like tinnitus in speech patterns, formless sounds that happened to coincide with her mouth moving. I could hear my own voice too. It was louder, and deeper.
"I can tell my voice is a lower pitch." I heard the ch sound. I repeated it, "Chhhhh."
"You can hear that, can't you?" Lalita asked.
I nodded. We played with some more phonemes. Lalita covered her mouth and apparently made a variety of speech sounds. I could barely hear any of them. There was a bird outside the window. No go. Couldn't hear it. A fan blowing was noisily buzzing away. I could hear that just fine. They decided to turn up the high frequencies. They loaded up the processors with different programs to experiment with. I made the next appointment, and then I was free to go.

Activation happened. Implantees are routinely advised to keep expectations low, that being able to tell the difference between loud and soft is a successful first day, and that how it sounds at first is not how it will sound a week later, and beyond. I vibrated with the anticipation fulfilled. Now I had a sense of how it sounds, and it could only get better as my brain adapted to the foreign signals.

What does it sound like? Such a simple question, so difficult to answer. Brian went into a Chipotle to grab lunch after the activation, leaving me in the car to play my first song with the implant. I chose "Holiday," an oldie, a song I know so well that I can play it back in my head without hearing it. It started in with the familiar light percussion and melody. As the song built, bringing in the bassline, the synths, and the cowbells, I started to weep. I had heard so much about how music was lost with a cochlear implant. "Music is absolutely ruined," I was told. It was my biggest fear by far, in going bionic. It was due to testimonials on just how amazing the Hi-Res Fidelity 120 program was in conveying music that I cautiously, optimistically chose Advanced Bionics over the other device makers. And here I was, hearing the cowbell, the rich bassline, the tambourine, and the synths, totally overwhelmed with the relief and joy I felt.

The lows are generally rich and full. There is an occasional electronic quality, sometimes a little buzzy. The middle to high frequencies seem flat and off, but that could be my brain. As we discovered at the activation, my brain wasn't even registering the higher pitches, sounds it didn't hear with the organic ear. I could not hear turn signals at first. In activation story after activation story, I read about how recipients heard the turn signal!!! So I therefore expected to hear the turn signal!!! But it was silent. I could see the green flashing arrow of the signal. No sound. Then later on, I did notice something, after all. An almost imperceptible, dog-whistle pitched clicking sound. Then once my brain was able to bring it into focus, it was inescapable. They are clear as day now. The process took about as long as the trip back to Tucson from the activation.

At first, when I took the headpiece off, my brain tingled, stunned, ricocheting with the electrical current. Now, just a few days later, my brain doesn't tingle. Instead it creaks with faint tinnitus, a slow, low, buzzing electrical sound, mourning to be rejoined with its electronic half. I am ravenously listening to music, and listening to audiobooks, training my fledgling bionic auditory cortex within the confines of my computer. I've had over a week to recover from the surgery. Monday, it is time to return to work as a cyborg, and see how the CI does in real life.