Wednesday, May 4, 2011

Upgrade Central-Bella 4.0...

Yesterday was an exciting day for Bella. She received the latest and greatest in cochlear implant fashion; upgrading her Nucleus Freedom processors to the new N5. She has the N24 internal piece (for all of you CI tech geeks out there). Previously she has had the sprint processors, the 3G and the freedoms, so this was upgrade #4.

The biggest change in the upgrade is the new size. As you can see from the pictures, it is quite a bit smaller and thinner than her previous model.

It also comes with a remote to trouble shoot issues with the processors and change programs. It looks like an ipod, if you ask me. I'm not sure how often we will use the remote. It seems to be a tool more likely used by parents of smaller children to check on things and so they don't have to mess with the small buttons on the processors themselves while their toddlers are running around.

We were going to wait until this summer to go get the upgrade since we have to travel 2 hours to Mayo Clinic for the appointment, but Bella has been having some issues with her hearing lately. Nothing super significant, but enough to know we better bring her in now vs. later. Her teacher at school mentioned in passing that she didn't seem to be hearing as well in the classroom. She explained that in the past she could call Bella from across the room and she would respond. That had stopped happening. Also, Bella was asking for clarification more on directions. Another sign. After hearing that, I did recognize that Bella had been confusing sound alike words more often in recent weeks.  The word "ham " might sound like "hand" to her. Subtle differences that she used to have no problem hearing. When I asked her about her hearing, she did say things had seemed softer lately.

During her Mayo appointment, we discovered that her MAP (cochlear implant programming) had changed, which accounted for her poor hearing. It didn't look like it changed that much on the screen, but hearing is a very complicated sense. This was illustrated to me during the session when the audiologist was adjusting Bella's MAP's and then she did the Ling Sounds to check her hearing. Bella mixed up the "oo" sound with the "mmm" sound. The audiologist was not phased at all and said that happens a lot when adjusting MAP's for a CI. With a slight click of her mouse, she adjusted one electrode on the computer screen and fixed it. She said "oo" and "mmm" were basically the same sound with a slightly different pitch. I have to say, I was pretty amazed!

There have been many reports that the N5 upgrade is mostly a cosmetic upgrade- meaning it is smaller and  as her implant surgeon put it "more sexy looking", but that it didn't really improve sound quality. Well, I'm not sure if it is because we had Bella's MAP adjusted at the same time or not, but she claims she hears quite a bit better with it. At a lacrosse game yesterday, she said the wind sound was a lot better.  In the past, Bella had always complained about not hearing well in wind. Now she says the wind is much quieter and she can hear people much better over it.

After the new processors were programmed and her back-up freedoms were adjusted as well, she went into the sound booth for some testing. Her report listed her as an "excellent performer" with cochlear implants. Here's her test results with both implants on:

AZBio-C Sentences in quiet list 13-100%
BKB Sentences in Noise (paired lists 9 and 10) 4.5 db SNR

In layman's terms here's the scoop. When hearing without noise, Bella hears extremely well. She got all of the sentences correct using the hardest list of sentences Mayo has. In noise, she is close to hearing as well to hearing peers her own age. A typical child needs the speaker to be 1-2 decibels higher than the background noise in order to get sentences right 50% of the time. Bella needed the speaker to be about 4 decibels higher than the noise to get the same results. A typical child with cochlear implants needs the speaker to be about 8 decibels higher than the noise to achieve 50% accuracy and a typical adult with cochlear implants needs the speaker to be 11 decibels louder than the background noise.

Here's some video of Bella's sound booth testing:

Technology is changing so fast, I wonder when Bella version 5.0 will arrive...

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