Bad News - Denied for CI

[Daredevel7]

Funny that people take CI more seriously than HAs. Howcome so few people have a desire to "tune up" their HAs so they can hear better? :roll:

I am not sure you understand the process of "tuning" up the CI. I understand your mission of spreading the word to "try on the best HAs before trying on the CI", but after reading so many of your posts, I don't think you understand how mapping works. It's really a different ballpark from "tuning" a HA. When you "tune" a HA, you are really either amplifying the sounds as much as you can or reducing the volume of certain frequencies because it's too uncomfortable (nowadays there's also the frequency shift). When you tune a CI, you also increase volume or reduce the volume of certain frequencies but there's also the attempt to match up what you hear and what the sound actually is. If you hear 2 different sounds, and they sound the same to you, you can actually change this. Is that something a HA does?

 

[faire_jour]

I am not sure you understand the process of "tuning" up the CI. I understand your mission of spreading the word to "try on the best HAs before trying on the CI", but after reading so many of your posts, I don't think you understand how mapping works. It's really a different ballpark from "tuning" a HA. When you "tune" a HA, you are really either amplifying the sounds as much as you can or reducing the volume of certain frequencies because it's too uncomfortable (nowadays there's also the frequency shift). When you tune a CI, you also increase volume or reduce the volume of certain frequencies but there's also the attempt to match up what you hear and what the sound actually is. If you hear 2 different sounds, and they sound the same to you, you can actually change this. Is that something a HA does?

And unless your hearing changes, there is no need to change your hearing aid settings. You get an audiogram, set the hearing aid, do the speech map, and you are done.

With a CI, you do the NRI's, do an impedence test to assure that all the electrodes are working within appropriate range, check T-levels with a listening task, set M-levels and then do the audiogram. If there are still issues, you adjust the T or M levels, or the gain.

It ALL needs redone every 3 to 6 months. If there is no hearing change, with a hearing aid there is NO need to adjust anything.

 

[Daredevel7]

And unless your hearing changes, there is no need to change your hearing aid settings. You get an audiogram, set the hearing aid, do the speech map, and you are done.

With a CI, you do the NRI's, do an impedence test to assure that all the electrodes are working within appropriate range, check T-levels with a listening task, set M-levels and then do the audiogram. If there are still issues, you adjust the T or M levels, or the gain.

It ALL needs redone every 3 to 6 months. If there is no hearing change, with a hearing aid there is NO need to adjust anything.

Also, your brain changes with the new inputs from the CI, so you need to adjust accordingly.

 

[overthepond]

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[deafdude1]

coolgirlspyer90, just to inform you....being anti CI is getting more and more unusual. I remember back in the old days A LOT of deafies being anti-CI. Now, it's a lot less. Which is good. CI is AWESOME for those who basicly have zero help (even enviromental or some speech sounds) from HA.

CI has been around long enough for it to slowly become accepted. When stem cells or some other radical procedure becomes available, I expect most Deaf people to oppose that for a few decades.

I am not sure you understand the process of "tuning" up the CI. I understand your mission of spreading the word to "try on the best HAs before trying on the CI", but after reading so many of your posts, I don't think you understand how mapping works. It's really a different ballpark from "tuning" a HA. When you "tune" a HA, you are really either amplifying the sounds as much as you can or reducing the volume of certain frequencies because it's too uncomfortable (nowadays there's also the frequency shift). When you tune a CI, you also increase volume or reduce the volume of certain frequencies but there's also the attempt to match up what you hear and what the sound actually is. If you hear 2 different sounds, and they sound the same to you, you can actually change this. Is that something a HA does?

I don't know everything about CIs but read around that 80% of a CI's performance is in the software/map and 20% in the hardware. Mapping a CI is very complicated with nearly unlimited possibilities. Ive read of CI wearers paying thousands for a custom programmed map that will fine tune their ability to understand speech and enjoy music better. An expert programmer can be hard at work for a month programming a map with all it's code and algorithms.

Results with CI varies a great deal and im still trying to understand how someone like lady schemit(cyborg queen) was able to get 10db across the board(reduced to 15-20db till her brain gets used to it) while others can't get better than 50db or 60db. Is this just bad programming or is it a limitation of that person's cochlea and auditory nerve? One CI audiologist claims he can get everyone to at least 40db and many people down to 25db!

A HA is much easier to tune but im seeing too many people with incorrectly tuned HAs analogous to someone with glasses too weak for him. My own HAs were incorrectly tuned. With more gain, I am hearing alot better and my dad is surprised at all the sounds im hearing. I never knew there was a faint echo in the downstairs bathroom! I also never heard the dishwasher humming from the other end of the house! My HAs from 10 years ago was leaving about 10db of low frequency gains on the table, I could have heard better for those 10 years.

I am unsure if it's possible to create a custom program for my HAs, but id like to have the transposition cutoff reduced to 750Hz or 1000Hz. 1500Hz is nearly useless since at 120db HL, I usually can't hear/benefit from transposition. :roll:

 

[faire_jour]

CI has been around long enough for it to slowly become accepted. When stem cells or some other radical procedure becomes available, I expect most Deaf people to oppose that for a few decades.



I don't know everything about CIs but read around that 80% of a CI's performance is in the software/map and 20% in the hardware. Mapping a CI is very complicated with nearly unlimited possibilities. Ive read of CI wearers paying thousands for a custom programmed map that will fine tune their ability to understand speech and enjoy music better. An expert programmer can be hard at work for a month programming a map with all it's code and algorithms.

Results with CI varies a great deal and im still trying to understand how someone like lady schemit(cyborg queen) was able to get 10db across the board(reduced to 15-20db till her brain gets used to it) while others can't get better than 50db or 60db. Is this just bad programming or is it a limitation of that person's cochlea and auditory nerve? One CI audiologist claims he can get everyone to at least 40db and many people down to 25db!

A HA is much easier to tune but im seeing too many people with incorrectly tuned HAs analogous to someone with glasses too weak for him. My own HAs were incorrectly tuned. With more gain, I am hearing alot better and my dad is surprised at all the sounds im hearing. I never knew there was a faint echo in the downstairs bathroom! I also never heard the dishwasher humming from the other end of the house! My HAs from 10 years ago was leaving about 10db of low frequency gains on the table, I could have heard better for those 10 years.

I am unsure if it's possible to create a custom program for my HAs, but id like to have the transposition cutoff reduced to 750Hz or 1000Hz. 1500Hz is nearly useless since at 120db HL, I usually can't hear/benefit from transposition. :roll:

Miss Kat's audiologist will not let the patient leave until he gets 30 db or softer in every frequency. I don't know who is getting 50, but they need a better audio.

 

[ceiliblue]

Phi --

I don't know where you are in the country (world?) but in the US the FDA sets the guidelines on cochlear implantation. The Medicare guidelines require less than 50% speech understanding in the non-implant ear and less than 40% in the implant ear. Private insurance companies often raise the limits to 60%/50%, respectively, and even that is changing. However, the guidelines do not mandate what speech material is used, only that speech testing be performed in the listener's best aided condition.
If you feel the evaluation does not adequately represent your true life performance on speech recognition, you can request more difficult sentence material, or request testing in noise. 72% unaided is an unusually high speech score, but it does not mean you absolutely cannot consider implantation in your worse ear.
The thing to remember is that these are guidelines, and the final decision about implant candidacy rests with the cochlear implant team at each center. So, you always have the choice to seek a second opinion at another center if it was the team who denied you. If it was the insurance company who denied your claim, ask your implant center to begin advocating on your behalf, writing letters in strong language emphasizing the potential benefit of an implant over the benefit you currently receive from traditional amplification.
Often motivation plays a large role in the determination of candidacy by the implant team -- you are obviously extremely motivated. It's a strong advantage to you. Best of luck.

 

[Daredevel7]

A HA is much easier to tune but im seeing too many people with incorrectly tuned HAs analogous to someone with glasses too weak for him. My own HAs were incorrectly tuned. With more gain, I am hearing alot better and my dad is surprised at all the sounds im hearing. I never knew there was a faint echo in the downstairs bathroom! I also never heard the dishwasher humming from the other end of the house! My HAs from 10 years ago was leaving about 10db of low frequency gains on the table, I could have heard better for those 10 years.

You're talking about hearing the most faint sounds. As I said before, tuning a HA is basically amping it up until you hear an ant breathe. An example of tuning a CI may be something like... turning off one specific electrode so you can distinguish a high frequency from a lower frequency better.

And Phi, I've had a change of heart. I do hope you can get the CI, perhaps they rejected you because if you REALLY want it, you will keep going. Maybe it's just to weed out those who are nonchalant about it. Or perhaps they have seen people who had the same situation as you who got it and ended up saying "Oh.. THIS is it? My better ear is still WAY better. The CI is almost pointless."

 

[deafdyke]

Or perhaps they have seen people who had the same situation as you who got it and ended up saying "Oh.. THIS is it? My better ear is still WAY better. The CI is almost pointless."

GOOD point.
Although your ear is dead, I think you need to be very cautious about the possible results. Most people who have qualified for it, up to now prolly had relatively low speech or sound perception even with an aid. You have very good speech perception...and it's possible that you'll end up thinking " Ah I don't need this after all....My HA is fine"

 

[SouthFella]

Well the audiogram clearly show he doesn't qualify base on pure tones. And he need to show his speech recognition numbers as well. Many " dead ears" don't do too well with a CI since the ear has been dead for so long... Actually, the insurance company makes the final decision while using the FDA guidelines...

 

[deafdude1]

Well the audiogram clearly show he doesn't qualify base on pure tones. And he need to show his speech recognition numbers as well. Many " dead ears" don't do too well with a CI since the ear has been dead for so long... Actually, the insurance company makes the final decision while using the FDA guidelines...

We would like to see an audiogram scan from you for both ears unaided/aided with HAs, before CI and with CI. Youve seen my audiogram and Phi4sius audiogram.

As for qualification, his dead ear definately qualifies. His good ear still has some ability to hear high frequencies but his hearing in the lows is actually similar to mine. Ive seen people with much more hearing in the low frequencies get CI, I consider their hearing to be better than even Phi4sius since low frequencies are much more important(I did tests and found my speech and hearing sounds goes up much more with boosting the lows than with highs, will post results in my blog soon.) also with only a moderate hearing loss, they are so lucky to still hear some sounds unaided which I can't.

You are right that he may hear worse with CI in the bad ear than with HA in the good ear. However even if that happens, bilateral hearing is still a good thing and he will gain the ability to tell direction of sound. He may be able to stimulate his nerve and slowly improve his hearing. Also in the future, stem cells will be able to regenerate any cell, including hair and nerve cells. Ive also read about proteins/hormones that can stimulate auditory nerve growth so he could go for that too in the near future and hear better with CI by then.

You are right, his insurance will decide. He has a CI evaluation soon and will take tests and get audiograms and speech scores. He will also tell the CI team why he wants a CI and his expectations. None of us can make that decision, only he and the audiologists/doctors can. But ill say that I know people who are worse candidates for CI than he is, yet they still got CI. Honestly I wish I had their hearing, id hear so good with HAs.

 

[deafdyke]

Private insurance companies often raise the limits to 60%/50%, respectively, and even that is changing.

On the other hand......I do think that they will become more strict on who can qualify for CI b/c it's so expensive. The only reason why they covered CIs initially, was b/c they were expensive, but only a small percentage of deaf people could benifit from them. I do think that if they crack down on eligabilty, they'll start covering hearing aids.