Kudos to Hearing Review for catching this awesome video of a TED conference talk on why cochlear implant users can’t hear music well. This one hits home for me, because when I lost most of my hearing nine years ago, music suddenly became a discordant jumble of noise that was impossible to enjoy any more. Now I find it’s exactly what cochlear implantees experience.

Dr. Charles Limb describes how devastating the loss of  music can be to his cochlear implant patients while explaining in layman’s terms why it happens. As both a musician and a cochlear implant surgeon, he combines his two passions to study the way the brain creates and perceives music. He is an Associate Professor, Otolaryngology, Head & Neck Surgery, at Johns Hopkins who performs cochlear implantations on patients who have lost their hearing. He is also an accomplished musician on the faculty of the Peabody Conservatory of Music who plays sax, piano and bass.

If you listen to the comparison on the video between “normal” symphonic music and an estimation of what people with cochlear implants hear, you will understand the problem better. Cochlear implantees can’t hear the difference–both sound equally bad (I can’t hear the difference either).

To Appreciate Music, You Need To Discern A Much Wider Range Of Frequencies And Amplification Than To Understand Speech

Part of the problem is that neither cochlear implants nor hearing aids are optimized as much for music as for speech. The chart that Dr. Limb displays shows the frequencies and sound levels you need to replicate or amplify for speech, versus the much wider range of frequencies required to convey the richness of music.

But the problem also extends to the brain’s ability to process sound as both music and speech, including the emotional impact music can have. Dr. Limb is fascinated with the idea “that acoustic vibrations in the air can make you feel deep emotion, something that can affect your life.” Music requires a comprehension of pitch, tone and timbre, but cochlear implantees, and people like me with certain kinds of hearing damage, can’t discern warmth in a tone or the timbre of a violin versus a trumpet–qualities that enable music to stir powerful emotions.

The interaction between the mechanical hearing functions and how the brain processes sound and music still is not very well understood. Sound waves are shaped within the ear canal and transmitted through the ear drum and middle-ear bones to the hearing-hair-cell nerves in the cochlea, where they are transformed into electrical impulses carried by the auditory nerve. But then the brain takes over and interprets those sound waves, understanding them as speech, music, a baby’s chatter or cry, random noise or other sounds.

Readers of Musicophilia by Oliver Sacks will be familiar with the mysteries of how the brain processes sound. I found some comfort in the research the book reviewed on the brain’s amazing ability to rewire itself to improve its comprehension of audio inputs after the hearing organs have been damaged. In one of his case histories (and to a lesser degree in my own experience), the brain is able to improve its comprehension of speech over time, and to a lesser extent music as well–to fill in the gaps when the hearing organs are malfunctioning.

But as Dr. Limb makes clear, a lot more is unknown than known at this point. How the brain processes and discerns the quality of music — pitch, tone and timbre — is relatively new territory for researchers. While cochlear implants (and hearing aids) have been wildly successful in restoring the ability of the deaf to hear and understand speech, there’s still a long way to go before they can restore a complete ability to appreciate music.

“If you had a sense to lose, we are furthest along medically and surgically with hearing,” says Dr. Limb, but he adds, “Most implant users really struggle and dislike music because it sounds so bad. So when it comes to this idea of restoring beauty to somebody’s life, we have a long way to go.”

I think most readers with hearing loss should be able to relate to my two immediate goals:

1. My old America Hears hearing aids, which have served me extremely well, are wearing out after nearly four years of use. In 2012 I will conduct a disciplined search for a new pair of high end hearing aids. The search will include comparison shopping. Writing about this extended shopping expedition should be fun and illuminating.
2. As I shop for hearing aids I will be striving for a deeper understanding of the world’s most mystifying business. I’ve been writing about hearing products and technology for more than six years, as well as about how I cope with hearing loss. In 2012, I will start writing more about how the hearing aid industry works (and doesn’t work). Wouldn’t it be nice to find some answers to that question everyone asks: “Why don’t the tens of millions of consumers who need hearing assistance (more than 30 million in the U.S. alone) have more products to choose from, at a broader range of price points, from a bigger competitive field than five or six global manufacturers?”

So, I’m excited about 2012 and expect to write a lot more than I did in 2011.

A note about my technical problems: last year I set up a hearing aid comparison chart showing the flagship products of the top six global manufacturers. It quickly became one of the most popular attractions on Hearing Mojo. Unfortunately, the WordPress plug-in I used to create the chart crashed my site. (Google the phrase WordPress White Screen of Death and you will get an idea of the extent of the problem).

I finally got the site up and running again, without the chart, and am revamping my approach to hosting and managing what has become a much bigger production than the small blog I started six years ago. I hope to make Hearing Mojo even bigger and better in 2012, and I will revive the product comparison chart(s) once I’ve sorted out the technical issues.

Stay tuned!

Everyone knows the Super Bowl is more than a football game. In fact, in the Madison Avenue circles where I used to move, it’s more a Super Bowl of advertising than an athletic contest. It’s where the most creative minds in media and entertainment show off their best and brightest ideas every year. That’s why when I lost most of my hearing, it enraged me that so few of the ads had captions.

A lot of other people were mad, too, and all the lobbying seemingly has finally paid off. I say “seemingly” because, when it comes to broadcaster and advertiser commitments to provide captions, seeing is believing. It’s not enough to say you’ll provide the captions.You have to actually follow through on your commitment:

• First, you really DO have to provide the captions (that’s right, even after the FCC mandated captions on all broadcast TV several years ago, there are still complaints about many shows that simply don’t have them).
• You also have to provide captions that that are comprehensible (sometimes there are more dropped lines than not in a live broadcast, and I’ve tried to decipher thousands of lines of gobbledygook trying to pass themselves off as dialogue in the captions I’ve followed over the past few years).
• And you can’t cut corners and costs by relying on your speech-recognition software without putting enough humans with brains at the captioning console. (I really did watch that show a few years ago about a “cereal killer” who murdered lots of people but didn’t once eat a bowl of corn flakes).

Therefore, the National Association of the Deaf, in its announcement of the agreement, encouraged everyone to keep score, not of the game, but of how well the NFL and FOX Broadcasting live up to their promise:

The deaf and hard of hearing community has engaged in an annual ritual of counting the number of captioned commercials and network promotions during the Super Bowl. Consumers are invited to join in this celebration by counting along as we reach our 100% captioning goal. The NAD is interested in learning about any technical issues that affect the pass through of captions to consumer’s television sets.

So, three cheers to the NAD and everyone else who brought enough pressure on the powers that be to bring captions to the world’s biggest stage. Let’s all keep score, and let’s let ‘em have it if the broadcaster or the advertisers fumble the ball on providing good Super Bowl captions.

Re-Booting Hearing Mojo

I’ve been letting people know I’m re-booting my Hearing Mojo hearing-loss blog after having taken a long break from posting new entries. In the past year I’ve let this blog lie dormant as I’ve gone completely “mainstream” with my communications consulting business, Aquarius Advisers. We have been successful, with a number of happy high-technology clients, but it’s been an education in coping with hearing loss in the business world. During my blogging hiatus, I’ve stayed current with the new developments in the world of hearing loss and hearing aids, including time spent consulting with America Hears, Inc., the leading online manufacturer and marketer of premium digital hearing aids. However, I’ve sorely missed writing about this industry and all the issues involved with it, so I intend to start doing so again. I’m still managing a transition to a new blogging platform (the new look and feel are enabled by the WordPress open-source content management system, as opposed to the Moveable Type platform I used in the past). So it might take me a while to get the new platform exposed to the search engines. But I’m starting to write again as of now. A lot has happened in my absence, and I intend to catch people up with all I’ve seen and heard, starting with my visit earlier this month to the American Academy of Audiology (AAA) AudiologyNow 2009 conference.

Musicophilia by Oliver Sachs addresses hearing loss.

His book Awakenings, about coma patients who were administered a drug and awakened, returning briefly to normal lives, only to tragically lapse back into their comas when the drugs wore off, was made into a major motion picture with Robert DeNiro and Robin Williams in 1990. Musicophilia is a big book about how the brain assimilates, creates, and otherwise processes music. Because of Sacks’s passion for understanding how the brain interacts with the physical world, it has a lot of information on how the brain works with the hearing organs to process sound and interpret what we hear. Most exciting to me, it hints at some of the reasons why I’ve experienced a marked improvement over the past several years in my ability to hear — not music, which is still gone completely for me, but to hear and understand people’s voices – even when my physical hearing tests have shown no improvement and even slight decline in hearing levels in both ears. Sacks is making me wonder whether the amazing human brain actually has the ability to correct and “cure” hearing loss to some degree, even when the physical hearing organs are damaged beyond repair.

Musicophilia describes and explains both musical hallucinations and amusia, the inability to discern tone or timbre, which makes music impossible to “hear,” listen to or enjoy. I never knew amusia had a name, only that when I lost most of my hearing five years ago I also lost my ability to hear music. While I’ve gotten better at coping with normal conversation, my amusia has been and continues to be the most devastating irreversible loss I’ve suffered. Sacks provides a case history that makes my problems with music seem small and also offers some hope. It’s about a professional musician, and composer, Jacob, who gradually loses his ability to process musical sounds correctly. But, like Beethoven, he is able to continue working by using the musical ability that his brain retains. Even better, he has “trained” his brain to correct the problem so that at times he is able to hear music properly again.

I’ve experienced something similar, in that when I concentrate really hard I can sometime properly discern a single melody played by a single instrument; often the tone leaps from one octave to another in mid-stream as my brain chooses an octave that my ears can process more or less properly, but I still can recognize the tune. I’d heard of something called “recruitment,” where the brain compensates for dead hearing cells by having adjacent cells tuned for higher or lower frequencies pick up and process the sound. So I can hear musical sounds, but they are a discordant mess because my ears hear them at all the wrong tones. But sometimes, seemingly through an effort of will or extreme concentration, I can hear the correct tones. Sacks explains this by identifying a process where the brain actually re-tunes the hearing cells to pick up and process notes at the proper frequencies:

What might seem a preposterous notion has gained support from recent work demonstrating that there are massive efferent connections (the olivocochlear bundles) going from the brain to the cochlea and thence to the outer hair cells. The outer hair cells serve, among other things, to calibrate or “tune” the inner hair cells, and they have an exclusively efferent nerve supply; they do not transmit nerve impulses to the brain, they get orders from the brain. Thus one has to see the brain and ear as forming a single functioning system, a two-way system, with the ability not only to modify the representation of sounds in the cortex but to modulate the output of the cochlea itself. The power of attention – to pick out a tiny but significant sound in our environment, to home in on a single soft voice in the ambient din of a crowded restaurant – is very remarkable and seems to depend on this ability to modulate cochlear function….

If this is true it may help explain why I’ve felt over the past several years that my hearing has improved, especially my comprehension of conversation. If the brain can command what’s left of the hearing organism to actively assimilate and discern specific kinds of musical sounds, perhaps it can also train the ears to “hear” spoken conversation in ways enabling the brain to understand speech more easily. Sacks describes how intensive work by Jacob the composer resulted in lessening of his amusia, as he worked with music and musicians all day long and actively concentrated on adjusting his tonal perceptions. I work just as hard as Jacob, but in conversational settings, because my work as a communications and media consultant requires I be the best possible listener. I thought for the longest time I was just getting better at speech reading and understanding body language and all the visual cues that help one understand what someone is trying to communicate. But perhaps my brain is also learning how to “order” my cochlea and hearing hair cells to interpret the sounds they do pick up in ways that enable my brain to comprehend speech and understand conversation better than I could when I first went deaf.

This may also hint at why a product like the Neurotone LACE speech-comprehension therapy system actually works. I have gotten through four of the 20 LACE lessons and will have a report on the results in a future post.

On the one hand, I can’t believe how much better I can cope now than I could in the first year or two after my sudden hearing loss in 2002. I’ve gotten more sophisticated about assistive technologies as well. At the same time, I’m getting a much deeper appreciation of the sheer effort it takes to get through a solid week of meetings, phone calls and work in the office. Boy, do I get exhausted sometimes.

But during this hiatus the number of visitors coming to Hearing Mojo has been consistent at about 1,000 a week. This is pretty good traffic and shows the interest in hearing loss and coping strategies is as strong as ever. So I intend to start posting more often about my experiences as I get busier in the mainstream, with my usual focus on coping strategies as well as occasional in-depth looks at products and technologies that are opening the world back up for people with severe hearing loss. I also hope to pick up on the action linking more often to news in the hearing industry where the major manufacturers have been busy with product launches, mergers and acquisitions, and where the smaller companies have been driving competition and innovation. Stay tuned.

The effect is not painful or even unpleasant, but it does make you question your sanity at times — out of embarrassment I buried the “God Bless America” story in the seventh or eighth paragraph of my post. But it turns out Dr. Neil Bauman has done an entire book on the subject called Phantom Voices: Ethereal Music & Other Spooky Sounds. Dr. Bauman, who is hearing-impaired, has made a career studying, writing about and speaking on sources of hearing loss and ways of coping with it. He’s an interesting guy, as his doctoral degrees aren’t in medicine or audiology but in astronomy and theology. But like many other lone voices in the wilderness, he has spoken up on many issues important to hearing-impaired people long before the supposed “experts” have dared to venture their opinions.

Among other things, he has written extensively on otoxic drugs, herbs and medicines that can cause permanent damage to your hearing, which medical professionals still are often unaware of. He was also using and writing about assistive listening devices when the rest of us were still unaware of any assistance available beyond our clunky old hearing aids. And he started writing about the possibility of gene therapies for regeneration of the inner-ear hairs responsible for hearing when scientists first discovered in the 1980s that birds are naturally capable of regenerating their hearing hair cells.

Now he’s on to what he calls “Musical Ear Syndrome.” You’ll get an indication of how far ahead he is on this subject if you Google those words — after the two lead entries on his book, you’ll find a reference to an article in the Journal of Nervous and Mental Disease on “musical hallusinosis,” which I’m sure would try to convince me I’m crazy after all. But beyond those items, there seems to very little scientific research on this effect. Hallucinations or not, I know I’m not crazy and that these noises are real. The more lists and chat groups I join, the more people I find who have experienced similar noises in their heads. (Some even hear voices — though apparently not the kinds of voices schizophrenics hear that command them to do things.) So I’m glad Dr. Bauman’s on the case. I’m going to order Phantom Voices right now, and I’ll let you know what I think. In the meantime, he has written a brief but clear introduction to the subject in a recent issue of Hearing Health magazine, the authoritative publication of the Deafness Research Foundation. Check it out.

The report goes on and on with an extensive list of physical and neurospychological problems causing all kinds of mayhem in people’s lives — lost jobs, broken marriages, alienated children, inability ever to play golf again — but I’ll let you discover them for yourself should you choose to support the work of VEDA by taking out a subscription. The organization in fact is an excellent clearinghouse for information and support available to people with all kinds of inner-ear and other vestibular disorders, many of them causing or accompanying hearing loss. If you’ve never suffered an acute vertigo attack, thank your lucky stars. The world starts spinning, down becomes up, and an attack can be so immediate and violent that you find yourself on the ground before you know what hit you. Then you throw up.

VEDA and other organizations gave me tremendous reassurance it would be possible to cope in spite of the mysterious problems that beset me. Their work is invaluable in helping people who need it most. So if you’ve been diagnosed with Meniere’s or have suffered some of the symptoms, make a contribution and check out On the Level. And don’t be put off by the academic prose — with practice you will become savvy to the lingo. At the very least, it will quickly become clear that no matter how bad off you may be, there’s always someone in far worse shape who is coping better than you are. Remember the old saying, “I cried because I had no shoes until I met a child who had no feet.”

As for MMWR, now that it’s on the web I occasionally dip back in for old times’ sake. Check out this week’s issue. I recommend the excellent retrospectives on the progress of two parasites that have caused severe gastrointestinal illness in the U.S., Cryptosporidiosis (1999-2002) and Giardiasis (1998-2002). Happy reading!!

I learned early on that the key to being a successful consultant is to shut up and listen. People are so accustomed to not being listened to, that if you simply let them talk, and if you take an honest and careful interest in everything they say, they will reveal things about themselves they’ve never exposed before. And they won’t even realize it. Once you get them talking, you can learn a person’s life story and nearly everything you need to know about what makes them tick. But the strangest thing is they often fail to listen even to themselves, so that after they’re done they have no recollection of what they’ve just told you.

I can’t tell you the number of times I’ve simply played back to new clients what I’ve just finished hearing them say about their most personal fears, hopes and dreams for themselves, their families, their new products or their companies, and been told I’m an absolute genius, a mind reader who seems to know more about them than they do about themselves. They tell me I must already be an expert in their field because I know so much about where they are going and what they are doing without even having been briefed about their strategy and plans — only minutes after they’ve shared all those plans with me, down to the smallest detail. There is truly amazing power in good listening skills.

Unfortunately, severe hearing loss takes away that advantage. It’s impossible to sit back and listen intently, vacuuming up every seemingly insignificant little detail and putting it to very good use later. With speech reading you can get a very good approximation of the key points of a conversation, but you have to come back later to fill in the details of what you missed: the subsidiary clauses, casual asides, jokes, analogies or contextual references that are critical for complete understanding but hard to get the first time through without hearing the exact the words. Getting through an initial business conversation is like trying to read War & Peace at a single sitting. I’m sure with enough Evelyn Wood speed-reading training you can get the gist of Tolstoy’s great novel, and if you skim enough of the high points you can hold up well in a dinner-party conversation, but you will by necessity have to skip 80 percent of the actual words in the book. Sometimes speech reading is even like skipping to the last chapter of a mystery to see who done it in advance — by the end of the conversation you finally figure out what was going on, but you have no clear idea of how the participants got there.

So my little trick of playing the genius on a first business meeting doesn’t work any more. But I can be quite effective anyway by getting the same information in different ways. First, I do ten times more preparation than ever before. I do voluminous research on the client’s busines problem, industry and market. And I make it my business to know that person’s life story before I go in, so when I’m hearing it in the initial conversation I have the context and basic high points of the client’s personal story. (Look at my recent posting, A Night at the Theater, on going to a play having read the script beforehand — speech reading is a lot easier if you know the plot and what’s coming in the next scene). Thank you, Google.

Second, I take in the visual details in a way I never did before. How the person is dressed, what chatchkes he or she has strewn about the office, whether the desk is neat (a buttoned up client who will be easy to work with, or an anal control freak?), or sloppy (a casual client who will be easy to work with, or a disorganized nightmare?), framed awards or diplomas on the wall, and personal pictures all tell a tremendous amount about the person and the business situation. They also provide useful clues that can provide hooks back into the conversation when you lose the thread.

Looking at the client’s bookshelf also tells you “volumes” about that person’s interests and experience. Especially if there are books you’ve read in common, which gives you a chance to steer the conversation to an area where you know the context and are more likely to understand his or her perspective on it. Informal get-to-know-you conversations are extremely revealing but are among the most difficult social transactions for someone with a severe hearing impairment, because all too often the repetitions required just to get going kill the spontenaeity of the moment and end the discussion before it gets started. But when you start a “spontaneous” conversation about a topic you both are familiar with, where you already have a context and know the points of similarity in your experiences, you have a much better chance of successfully negotiating this opening social ritual.

Having several people in the room is also very useful, because body language comes into play much more prominently. I’ve sat in group meetings around a conference table with people who initially were complete strangers to me, but who at the end of two hours I know quite well, even without having understood much of what people at the far end of the table said. I know who’s mad at whom, which side of the issue different players are on, who is the funny one who provides social lubricant, who is the organized one who moves the meeting along, who is skeptical of the idea of hiring a consultant in the first place (take a note to set up a one-on-one later), and who through vigorous head-nodding is ready to sign a contract today. Sometimes this information is more important than the details of the problem at hand, which can often be established quickly through advance research. Having a grip on these dynamics can mean the difference between being effective or ineffective as a consultant and ultimately between success or failure. But none these things are obtained verbally.

So while I still find it very difficult to hear, I still manage to be one of the world’s greatest communicators. Just ask me. Then, listen up!