Why I went all in with a second cochlear implant

I thought long and hard about whether I should get a second cochlear implant. But I'm glad I did.

We recently activated my second implant, and it's as big a miracle as the first. In January I decided to go ahead if I qualified, and after several months of preliminary testing and insurance screening, I had successful implantation surgery on my left side on March 30. We activated the sound processor on April 14, and I could hear and understand speech immediately.

My hearing with the new cochlear implant is still not as good as on the other side with my first one, where my hearing has steadily improved in the nine months since we turned it on. But in the two weeks since activation of the left side, hearing with it has improved substantially. People's voices, which initially sounded nasal or guttural, are starting to sound more normal. I'm hearing and identifying more high-frequency sounds. And I'm understanding speech and the TV and radio with it much better than at first. Best of all, together with my right ear, I'm hearing a full range of sound once again, in stereo. I feel more myself again. It's truly amazing.

Even so, going ahead with the second implant was a major decision. Given the success of my first implant, which enabled me to function better in the hearing world than I had in years -- including success once again with the telephone -- friends and relatives questioned whether I really needed to go through with the second implant. It's major surgery after all, which can be risky. And even though I qualified for insurance coverage, the co-pays on my plan are substantial, so I knew it would be expensive as well.

Those who follow gene therapy and regenerative medicine also asked why I wouldn't wait until ongoing experiments that have already restored some hearing in deaf mice and gerbils lead to an organic cure for human hearing loss. (The cochlear implant electrode can damage your hearing hair cells and is assumed to preclude their eventual regeneration through gene therapy).

Therefore, the question I had to answer to my satisfaction, as well as to friends' and relatives, was whether the benefits of the second implant would be worth the risks, costs and tradeoffs. Believe me, I gave it a lot of thought. Five considerations made me decide to go ahead:

1. Two implants have got to be better than one: No matter how successful the outcome, a cochlear implant isn't a "cure." Even after I scored in the mid-90s on my word recognition tests with the cochlear implant processor in my right ear, I still was not hearing as well as someone with a "normal" hearing ear. The sound I get from my first implant is amazingly realistic, but it's still processed electronically. The 80 electrodes that transmit sound into my auditory nerve simply can't compete with the thousands of hearing hair cells that resided in my once-healthy cochlea, transmitting the full, glorious range of auditory frequencies, tones, and timbre into my brain. So music is much less appealing to me than when I had full use of my natural ears, and while my speech comprehension is vastly improved, I still have to depend on speech-reading skills and other tricks people with hearing loss use to get by. I decided that a second cochlear implant that would effectively double the auditory inputs into my brain would have to deliver a big improvement in my hearing. And I was right!
2. Single-sided deafness is the worst: Once I got my hearing back on my right side, I started dealing with all the issues experienced by people who are deaf in one ear. Localizing sound is very difficult, and understanding speech in any kind of noise, or from someone sitting on your bad side, is a problem because of the "head shadow affect" (high-frequency tones in speech don't reach the hearing ear if they come from the other side of your head). Single-sided deafness is an insidious malady, because until recently many people regarded loss of hearing in one ear as a nuisance but hardly a catastrophe -- after all, you still have that second ear as a backup, right? But recent research has made it clear that single-sided deafness increases lifelong stress and causes many if not most of the same problems you suffer with severe bi-lateral hearing loss, even when one good ear works quite well. For me, even a short-lived experience with single sided deafness was far more than a nuisance. It was a real negative impact on my quality of life. In short, getting my hearing back on both sides has been a joy. I feel whole again.
3. I wanted to keep both halves of my auditory brain "alive": I had always used both hearing aids to get every possible auditory input into my brain through each ear. Even when nearly all my high frequencies were gone, I could still process some speech with hearing-aid amplified low frequencies that were still making their way into my brain, supplemented by a lot of good guesswork. (It's amazing how much you can infer from a string of low-frequency vowels, even when the high-frequency consonants are silent: "Eh-oh oo-oo oo-eeth" = "Let's go to the movies.") But after my first implant restored so much hearing on my right side, I started to find my left ear essentially useless. The noise blasted into my left ear by my super-power hearing aid still gave me some of those low-frequency vowel sounds, but the noise was now an annoying distraction from the full-bodied speech I was getting from the implant on the right side. After a while, I simply stopped using the hearing aid on the left side. But I worried that the longer I went without using the left auditory nerve to process sound, the more my synapses on that side of my brain would atrophy and/or re-purpose to other, non-hearing, activities. There's a theory backed by a growing body of evidence that the longer you go without using brain to process inputs from your auditory nerve, the less successful you will be when you start transmitting sound back into it through a cochlear implant. I decided that instead of abandoning my left ear, I would start blasting that sound back in with a second cochlear implant as soon as I could. I'm glad that I did.
4. I wanted redundancy: No matter how good the cochlear implant processing technology gets, you are always dependent on electronic parts that occasionally experience outages or failures. There's nothing worse than abruptly shutting down a conversation because you suddenly can't hear, or, if you're on the phone, hanging up on the other party in mid-sentence after telling them you've stopped hearing them. Having a second cochlear implant processor working in my second ear ensures that if one implant processor goes on the fritz, I'll always still be able to hear with the other until the defective part is repaired or replaced. It's a big issue, especially in business settings, and I am vastly relieved now that I've got redundancy with processors working on both sides.
5. There was no way I was going to wait for a gene-therapy cure: Call me a skeptic, but I simply find it impossible to believe we will see regeneration of hearing hair cells to restore natural hearing in humans until I have advanced well into old, old age. I've followed the research closely and spoken with numerous experts in the field, and my best estimate is that it will be at least a decade before therapies are approved for normal patients. I just didn't want to wait another ten years (or, in my humble opinion, most likely far, far longer) to get decent hearing in my second ear. My risk in going ahead with the second cochlear implant was that it wouldn't work very well, and that in a few years I'd regret not being able to get really great hearing from an organic therapy. It's a real risk -- there is still a big range of outcomes from cochlear implantation, with many patients getting only modest returns compared to what I experienced with my first implant. But I felt that even a modest result would be far better than living with a deaf left ear. And, lucky me, even in the first two weeks since we activated the second implant, I've experienced really good results. Even if a cure comes along ten years from now, I will have had that decade of good hearing in both ears, in the prime of my life, that I would not have had if I waited.

I'm only starting to comprehend the benefits of having a complete solution for both ears. In a few months I'll know if the left side catches up to the right side, and I'll see just how good my hearing will get. 

But I already feel I'm hearing better than I have for more than a decade. Instead of struggling with severe hearing loss as I did for all those years, I feel my hearing right now is more comparable to someone with moderate hearing loss (something that half the people in my age cohort seem to be dealing with anyway, thanks to age-related hearing loss, too many rock concerts in their youth, etc.) 

And if my brain continues to improve its interaction with my bionic implants, there may be the possibility that my hearing will improve to the point that I can compete with all those youngsters who only have very mild hearing loss. Wouldn't that be something?