Tag Archives: hearing-aids

The Sound of Silence, Part III

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This is the third post in a series about my journey navigating recent sudden profound hearing loss. If you haven’t read them already, I recommend reading Part I and Part II first.

Warming up with the Oregon East Symphony last weekend

“Friends, Romans, Countrymen, lend me your ears” – From “Julius Caesar” by Shakespeare

Today is 91 days since I suffered sudden sensorineural hearing loss (SSNHL) in my left ear.

I perceive no recovery or improvement in my left side hearing despite a long succession of treatments and therapies (described in previous blog posts).

As I wrote in Part I, I had the scary experience of playing in an orchestra one week after my sudden hearing loss and not being able to hear myself.

In Part II, I described receiving hearing aids that I hope might enable me to continue performing with orchestras. It has been two weeks since I received my new crossover hearing aids.

I purchased Starkey Omega AI CROS (crossover hearing aids) for single-sided severe/profound hearing loss. I chose them because a) they are the most configurable (a cell phone app allows me to configure unique profiles and adjust equalizer settings), and b) they can run up to 48 hours on a charge. They are expensive, but given a unique set of circumstances, my insurance covered nearly all of the cost of the purchase.

Starkey Omega AI hearing aids

How normal crossover hearing aids work is basically a mic is placed in the deaf ear, and sound is transmitted to a “speaker” in the good ear. However, sounds on the good side are picked up through the air and travel as usual straight into the good ear.

Prior to my hearing loss, I diligently wore musicians’ ear plugs during orchestra rehearsals and performances to protect my hearing from the possible damage. Sitting close to woodwind and/or brass players, many experienced musicians suffer from hearing loss and tinnitus. I wanted to protect myself from that fate.

Note: Fellow musicians, please, please protect your hearing when performing in orchestras or amplified settings!

Prior to my hearing loss, I used Eargasm™ high fidelity ear plugs

Since I now only have one good ear, I really need to protect it, so my audiologist ordered special “ear cones” I can attach to my good-side hearing aid. An ear cone is a flange that will help muffle natural sound coming in through my right ear. It attempts to convert my hearing aid into both an ear plug and a hearing aid at the same time.

Practicing Alone

I tried playing my viola by myself, and I’m reasonably satisfied with the quality of the sound I’m getting through my crossover hearing aids. Of course, my viola doesn’t sound quite as warm across the range of frequencies, but it isn’t tinny or low fidelity. Overall, I find the sound quality satisfactory.

But that was playing solo, in a quiet setting, and not surrounded by 40-60 other musicians.

I attempted to artificially create a scenario to test my hearing aids the week before my first rehearsal with the orchestra. Here’s how I did it:

  1. I installed a large ear cone on my good hearing side hearing aid to muffle incoming natural sound
  2. I put on headphones but covered my good ear only
  3. I played recorded orchestra music at high volume through the headphones
  4. I picked up my viola and played along with the recording

I was able to hear myself and the recorded orchestra music … but this was still not a real orchestra setting.

I finally got to experience playing my viola in a full live orchestra last weekend in rehearsal and performance with the Oregon East Symphony.

In brief, the hearing aids worked! I was able to hear myself and the orchestra, and I was able to perform to my satisfaction.

There were issues, though, and I hope I will be able to work them out with the help of my audiologist.

Difficulty Tuning Up

I had to jump in early when the orchestra was tuning.

Typically, the concertmaster will stand and nod to the oboist to play an “A.” Various sections of the orchestra will tune. Finally, the “A” is given for the strings. We wait for the concertmaster to begin tuning, then the string sections all follow suit starting with tuning their A strings and subsequently their other three strings.

Three members of our smiling viola section

If I waited until all the strings were playing, I found it very difficult to single out my own “A.” So I began quietly playing and tuning my A string soon after the oboe gave their A and slightly before the other string musicians began tuning.

Also, I found it impossible to tune during warm-up.

10-30 minutes before a concert starts, many musicians come out on stage, sit down, and warm up. They get their fingers moving, review the program, and play through difficult parts. The combined sound of all the musicians warming up and practicing different things can be a cacophonous mish-mash.

In the past, I could tune in the midst of this sonorous chaos — but no longer.

Normally, this would not be a big issue. My instrument typically remains close enough to being in-tune most of the time, and I can simply wait until the official concertmaster-led tuning to make the last minute fine adjustments to my strings.

But occasionally, a string may become seriously out-of-tune, and that can pull the other strings out of tune sympathetically. One may install a new string which will stretch significantly over the first few days. Also, one of your tuning pegs may slip causing one string to be way out of tune, even an octave or more.

The latter happened to me. My C string tuning peg slipped, dropping my C way out of tune. The change in string tension caused the remaining strings to compensate becoming a little bit tighter and sharper. This meant all my strings needed to be corrected.

In the musical din created by all my fellow musicians warming up, I could not hear myself sufficiently to rectify the situation. I ended up having to ask a sympathetic colleague in my section to tune my instrument for me. Thankfully, he readily agreed and in a few moments had my instrument ready for the performance.

Overall Sound Levels Playing In The Orchestra

After tuning, it was time to play surrounded by musicians in the orchestra. Was I be able to hear myself and the orchestra? Yes. But overall, the sound level was uncomfortably high.

I found the ear cone allowed more sound to pass through into my good ear than I was accustomed to. This caused the overall combined sound level in my right ear to be very high. The flutes, oboes, and clarinets, though they played beautifully, generated a volume that approached piercingly painful levels. It was not enough to give me a headache, but it more than was comfortable, especially during really loud or bombastic moments in the music (one piece on the program was Stravinsky’s Petrushka).

But the most important thing — being able to hear myself — that worked.

I was physically spent by the end of the concert. This would not be surprising given the length, concentration, and physical exertion a work like Petrushka requires. But I also had sound fatigue.

These days, if I am in a noisy bar or restaurant, or any situation where there are multiple simultaneous conversations, I last maybe an hour before I am physically and emotionally exhausted and need to retire to someplace quiet. I felt the same after the performance.

I removed my hearing aids and spent some time socializing with audience members and fellow musicians in an after-concert reception. But not for very long.

Soon, I was on the road driving home. I needed quiet. I discussed the concert with my partner, but in low tones just loud enough to hear over the road noise.

Next Steps

My next follow-up visit with the audiologist is later this week. I’m hoping there might be a more effective earplug/hearing aid solution for my good ear and future performances.

I cherish my hearing, and although I grieve the loss of my left side hearing, I still can play music and do the things I love. For that I am grateful. I just need to do everything I can to protect what I still have.

The Sound of Silence, Part II

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Summary: The continuing and sometimes strange adventures seeking hearing recovery

I wrote about my sudden severe-to-profound sensorineural hearing loss (SSNHL) in my left ear in a previous post. If you haven’t read it, I recommend you read that first. There is also a new post that follows this one.

In this post I will share the latest updates, including a very strange twist in my journey.

1. Hearing Aids

Last week I received my crossover hearing aids. This was 66 days after the onset of my sudden hearing loss.

They look like normal hearing aids, but at the simplest level, the left (deaf) side is a microphone which transits to the right side (my good ear). My right ear receives sound both naturally from the right side of my head plus the sound transmitted from the left side hearing aid.

This should make it possibly for me to hear things and understand conversation on the left side of my head. I previously could not hear or understand anything on my left side except in the quietest settings.

The hearing aids I chose are very configurable. They have equalizer settings and multiple ear cones I can mix and match to find the best combination for various conditions.

My hope is to test these thoroughly and come out with an assortment of specialized profiles for different sound settings (e.g. driving a car, attending a meeting, noisy bar, performing music. etc.). It will take time and a lot of trial and error. But I’m hopeful.

I understand these will do little to help me in noisy situations (e.g. holding a conversation in a noisy bar or restaurant). I also will have no aural directional awareness.

While sitting in the audiologist’s waiting room, my ENT saw me, sat with me and talked a bit. He expressed sincere empathy for me and my situation.

We had exchanged a few messages about the various naturopathic therapies I was considering. He reiterated that although it is completely understandable I want to explore every possible avenue for recovery, none of those other therapies are supported by clinical trials. Some might only be available in places like China.

2. Neurologist Orders More Imaging

I also visited my neurologist last week. He reviewed my recent MRI. He didn’t believe anything stood out that would explain my hearing loss or any other symptoms, but agreed that we should order a more comprehensive MRI as well as a new cerebral angiogram.

These two procedures should give more detail and help identify if there is any malformation, growth, or anything else in my head that might be concerning and/or related to my hearing loss.

My angiogram is scheduled for next week and I’m still waiting to schedule my MRI.

3. My Therapy Journey Takes a Strange Turn

As I wrote in my previous post, a dear friend persuaded me to pursue naturopathic therapy. With their help, I found a local naturopathic doctor (who is also an MD) who proscribed a couple of options – acknowledging openly that none has been proven through clinical trials to cure SSNHL.

Another famous naturopathic doctor in Seattle was recommended to me. I contacted the Seattle clinic and was able to get an appointment for last week, the afternoon of the same day I was receiving hearing aids from my audiologist.

I decided to go for it. I scheduled a flight to Seattle right after my audiologist appointment.

During my hearing aid appointment, I received a call from the Seattle clinic reconfirming my afternoon appointment.

I left the audiologist, drove straight to the airport, hopped on my short flight to Seattle, and went to sleep.

I woke as we were landing and turned on my mobile phone. A voicemail was waiting from the Seattle clinic:

“Hi Toby, this is xxx calling you from [clinic name]. I’m calling you to inform you that unfortunately we are closing the clinic indefinitely right now due to an investigation. I am so sorry for the inconvenience. Please let me know if you have any other questions. All that to say that the appointment is canceled today as you might imagine…”

I was dumbfounded, but I accepted this as a sign that maybe this wasn’t the best option for me.

I decided to enjoy my unexpected free afternoon in Seattle, visiting one of the best donut shops in town as well as the beautiful National Nordic Museum with its Thomas Dambo troll, Frankie Feetsplinters.

I have a brief international vacation coming up with a symphony performance the week after. These new crossover hearing aids will definitely be put to the test.

P.S. I have seen no news whatsoever about the abrupt closure of the Seattle based naturopathic clinic.

Please continue to read my next post in this series.

The Sound of Silence, Part I

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Summary: Appreciating Beethoven in a completely new way.

Conceptual image about human hearing

Note: I added updates to the bottom of this post. But it became so long that I posted two follow-up articles. Here is Part II and here is Part III.

I. Hearing and Music

As a musician, my hearing is precious to me. I love listening to and playing music, and when I’m doing neither, during almost every waking hour, some music is playing inside my head.

Sometimes I can get earworms that last for days. If the song is one I don’t like, I’ll listen to other music or concentrate on any of a handful of favorite works to push the offending earworm aside.

The idea of losing one’s hearing is so disturbing to contemplate, especially to musicians, that I imagine many may superstitiously avoid even thinking about the possibility.

I studied ASL years ago, was given a sign name, and find the language and Deaf Culture beautiful and fascinating.

I have been careful to protect my hearing. I almost always have earplugs in my pocket, wear them whenever I travel, and have musicians’ ear plugs I wear in every rehearsal and concert. Well into my late 50s, I have enjoyed excellent hearing with minimal loss.

Last September, the Newport Symphony performed a stunning work called “A Silence Haunts Me” by Jake Runestad.

This 2019 work for chorus and orchestra is inspired by a letter Ludwig van Beethoven had written to his brothers.

Beethoven penned this letter, known as the “Heiligenstadt Testament” in 1802. He never sent it, and it was discovered after his death. In it, Beethoven despairs over his hearing loss.

It was emotionally profound performance. Playing in the orchestra, we could not hear all the words being sung. But we heard enough. At one climactic moment, the chorus sings:

“Why? — Silence is God’s reply
— and so I beg me take my life —”

I highly recommend attending any performance of this extraordinary work. If you are a choral director or a member of a chorus, I encourage you to seek out this work and consider it for performance.

Since it is a recent composition, there are not many recordings, but here is one:

Just thinking about this piece can stir deep emotion in me. Little did I know I would soon understand it at a wholly new level.

II. Sudden Silence

A little over a week ago I underwent minor surgery during which I was put under general anesthesia. The surgery was successful.

I woke up with a dry, raw throat, most likely an after effect of intubation. It took a day or two for my throat to recover to where I could eat and swallow normally.

My left ear was also plugged when I woke up. I figured drainage and sinus congestion was the cause, but while my throat recovered, my left ear did not.

I took antihistamines, used nasal spray, took throat lozenges, and tried steam inhalation. Although all were successful in clearing any congestion, I still could not hear anything in my left ear. Maybe I had some other blockage either in the external or middle ear? I went to Urgent Care to have my ear inspected.

No fluid or infection was detected. They prescribed Prednisone and instructed me to see an Ear, Nose and Throat (ENT) doctor immediately. Since it was the weekend, I had to wait, worried and impatiently for Monday to try to see an ENT.

When Monday arrived, I called multiple ENT offices around the city to find an appointment. Most had no openings for a couple days. I found one office on the far side of town that had appointments available for an audiologist and an ENT. I got in my car and drove nearly an hour, anxious and worried about what I might learn.

The audiologist did a full battery of tests. I had gone through this just four years earlier, so I had a good baseline against which to measure.

The results were unnerving. My left side hearing loss was serious to profound — I could not distinguish words on the left side. The audiologist suspected I had SSNHL (Sudden Sensorineural Hearing Loss).

SSNHL is idiopathic – we don’t know what causes it. There are many theories, but none has been verified. The treatment is steroids, and it is important to take them as soon as the sudden hearing loss occurs – ideally within days. If one waits one or two weeks before treatment, chances of recovery greatly diminish.

To make matters worse, the ENT I had hoped to see was tied up in the operating room and wouldn’t be able to see me the same day. I would have to wait two excruciating days more to see an ENT.

Driving the long way home, thoughts of “A Silence Haunts Me” filled my head and overwhelmed my heart. What if I were to lose my hearing permanently? “Dr. Google” indicated I should have started taking steroids within 72 hours of onset, and I beat myself up for waiting longer than that period.

Wednesday finally came, and I saw an ENT. Thankfully, he was very thorough, compassionate, and explained everything to me. Yes, I do have SSNHL.

Since the Prednisone did not seem to be helping, the ENT recommended the next step, which he admitted sounded scary. He would be injecting steroids into my ear. I would receive three shots, one per week. He assured me this is the “gold standard” of treatment for SSNHL.

As unsettling as that treatment sounded, I would have let him do anything to increase my hope of recovery.

He also ordered an MRI to rule out any circulatory, growth, etc. conditions that could be the cause.

I asked him what the chances of recovery are. He said that about one-third of patients experience complete recovery, another third gain partial recovery, and the last third do not recover at all. As stark as those odds were, they were better than I had been contemplating before meeting him.

He also said that because a) I had started my Prednisone regimen early (within two weeks) and b) that I still had some hearing in my left ear, he was optimistic about my chances of partial to full recovery.

He told me about one patient that had absolutely zero hearing from SSNHL. He was not optimistic about that patient’s chances, but they actually recovered most if not all their hearing.

III. My first rehearsal

I had not performed in four months. I was recovering from a shoulder issue, and the evening of the same day as my ENT appointment was my first rehearsal. I didn’t know what to expect.

For the first hour, I could not hear myself at all.

As musician, especially a string player, this is akin to flying blind – you have no idea whether you are playing in tune. My fingers moved with muscle memory to their spots on the neck of my viola, and I just had to hope and pray.

Gradually, my right ear began hearing a little of my own playing, and it wasn’t bad. I made it through rehearsal without incident.

This weekend we will perform an ambitious concert including Bernstein, Verdi, and Korngold.

Beethoven is not on the program, but he will be in my mind and heart as we perform.

The next month will reveal if and to what extent my hearing returns.

Update 1: Post-Concert (4 Days After the Onset)

I was able to make it through 4 hours of rehearsal Friday, two hours of rehearsal Saturday, and concerts both Saturday night and Sunday afternoon.

Although I haven’t noticed any change in my left ear, I have been able to adjust to hearing myself playing a little bit with right ear. Only at moments, though.

My next shot in the ear will be in a couple days. I am also scheduled to get an MRI on the same day.

I wait with hope with as much grace and as little anxiety as I can muster.

Update 2: Second Shot and MRI (15 Days after Onset)

I received my second shot in the ear today. I will get a third one a week from today. Amazingly (and rather scarily), they administered no anesthesia and were able to insert the shot through the tiny pinprick created by the shot one week earlier. I experienced no discomfort, heard some odd noises, and could slightly feel the drops that were injected. I experienced no pain, dizziness, or nausea.

Less than an hour later, I arrived at medical imaging for an MRI. I spent 30 minutes inside the massive tube listening to classic Rock punctuated by the whines, pounds, and buzzes of the machine.

Since my left ear is so impaired, it sounded like they were only imaging the right side of my head. I guess having reduced hearing is one small advantage to enduring an MRI scan.

I will receive my third ear shot next week, and the following week I will have a comprehensive hearing test to see if any of my hearing has been restored, and to what extent. I remain quietly hopeful.

Update 3: Acupuncturist (17 Days after Onset)

I had appointments with both my chiropractor and my acupuncturist. The good news is that my shoulder is healed. I still need to exercise it to strengthen it and increase flexibility, but after the rigorous and extended workout it endured rehearsing and performing last week, I experienced no pain.

I informed my acupuncturist about my hearing loss. He said he could assist me in healing my ear and promptly inserted about four needles around my left ear. He gave me added hope for recovery.

Update 4: Acupuncture and Ear Shot #3 (22 Days after Onset)

Up to this point, I have mostly kept a calm demeanor, letting myself rest and heal and keeping note of any changes however small I might be experiencing. I woke today, though, with some dread and heavy sadness I haven’t felt in a few weeks regarding my condition.

Today I had my third acupuncture treatment focused on my hearing. I always concentrate on anything I notice or experience during and after my acupuncture treatments, and when I shared them with my acupuncturist, he was upbeat and expressed confidence positive things were happening. That gave my mood a boost.

I then visited my ENT to receive my third and final shot in the ear. When asked if I was noticing any improvement, I answered, “no” and saw their face fall. That hit me hard.

There are instances where hearing recovers weeks or even a couple months after the shots have been administered. But they normally see improvements by now.

She gave me a larger shot, filling my middle ear with corticosteroid, then left me for 20 minutes to let the drugs hopefully permeate my thus far recalcitrant hearing anatomy.

I will return next week to get a full audiological test which will provide quantitative measurements of any changes or improvements.

I remain as calm and patient as I can, although today am experiencing more fractures in my equilibrium and serenity.

Update 5: Second Hearing Test and ENT Appointments (30 Days after Onset)

Today, I received another in depth hearing exam to compare with the one I had a little over three weeks earlier. The results showed no improvement in my left-side hearing. In fact, there was one higher frequency at which my hearing had degraded from “serious” to “profound.”

The ENT does not think there is any chance that I will experience recovery.

I have scheduled an appointment with another audiologist to discuss various technological solutions, the most likely being a crossover hearing aid (CROS) designed specifically for single-sided deafness.

One day later I met with my acupuncturist (who is also an MD), who encouraged me to not to lose hope. He allowed that the odds are long, but that in every group of people, there will be outliers. Additionally, he believes the second hearing test was performed too early, and that healing and recovery may still occur. HIs words were encouraging, although I have to acknowledge my chances are slim.

I have also reached out to my neurologist to make sure there isn’t anything else going on which could either explain my hearing loss. Additionally, I want to rule out anything that might lead to further neuron death or sensory losses.

Update 6: Audiologist Hearing Aid Appointment (37 Days after Onset)

Today I visited an audiologist recommended to me by my ENT. This one specializes in various hearing aid/surgery options.

The audiologist was friendly, boisterous, and a font of knowledge. As expected, we’re starting with crossover hearing aids. Oregon law grants me a 60-day trial period during which I can return the hearing aids for any reason. That 60-day period resets when I get my second set. Since I’ve never had hearing aids before, it’s nice to know I have the easy option to compare sets rather than being locked into whatever I choose initially.

I decided to try a set that gives me a lot of options to tweak and adjust. My thinking is I may have one configuration for everyday work, another for conversations in noisy environments, one for when I’m rehearsing and performing with the symphony, etc. I’ll receive them in time to test them on a short overseas trip as well as during my next orchestra concert with Oregon East Symphony.

We also briefly discussed a couple invasive surgical solutions:

  • Bone conduction crossover surgery (aka contralateral routing of signal or CROS via implant)
  • Cochlear Implant (CI)

I’m not keen on invasive surgery, so of course we’ll try crossover hearing aids first. Hopefully the non-surgical solution will be satisfactory.

Update 7: Naturopathic Medicine (51 days after onset)

Two possible treatment paths have come to an end a new one has started. My ENT has no more treatment to suggest. All I can do is wait for my crossover hearing aids, which are due to arrive in a couple weeks.

My acupuncturist has completed his regimen of treatments. He urges me to remain hopeful. He thinks there is still room for improvement and to remain open to that possibility.

A good friend of mine encouraged me to see a naturopathic doctor. With their help, I found and secured an appointment with a recommended practitioner.

That appointment was last week (42 days after onset). The doctor suggested several therapies, openly acknowledging that none has been proven through human clinical trials to cure SSNHL. They have shown positive results in animal tests and in human cases for other ailments.

I figured, they can’t hurt, and if there is a chance they can help, I’ll try them.

It’s been a little over a week, I have not noticed any changes.

I have continued sharing my journey with a second blog post followed by a third post.