One Ear Two Ear Old Ear New Ear

Over the past decade, it has become standard practice to implant deaf children bilaterally (that is, on both sides), but this was not always the case. When our family was going through the implant candidacy process, it was customary to only implant one side, even when, like Grace, the recipient had a profound hearing loss in both ears.

So, Grace experienced her first seven years of sound hearing only through her left ear. She, like many other children who received unilateral cochlear implants early, and participated in ongoing and effective intervention for speech and language development, did remarkably well. She developed an impressive vocabulary early on, and learned to understand some Spanish as well as English, because her caretaker Ana spoke Spanish with her almost exclusively from the time her implant was activated. She developed friendships, succeeded in school, played sports, and solidified her role in our family.

When Grace was eight years old, she had implant surgery on her right side, and in the winter of her third grade year, she began learning to hear bilaterally. She knew it would take a good amount of work to train her new ear to understand the input it was receiving. And we weren’t sure how much added benefit Grace would get. But we did know she would now learn to locate the source of the sounds she heard, because she’d be hearing in stereo. We hoped she’d have an easier time navigating and sorting through various sounds in noisy situations. And, she was going to have a backup in the event of device failure.

This summer, Grace is twelve years old. She is now nearly two inches taller than I am (which isn’t saying all that much, since I’m only five foot one, but still…), and has finished her first year of middle school. She went away to camp for the first time – to a science program at a small liberal arts college in Central Pennsylvania. The manufacturer of her CI, Cochlear Americas, has released the Aqua+, a waterproof casing, transmitter coil, and cable, that has enabled Grace to swim with her processor on for the first time. But after several successful swims with her cousins and sister at the pool where her grandparents live, something went wrong and her right processor stopped working.

I’d been a bit nervous about letting Grace use the Aqua+ accessory, and so was rather tyrannical about only letting her use it on her right side – the one that over time has gotten pretty good on its own, but that is the newer, and therefore the weaker ear, and probably always will be. I had reasoned that if something went wrong, she’d still have her “good” ear until we were able to get a replacement.

For several days, Grace went back to wearing only her left CI. And, around the same time, she experienced her first case of swimmer’s ear. I hadn’t realized how painful swimmer’s ear was – but after three nights with my usually stoic Grace being up most of the night, I kept wondering when the antibiotic drops would kick in and give her some relief from the pain. The right ear was considerably worse than the left, so when her new replacement processor showed up, she wasn’t ready to wear it.

All this to say, Grace and I have had a series of really interesting conversations lately about her observations with one CI versus two. Here are some snippets and sum-ups from them.

• After spending a few days with only one processor and then returning to two, Grace said that although she’d stopped really noticing or paying attention to what things sounded like bilaterally, she was now appreciating just how much benefit she got from a second. I asked her if things were a lot louder. She said, yes, but the biggest thing she noticed was the crispness of things – the clarity. Music, especially, sounds better. I asked if she could explain how – was it easier to hear the different instruments or pick out the lyrics? Yes, she said. Then she said, “It’s like pixels on a TV screen. With one CI, it’s like having 10,000 pixels. With two, it’s more like having 100,000.”

• I noticed that I needed to repeat myself a lot more often when trying to get Grace’s attention when she was only wearing one CI. Before she received her second one, I don’t remember this happening as often. Maybe I just used a louder voice back then?

• Grace said that using only one CI was “confusing”, now that she’s gotten used to using two. She has grown so accustomed to knowing where sounds are coming from, that her week+ with only one was baffling, since she could no longer determine the source of sound without seeing the speaker or using deduction. Grace told me that one night, right before bed, she was trying to talk with Jason, but in the dark, she couldn’t tell if he was above or below her. Not only can she not figure out if sounds are coming from the left or the right when she’s only got one processor on, but she can’t tell whether they’re up and down either.

Grace is back to using both processors again. Her ear is all better, she’s back to school, and she’s hearing in stereo again.