Bilateral Cochlear Implants – On Beyond the Testing Booth

By Arlene Romoff

As a bilateral cochlear implant user and author of Listening Closely: A Journey to Bilateral Hearing, I’m frequently asked about the benefits of bilateral CIs.  The quick answer?  Better hearing, doing better in noise, directionality, not having a “better side,” being able to turn to danger, having backup in case one CI stops working, and an elusive happy feeling about hearing with two ears.  As appealing as these reasons seem, they don’t even begin to convey the true impact on daily living – the real reasons.  Here’s the insider’s view, so listen closely.

I was a single cochlear implant user for over ten years, and was happy to remain that way. Why rock the boat, I figured.  I had attended workshops and read articles on the benefits of bilateral CIs, but nothing was compelling enough to make me go through another surgery – until my first CI stopped working.  The full impact of those words “having backup in case one CI stops working” didn’t really hit until the world went silent. For me, I was thrust into 24 days of deaf silence until I could get the internal component surgically replaced and activated.  That’s the reason I went bilateral 3 ½ years ago; being instantly isolated by silence gave me the courage to realize just why I needed backup.  I never wanted to experience that silence again.

Making the decision to go bilateral seemed simple enough, but choosing to have elective surgery requires true commitment.  As the surgery date approached, the doubts started creeping in – and that is perfectly normal. It’s a different psychological mindset than opting for the first cochlear implant, where the change is expected to be dramatic. The benefits of going bilateral are far more subtle. The best advice is to stay focused and just keep going with those bilateral plans – it’s worth it.

One remarkable revelation when implanting the second ear was that the entire surgical experience could be done with sound – not deaf.  I arranged for the first ear’s processor to be held during surgery, and put back on in the recovery room. That resulted in a far less stressful experience than navigating an entire hospital stay in silence.

Once the surgery was over, the backup was in my head, and that meant that I was what I called “bilaterally enabled.”  YES!  Even before being activated, I could check off one of the items on the bilateral benefits list – the backup was there!

The fun begins at activation.  It seems that Mother Nature has created human beings with two ears for a reason, and evidently there’s a part of the brain that is dedicated to coordinating those two ears.  Once that second ear is activated, the brain can begin doing all the wonderful things it couldn’t do with only one ear.   It’s quite possible that “better hearing” and “better hearing in noise” can happen immediately simply because the brain can make it seem as if the new ear is functioning better than it could alone.

Directionality is a bit trickier.  It seems that when the second ear is activated, it launches our “hearing age” clock. Just as babies don’t turn to sound for a few months, the same is true when that second ear is activated.  It took me several months before I turned to someone calling my name – just like a baby.  But once that happened, it unlocked the powerful realization that there’s much more to “directionality” than simply turning to sound.

Being able to locate sound gave me a feeling of connection to my world, creating a virtual sound landscape.  I could tell where conversations and sounds were occurring around me, and that was empowering.  I could choose to join conversations or even eavesdrop!  The ability to communicate with others with greater ease is also the basis of socialization and, ultimately, personality.  As confidence builds, long-standing behaviors change – initiating conversations rather than just responding.  This is a real consequence of “better hearing,” and can turn a quiet, tentative person into a social butterfly.

Turning to one’s name is not just a convenient trick; it impacts the behavior of others.  If someone knows that you won’t turn around if they call you, they’ll stop calling or only get your attention for “important” things. But life is in the details, isn’t it? If you respond quickly and appropriately, then you’ll get the small stuff that is “not important” enough to repeat.  The basic reality of this situation is that people treat you differently when they know you can hear them.  If you behave normally – turning to their call – they will behave normally, too.

The sound landscape concept is also the basis for “hearing better in noise.”  With the sounds separated, and knowing where they are coming from, it’s easier to direct your attention to the voices or sounds you want to hear.  It’s not just an incomprehensible jumble, but a palette of sounds to choose from.

Not having a “better side” is a benefit that seems simple and obvious, yet its impact on socialization is enormous.  With one ear, there are continually decisions to be made on where to sit or which side to stand on. That means that “hearing impaired” behavior is constantly figuring out how to optimize that single ear.  With a second ear, those concerns and behaviors evaporate.  No need for them anymore.  That’s liberating, and creates the opportunity not to dwell on hearing loss – and even the possibility of not mentioning hearing loss when communicating with others.  That impacts personality as well, producing an aura of confidence and a greater command of one’s surroundings.

Reflexively turning to danger – automatically whirling to the source of sound – is very different from just being startled by a sudden noise.  It’s a split second warning to action, whether a car horn or something crashing behind you.  It’s a human function that is designed for safety, and simply doesn’t happen with a single ear.

And what about that last item on the benefits list, an elusive happy feeling of having two ears?  Surely the above explanations give ample reason to feel happy, yet the real explanation probably lies somewhere in the depths of the brain, reinforcing behaviors associated with speech, language acquisition and socialization that developed over thousands of years of evolution.  For our purposes, it’s simply icing on the cake, giving confidence to encourage communication and social development.

You’ve now gotten the insider’s glimpse of the real impact of bilateral CIs. There’s much more, of course – and if you read my book, blog, and Twitter @aromoff, as well as what others have written about their bilateral experiences, you’ll realize that much of the benefits of bilateral CIs are “on beyond the testing booth.”  But the clues are all there if you listen closely.

Arlene Romoff is author of Listening Closely: A Journey to Bilateral Hearing and past president of the Hearing Loss Association of NJ