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| Ari Gold as air drummer Power in a scene from “Adventures of Power.” Photo courtesy of Variance Films |
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| Barbara Gallagher. Photo courtesy of David Pell |
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| Children recently implanted with an Advanced Bionics CI receive Melody the Monkey, a plush toy with bilateral CIs. Photo courtesy of Advanced Bionics |
As a researcher, I have had the distinct pleasure of working with numerous cochlear implant (CI) users, both children and adults. Without exception, they are thankful to be able to hear, and for many of them, I can barely tell they have a hearing problem at all. Some understand nearly everything I say and can hear me just fine. Others have a little trouble understanding speech but function as though they had mild to moderate hearing loss and get along quite well. CI-users typically have great difficulty hearing speech in noisy environments, being much more adversely affected by noise than even hearing aid users. Nevertheless, the ability to understand a spouse, parent or child, or to hear birds or one’s teacher demonstrates that the CI has been nothing short of a technological marvel.
Nearly all of our research participants say that, next to hearing people speak, nothing is more important than being able to hear music. A number of those who have participated in our research projects are or were musicians. Even for those who aren’t, old-time rock ’n’ roll, country, jazz or the classics like Beethoven were an important part of their lives. Here, the implant consistently disappoints. And the accompanying question is: why?
The primary weakness of CIs is their inability to deliver pitch information. There has been a long-standing controversy regarding what acoustic information normally hearing people use to allow them to perceive pitch. This controversy dates to the days of Georg Ohm and Hermann von Helmholtz in the mid-19th century. They postulated that the ear acts as a frequency analyzer, extracting the frequencies of the many tones comprising the sounds we hear. This is consistent with a theory of hearing which says that some places in the ear respond to high frequencies, others to low. Later work by Nobel laureate Georg von Bekesy demonstrated that this theory was true: The base end of the cochlea responds to high frequencies and the apex (or the end) of the cochlea responds best to the lowest frequencies.
Nearly concurrently, another scientist named August Seebeck postulated that pitch perception actually involves hearing the timing of successive pulses. Seebeck generated a siren using a wheel with holes in it. Then he forced air under pressure through the holes with a fixed nozzle. The air going through the holes made noise and spinning the wheel created a pulsating sound with a certain pitch. The faster the wheel turned, the higher the pitch. If the spin rate doubled, the pitch would go up an octave. Thus, Seebeck demonstrated that there was a temporal element to pitch. Helmholtz was the more respected scientist at the time, so his theory held for nearly a century. But in the 20th century, research was conducted that confirmed that timing information also contributes to pitch perception and that this could lead to the perception of pitch at a place where there was actually no acoustic energy. That is, a repetitive buzz-like sound could have the same pitch as a 200-hertz sine wave, but not actually have energy at 200 hertz, so long as the repetition rate was 200 hertz. It turns out both theories are correct. The human ear encodes pitch according to place and timing information.
So, what does all this theory have to do with CIs? The CI encodes frequencies according to place. Unfortunately, however, most of the fine timing information that could contribute to pitch is lost. The implant divides incoming acoustic information into 12, 16 or 22 channels, whereas normal hearing gleans information from 30 to 40 channels. Even in the best scenario, place information is already degraded relative to normal hearing. The degenerated condition of the auditory nerves of implant recipients further limits the end result to eight or nine functional channels. Additionally, CI-users lack information that hair cells normally “gather.” Groups of hair cells and their associated nerves, working in tandem, have the ability to capture the detailed pitch timing of each wax and wane of the acoustic wave up to 3,000 to 4,000 hertz. This ability is almost completely lost in the implant-user, who rarely gets such information greater than 300 hertz. Thus, the refined pitch, chords and melodies in music that normally hearing people enjoy often become a garbled, blurred mess when heard via a CI. For the CI-user then, the ability to perceive both place and timing information about pitch is marginalized.
Despite these unfortunate limitations, rhythm perception, an essential element of music, is nearly normal in CI-users. Rhythm carries a lot of information and is an underestimated component of music composition. In fact, half the challenge of composing intriguing, aesthetically pleasing music is creating an intriguing, aesthetically pleasing rhythm. If someone were to tap the rhythm of a familiar melody, many people could identify the melody without any pitch information at all. Imagine, for example, the rhythm of “Happy Birthday” tapped on a table. As such, more rhythmic or percussive music might be more enjoyable to CI-users. Additionally, the CI-user might be able to superimpose a melody they learned at a time when their hearing was better, making good use of auditory memory.
The brain is the CI-user’s greatest asset. With training and effort, the CI-user can utilize the garbled mess they hear, perhaps finding cues in the implant stimuli, and make the best use of music based on memory. Also, in the vein of Charles Ives, in which any sound might be considered music, the CI-user can learn to find aesthetic value in the “new” sound. Perceiving art, and art in sound, is primarily a state of mind. This is especially true for congenitally deafened children who have no memory of “normal” pitch perception. In a special session of the Association for Research in Otolaryngology a few years ago, a number of outstanding musicians who wear CIs were featured. They were all truly talented artists and their ability to make music, with their marginalized hearing, was amazing. As also evidenced by Beethoven, the famous post-lingually deafened composer, a musical mind remains a musical mind, with or without hearing.
While musical perception occurs largely in the mind, there have been efforts to improve the quality of sound delivered to CI-users. One of the more promising is an Advanced Bionics device that uses current-steering, a process by which the electrical current is balanced between electrodes, creating “virtual channels.” It has been well documented that current-steering can create an increased number of pitch perceptions with a single pair of electrodes. Current- steering has been implemented commercially with HiRes Fidelity 120™ CIs (F120 for short). Many listeners like the quality of sound that results from this CI’s processing, although there is little evidence of objective clinical benefit of the processing. Some data has suggested that spectral resolution is improved via F120 for some of the better listeners.
Another strategy developed by Cochlear, called MP3000, reduces the number of spectral peaks in the electrical excitation by only delivering electrical information that a normally hearing person could hear. This could theoretically improve spectral resolution. Another experimental approach includes extracting the fundamental frequency of incoming sound, then setting up an electrical pulse rate at that fundamental frequency to recreate timing-based pitch. This has had some marginal effect on improving speech understanding in a noisy environment. Yet another approach that is advantageous for musicians involves adjusting the filters in the implant to match known pitches. If the filters are well-matched to known intervals, this could make music that normally sounds “wrong” sound more right. This kind of approach is more technical and requires a musically astute CI-user. Recently, a validated test of hearing has been developed to evaluate such engineering effects. It is called the Clinical Assessment of Music Perception (CAMP). The CAMP incorporates a test of complex pitch-perception using piano-like tones with a harmonic structure; a test of musical timbre perception where listeners identify one of eight different instruments in a live recording; and a test of melody perception without any rhythm information. For a larger group of listeners in a multisite clinical trial of the CAMP, average pitch discrimination was 2.6 semitones (half-steps on a piano), which is significantly worse than normal hearing, which is less than one-half a semitone. For timbre and melody, average scores were 43 percent and 27 percent, respectively, with about half of the listeners scoring at chance levels on the timbre test and two-thirds on the melody test. For a few star listeners, melody and timbre scores were over 90 percent correct, which is near normal. The CAMP has been used to compare different processing strategies and unfortunately, to date, no significant effects have been observed.
In summary, CIs deliver musical rhythm well, but are mostly poor at delivering pitch information. Some technologies have been developed which are intended to improve music perception in CIs and, while subjective qualitative benefits have been observed, none of the new processing schemes have yet been shown to provide objective improvement in basic music listening skills. Nevertheless, CI-users can still enjoy music, especially the rhythm of music. With substantial determination and self-training, many CI-users continue appreciating and partaking in the musical arts.
Ward R. Drennan, Ph.D., is a hearing scientist at the V.M. Bloedel Hearing Research Center at the University of Washington. He has previously worked for the Kresge Hearing Research Institute in Michigan and MRC Institute of Hearing Research in Scotland. He also freelances as a clarinetist in the Seattle area.
ADVENTURES OF POWER
REVIEW BY DONNA LEE SCHILLINGER
If the news that cochlear implant technology still has a long way to go before users can appreciate music is discouraging, you need to know that you still have options: You can always become an air drummer. Don’t laugh! (Or cry.) Air drumming is serious business to those who have it in their blood, like Power, the protagonist of a new movie this fall, called “Adventures of Power.” An official selection of the Sundance Film Festival, this comedy in the vein of “Napoleon Dynamite” is a window into the world of those who could have, should have, but didn’t get a set of drums as a kid.
Power (played by writer-director Ari Gold) works in a mine with his father (Michael McKean), but he’s only as productive as the rhythm of whatever music he’s listening to will allow, making him the object of constant ridicule, to which he is impervious. When the inevitable work accident gets him fi red from his job, he decides to follow his passion to Newark, where he trains with five other like-minded misfits to become a “set of drums.” The stakes are high, with a $2,000 pot on offer in the upcoming air drumming competition of the year. The only problem is that a ringer has signed up to compete: Dallas Houston (Adrian Grenier), the mine-owner’s son, who could have, should have and did get a set of drums as a kid. In fact, his father was adamant that his son learn to play real drums so he would give up the abomination of air drumming. Trouble is, once it gets in your blood, there’s no cure.
The contest propels Power to air-drumming fame but the greater gain of his move to Newark is meeting Annie (Shoshannah Stern). Deaf as a result of sound trauma from a rock concert she attended as a toddler (it’s a comedy, folks), Annie can only feel rhythms, but has no recollection of what music sounds like. Through Power, she “sees the music.”
“Adventures of Power” is understated on all but one level – the soundtrack. Rockers of the 1970s and 80s will not be disappointed, as the movie is peppered with memorable hits from Rush, Dazz Band, Phil Collins, Mr. Mister, Bow Wow Wow, Loverboy and Judas Priest. However, the superbly cast line-up suffered under rookie direction, film and sound editing. Even so, Grenier was born to play Dallas Houston, the closet air drummer. And the moment when Power and Dallas lock eyes in a pre-competition meeting is cinema magic.
Although some minor misconduct (the cock fight, maybe?) earned the film a PG-13 rating, teens who dig cult films will find a new icon in Power. Teens with hearing loss will enjoy Stern, whose first language is ASL, in a speaking role. And for the rest of us, beyond the “feel-good” we get from just watching another geeky underdog triumph in the end, “Adventures of Power” provides a funny way to seriously consider music appreciation via rhythm. Gold and Grenier, both truly excellent air drummers (and real-life musicians), yielded a new appreciation of something many might regard as being on par with singing in the shower.
Watch the trailer and learn more at www.AdventuresofPower.com. Limited release in theaters beginning in October; check the Web site’s Theater/Events link for venues.
THE MUSIC WITHIN
BY BARBARA GALLAGHER
Growing up in a musical household, I always loved music, spending countless hours exploring at the piano – making up tunes, trying out combinations of harmonies. Music was my special place to create, express and play.
I studied music composition, earning degrees from the University of North Carolina School of the Arts and The Juilliard School, where I held a teaching fellowship in ear-training and solfège, a technique for teaching sight-singing.
My career began to blossom as I took on freelance composing, performed in restaurants and churches and was offered a teaching position in the pre-college division of Juilliard. But in 1985, at the age of 26, I started experiencing tinnitus and hearing loss, which I suspect were related to noise exposure. I went to various doctors hoping for a remedy but my hearing loss became so problematic that in 1989 I decided to return to my home state of North Carolina, which offered a quieter environment than New York City.
I got my first hearing aid, a Beltone, in 1990, which enabled me to continue performing, composing and teaching at a local community college. As my career progressed over two decades, so did hearing technology. Next I purchased a pair of Rexton CICs, then Phonak ITEs and I now wear Widex BTEs. The next step will be cochlear implants. Technology and professional medical assistance have kept pace with my hearing loss and have enabled me to compose, release several CDs, perform orchestral works, do radio broadcasts, play for ballet, theater, live television and even tour. It's been a busy 20 years!
One might wonder how a person with hearing loss can work as a musician. I have adapted with some important communication aids. I rely on visual signals: My cue to begin playing at church is when the priest lowers his hands or makes eye contact. At holiday carol parties and church hymn-sings, I have an assistant show me which song I need to play. In workshops, I gather students around the keyboard so I can more easily hear them and when teaching classes, I walk up to the students' desks when they have a question. I also try to get input in writing: I pass around a notepad on which students can write their questions. And, instead of making phone calls to conductors and performers, I use e-mail. Finally, I often have my students sing their ideas to me because music is so much easier to understand than speech!
But what about issues with the actual music? Both composing and performing hold unique challenges. When I compose, I sometimes use a piano, but often the music evolves without an external sound source, because the music exists internally, in my mind. To better understand this concept, think of a song you like; you can “hear” it in your mind with “internal ears.” Some composers rely completely on this internal hearing such that their work is not impeded by hearing loss. I can play music with notes I can't physically hear, but I know in my imagination what they sound like. When I play these “inaudible” notes on the piano or organ, I can double them with lower ones that are audible to me. My hearing loss is in the higher frequencies, so playing the passage lower on the piano, in a cello range, makes it easier to “feel” the effects of the chords.
I think the biggest challenge performing musicians have, regardless of hearing ability, is to focus and transcend – to forget we are there, playing, that the audience is there, listening, and to let the music break forth from its otherworldly realm into ours, into us, into our souls. When I play, I try to reach out beyond the "cymbal tremolo" and "snap, crackle, pop" of my tinnitus, beyond the distorted sound of my physical ears, to another level. At times I can do it easily while other times it eludes me, but when it happens it's a wonderful experience.
My advice to any musician grappling with hearing loss is to find a hearing healthcare professional who really cares about your situation. That person will be an important ally in your quest to continue making music. My audiologist, Aimee Parker, has proven to be such a person, taking the time to find the best settings for my hearing aid programs (including one especially for music), troubleshooting problems quickly and effectively and being sensitive to my particular needs as a musician.
Every field has its great masters. Some of music’s greatest composers have faced deafness, including Gabriel Fauré, Bedrich Smetana, and of course, Ludwig von Beethoven. His “Heiligenstadt Testament,” written to his brothers, expressed anguish over his condition. Yet in his music, perhaps even through his music, he rose above his affliction and gave the world affirming, triumphant works, becoming a voice for all people. Although his ears were failing, he listened to his fellow humans with his heart and expressed their longings, hopes and dreams. While we may speak of music as sounding high or low, loud or soft, fast or slow, these are only components of music that work together to express music’s real intent. Music is not so much about the sound as it is about the feeling, expression of imagination and communication of ideas. And that expression reaches far deeper than the ear.
Barbara Gallagher’s music has been broadcast internationally on National Public Radio and religious radio stations, performed by several orchestras and is published by Hal Leonard Corp. and G.I.A., Inc. She is an active musician and educator in southeastern North Carolina, working with organizations such as Carolina Ballet, Magic Trunk Theater Co., Cape Fear Community College, Fifth Avenue United Methodist Church and St. Mary Catholic Church.
DON’T GIVE UP – TUNE UP!
People with cochlear implants (CIs) may not perceive music the way a person with a typically hearing ear does, but that does not mean that music can’t be fun and enjoyed in a unique way. Children with CIs in particular need to be exposed to music so they can begin to make their own sense out of this complex and wonderful sound that is such a huge part of life in the hearing world.
To this end, Advanced Bionics offers Tune Ups: A Music Program Designed to Foster Communication Development. As the name implies, it is primarily an aural habilitation tool – mixed with some good, old-fashioned schooling. For use by children from preschool through elementary school, the CD with 18 songs also comes with sheet music, lyrics and instructions on how to use each song to promote language development. Additionally, there is an illustrated flashcard for each musical instrument and voice featured on the CD. Developers Christine Barton and Amy Robbins have used the program successfully in the language development of children with CIs; in fact, the background singers on many tracks are children with CIs. Further support for the program is available online at the Advanced Bionics’ Listening Room, by clicking on “Kids” and then “Tune Ups,” located in the online community forum www.HearingJourney.com. To purchase Tune Ups ($19.99), visit www.BionicEar.com (then click on Support, Educational Support, Therapy Resources and then Therapy Resources for Children) or call 800.678.3575.
Tune Ups is a great follow-up gift for children recently implanted with an Advanced Bionics CI, each of whom receives Melody the Monkey, a plush toy with bilateral CIs. The doll’s musical moniker is a tribute to Advanced Bionics’ commitment to software upgrades for its “bionic ears” that enable superior music listening. The Harmony® HiResolution® Bionic Ear is the only CI with the 120 spectral bands necessary for deaf persons to go beyond deciphering simple speech to hearing and enjoying music.
