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Musicians with Cochlear Implants (CIs): Singing or Playing Instruments While Using Cochlear Implants: Information for Audiologists

last modified on: Wed, 05/19/2021 - 23:42

See also: Articles on Music, Hearing Loss, and Hearing DevicesPages for audiologists

 

 

 

Musicians with Cochlear Implants:

Information for Audiologists

 

Information for cochlear implant (CI) users who are professional or serious avocational musicians:

Resource materials written specifically for CI users can be viewed and downloaded at the patient page for musicians who use CIs. 

 

Audiologists focus primarily on spoken communication. What makes musicians' audiological needs unique?

  •  Musicians have invested years in musical training; music can be part of their personal identities. For these CI users, successful engagement with music is an important aspect of device satisfaction.

  •  Before hearing loss, musicians typically found music personally rewarding and pleasurable. Restored enjoyment in making music can enhance the quality of life and normalization.

  • Group music-making provides social opportunities and support; this helps maintain social relationships and community involvement.

  • A passion for music can motivate musicians to invest considerable time and effort in rehabilitation exercises. Improved music engagement may carry over to enhanced speech communication.

Gospel choir Orchestra and choir performance

1, 2  

Music has always been my greatest source of joy, and I was determined to never give up on it or lose it.

 

Audiology appointments are already full from programming and speech-related concerns. How can I find time to talk about music?

  • Consider including some questions about music as part of patient intake materials to determine how important music is for individuals.

    • Identify patients with strong interests in music.

    • Compile a list of web links about music and CIs that you can print out or e-mail after the appointment.

      • This website includes pages written for patients who are interested in music. Keep those links readily at hand if questions arise.

      • Some online CI users groups focus on music. Those user groups may include interactive pages or blogs. 

 

Why is music-making with a cochlear implant difficult?

Cochlear implants are not ideally suited for transmitting the structural features of music. [link to CI technology and music page]

  • Music may sound distorted or strange.

  • Cochlear implants do not transmit pitches like a normal ear does. 

  • Playing instruments and/or singing in tune with others is especially difficult. 

  • Slow or limited improvements in music listening and music-making can be discouraging and exhausting.

  • Musicians may have to cope with unpleasant sounds while adjusting to their instrument; this can undermine long-term commitment to device use.

As a professional flutist, I had an extremely difficult time adjusting to my own instrument and stopped playing for a number of years. I just couldn’t hear the timbre or tone quality that I remembered.

 

Musicians who use CIs have reported the following problems:

  •  Difficulty hearing clearly in rehearsals spaces because of 

    • poor room acoustics (echoes, background noise)

    • many instruments or voices making music at once.  

    • the CI user's location in an ensemble-- for example, sound coming from all directions if seated in the middle.

  • Problems with CI Technology, such as

    • poor pitch resolution makes it difficult to sing/play in tune.

    •  difficulty changing program options to hear speech or music.

    •  reduction in quality of tone and timbre.

    • adjusting to one’s musical instrument or voice after implantation can make practicing frustrating and overwhelming.

  • Negative feelings associated with making music such as 

    • missing how music used to sound.

    • missing out on sounds other musicians can hear.

    • feeling stigmatized by other musicians.

    • discouragement in re-learning musical skills.

I sing in a choir and the rehearsal room (in a church) has horrible, live acoustics. I find I have to keep changing my CI program to 'voice' when the conductor is speaking and then to 'music' when we are singing.
It is very difficult for me to hear all voices and harmonies in a full ensemble, plus accompaniment if applicable. My experience can easily turn into what I call ‘sound soup.
Being dismissed as a musician due to deafness or CI happens occasionally and is difficult to accept.

 

No two CI users are exactly alike. Each musician with a CI has different experiences with music-making.

There are a variety of factors that influence these differences:

  • Different instruments (including the human voice). Some instruments may be more or less difficult to play when using a CI.

    • Some instruments have fixed pitches (e.g. piano or percussion) and do not require ongoing tuning. Other instruments (e.g. violin, guitar, or trumpet) require on-going tuning. Instruments with fixed pitches tend to be easier to play.

  • Extent or type of music instruction before or after implantation.

    • Some individuals use their knowledge of music theory or ear training as part of listening practice.

  • The amount of residual hearing and/or onset of hearing loss.

    • More residual (acoustic) hearing can help CI users hear pitch and timbre more accurately.

    • Some people who grew up listening to music can use top-down mental processing to ‘piece together’ the musical sounds.

    • Some people who grew up with CIs are more satisfied with the sound of music through their CI because they cannot compare it to more ‘normal’ sounds.

  • Individual personality traits can make a difference. Characteristics (sometimes referred to as self-efficacy) that tend to help with music-making after implantation include:

    • Persistence and hardiness.

    • Positive attitudes and the ability to focus.

    • A sense of accomplishment in adapting to new challenges.

  • Amount of experience with the cochlear implant.

    • Music perception can improve over time with increased experience and devoted listening practice.

For about 6 months, music sounded absolutely horrible and I was afraid I might never enjoy it again. But I persisted.
I chose to sit at a piano and play things [patterns of notes] until they sounded different. At first, the keys C and G, a perfect fifth interval, sounded the same.

 

Here are some stories from musicians who use cochlear implants: 

In this video, Cochlear implant recipient Tim Brandau talks about how he hears music via cochlear implants. 

Kay Basham, who is a pianist and a cochlear implant recipient, talks about her experience with cochlear implants and music. 

A musician and bilateral cochlear implant user, Alex Mansouri shares the story of improving music perception. 

 

 

 Trombone playersConga player

Prior musical experiences and training may enhance music listening perception in a number of ways:

  • Increased exposure and repeated listening supports learning and how the brain processes music.

  • Understanding building blocks of music makes it easier to discriminate between different musical components.

  • Development of discipline and strong work ethic can come from taking lessons. This can carry over to music training with a cochlear implant.

I was a musician in high school and middle school. I understand elements in music and have a decent idea of what to look for.

 

 

Accommodations and Approaches for Music-Making

Through dedicated practice, CI users can be very successful at making music. There are approaches that can help create a more pleasant music-making experience. However, it is important to keep in mind that what works for one person may not work for someone else. Some trial and error are usually necessary. 

CI users have shared the following problem-solving strategies when making music:

  • Limit competing noise and adjust the environment for good acoustics.

    • For example, putting quilts or blankets on the walls to help absorb sound.

  • Adjust the CI programming and/or sensitivity for different kinds of music and environments.

  • Use a visual tuner to help you play in tune with others.

  • Try different instruments, types of music, or environments to see what works best for YOU. 

  • Use non-auditory sensory cues to complement the information you hear.

    • Visual cues can include following sheet music or lyrics to support perception.

    • Sense of touch can help you feel the beat of the music.

  • Seek practical ideas and moral support from other CI users at conferences, support groups, or online.

  • Engage in social aspects of music, such as local choirs/ensembles that are supportive of your unique musical needs.

    • This can be more motivating and support practice.

I believe that engaging all of the senses is very helpful to regain music perception.
Playing piano- For this I need to be in a room where the acoustics are good and do not reverberate. I have a quilt hanging behind my piano to help stop the sound bouncing off the wall.

 

Musician using tuner Saxophone player reading sheet music

Recommendations for choosing instruments to play:

  •  CI users who have difficulty hearing pitches may prefer to choose a rhythmic instrument, such as the drums or piano.

    • However, some CI users may enjoy the challenge of learning instruments that require ongoing tuning.

  • Choose an instrument that has a pleasant sound to you;

    • Instrument preferences may change after getting your CI. 

    • Preferences may differ from one CI user to the next.

  • If you have some residual hearing, select an instrument that complements the notes (low to high) you hear most accurately.

The last three years, I have taken up violin. I chose this instrument because it gives me the basic melody and doesn’t get lost in the chords like on the piano.

 

Recommendations for musical instruction:

  • Choose a teacher who will accommodate and understand your hearing loss. Switch instructors if you need to.

  • Practice self-advocacy by communicating your needs to teachers.

    • Give teachers information about hearing loss, cochlear implants, and music so they understand the challenges. 

 

In conclusion, music is important to the lives of musicians. Music can be central to the identity of musicians; it can also be both socially and personally rewarding. Audiologists should be sensitive to the significant loss a musician may feel after implantation, due to potential reduction of sound quality and subsequent adjustment. Dedicated and persistent music listening practice can improve perception over time, but it can be an ongoing and difficult process. Progress may not always be immediately apparent, so CI users may need continued motivation and support. Recommendations discussed on this page may also be beneficial for CI users who want to try making music.

 

Suggested reading:

This article shares input from a unique cohort of CI users who are high-level musicians, and their strategies for improving music enjoyment and music-making. 

  Click on the title to access the article:  Gfeller, K., Mallalieu, R. M., Mansouri, AL., McCormick, G., O’Connell, R. B., Spinowitz, J., & Turner, B. G. (2019). Practices and attitudes that enhance music engagement of adult cochlear implant users. Front. Neurosci, 13, 1-11.

 

References

Gfeller, K., Mallalieu, R. M., Mansouri, AL., McCormick, G., O’Connell, R. B., Spinowitz, J., & Turner, B. G. (2019). Practices and attitudes that enhance music engagement of adult cochlear implant users. Front. Neurosci, 13, 1-11.

Gfeller, K., Oleson, J., Knutson, J. F., Breheny, P., Driscoll, V., & Olszewski, C. (2008). Multivariate predictors of music perception and appraisal by adult cochlear implant users. Journal of the American Academy of Audiology, 19(2), 120–134.

Hsiao, F., & Gfeller, K. (2012). Music perception of cochlear implant recipients with implications for music instruction: A review of literature. Update: Applications of Research in Music Education, 30, 5–10.

 

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