Our last blog post was by musician Richard Reed, who was late deafened and subsequently received a cochlear implant (What-s-Old-is-New-Again-if-We-re-Lucky). I would like to follow up on Richard’s touching personal account with some professional observations based on my work with adult recipients.

Many CI recipients experience initial frustration in appreciating music. Perception of the richness of music requires various auditory skills including being able to distinguish between sounds that are similar (but differ in their frequency and/or intensity) as well as the ability to follow rapid changes in the music. Cochlear implants cannot convey all of the characteristics of music due to the limited number of electrodes. Regardless of the type of listening device, the auditory system of people with severe to profound hearing loss typically cannot accurately represent the acoustic characteristics of music.

Music appreciation is not an assured outcome of cochlear implantation but many recipients do seek it as an additional benefit that adds to quality of life. The ability to appreciate and enjoy music depends on many individual factors such as age (teens often spend a lot of time listening to music), musical education (before or after the CI), life experiences, and personal preference. It is important to note that not every person with typical hearing enjoys music to the same extent. Some people prefer to read books, watch TV, or go to the theater rather than listen to music or attend concerts.

If you previously enjoyed listening to or playing music and consider musicality as a contributor to your quality of life, you may wish to pursue a specific practice program. According to studies and clinical observations, there are differences in enjoyment of music by CI recipients. Nonetheless, people can enjoy listening to music following cochlear implantation, even if it is not the same experience that they remember prior to losing their hearing (if late deafened) and receiving a CI.

Discerning melody is the most difficult challenge

The difficulty in perceiving music by CI recipients relates primarily to one’s ability to recognize the melodic components of music and isolate a specific sound in the presence of other sounds. For example, listening to a vocalist in the presence of instrumental accompaniment or distinguishing between different musical instruments playing at the same time are difficult tasks. Listening to classical orchestral music, large group ensembles, or lyrics with loud instrumental accompaniment can be frustrating experiences for CI recipients. However, since there are so many styles of music, you can be selective in your music choices and pursue those with strong rhythm, solos, or vocalists with an accompaniment of only one or two instruments. You may be encouraged by studies and personal accounts indicating that auditory training for music can result in improved music perception as well as greater music enjoyment.

What can you to improve your appreciation of music?

When dealing with music appreciation (and other topics related to rehabilitation following cochlear implantation), there are two key factors that affect individual’s satisfaction: (1) duration of CI use and (2) quality of therapy/practice. Longer periods of CI usage combined with specific music therapy and self-practice often results in higher levels of music enjoyment. With patience, persistency and hard work you can improve your appreciation of music.

Professional music therapists utilize systematic programs for individuals or small groups. Musical selections and music-making activities may be modified for participants' preferences and needs. Research on CI recipients, both adults and children, revealed positive effects of music therapy on self-esteem, communication skills, music perception, and music enjoyment.

Self-practice is less structured and can be undertaken independently in different ways. For example, you may choose your own materials and progress according to your own schedule and preferences. You can also use materials designed specifically for CI recipient music training. (I’ve provided some examples below.)

When you practice on your own, you should follow a few guidelines:

• Practice when you are well rested.
• Choose a quiet environmental with minimal background noise
• Ensure that you have the best possible sound system with appropriate volume. Use direct audio input, Bluetooth or assistive listening device to connect to your sound processor

Attentive Listening

Attentive music listening is more effective than simply being exposed to music. When you listen attentively, you can selectively identify musical characteristics. You may ask yourself:

• Do I recognize the rhythm?
• Have I noticed the dominant instrument change?
• Do I recognize what is playing now?

In the early stages, I recommend using videos that enable you to see which instruments are playing. When you become familiar with different pieces of music, ask yourself questions:

• Can I recognize the selection that I’m listening to?
• What feeling do I have while listening to certain music?
• Do I have a preference for a certain style?

Try to listen to different music styles, even those that you did not previously listen or did not enjoy listening to in the past. While listening to songs, you may ask yourself:

• When did the vocalist start or stop singing?
• Can I identify repeated words or phrases?
• Which is easier for me to listen to—a male or female vocalist?
• Are there specific singers I prefer to listen to? 

Read the lyrics while you listen to songs to further help you enjoy your musical training experience. These principles may help you adjust your practice. You may want to share your experience with friends who have typical hearing and ask them to recommend musical selections.

Where to Start Your Practice Program

Start by listening to simple musical pieces, including familiar music you remember from the past. It is preferable to listen to music accompanied by only one or two instruments versus a large band or ensemble. Many CI recipients prefer to start listening to instruments such as piano, cello, saxophone, bass and drums. Note that almost any song or musical piece can be performed as a one-instrument solo.

Choice of Songs

Begin by listening to songs which have one vocalist accompanied by a limited number of instruments. You may even fall in love with some new songs that you did not notice in the past. Select relatively slow tempo songs by singers who have clear articulation. Nursery rhymes and holidays songs that are familiar to you are often a good choice to begin with.

What practice materials are available to help improve your music appreciation?

The cochlear implant companies all have excellent music rehabilitation materials. I encourage you to explore their websites to find materials for your use.

Advanced Bionics rehAB http://www.abmusicrehab.com/EN/?err=login offers Musical Atmospheres, an interactive online program designed to help teens and adults with cochlear implants explore their music perception skills. It guides users through different musical features with increasing complexity (i.e., solos versus duets). This hierarchical training program invites you to experiment with a variety of tasks from basic (distinguishing between a human voice and the sound of musical instruments) to intermediate and advanced (i.e., identifying specific instruments, a vocalist's gender, or song lyrics).

Cochlear Americas offers HOPE Notes, a music rehabilitation tool developed by Richard Reed. (View Richard’s prior blog post to learn his story). HOPE Notes includes original and traditional songs and tunes, sometimes played in various ways to allow different listening experiences. The DVD includes captions that literally describe the music (Which instrument is now playing? Which chords are dominant?) This can be very helpful as you are learning to listen. I recommend using the DVD with the User Guide because it provides both theoretical and practical tips and most importantly—it encourages you to work on improving your music perception and appreciation. Richard's practical and positive approach, as expressed in the HOPE Notes tool, is both a source of support and an effective self-training program. The product is available for purchase from Cochlear. https://store.mycochlear.com/store/index.php/usb2c

MED-EL designed the first Spotify playlist for CI users. The playlist was created by MED-EL’s in-house musicologist, Johanna Pätzold, based upon research on music and cochlear implants. The list includes a variety of songs by various artists using different styles to enable as many CI users to enjoy using it and to motivate recipients to listen to music. The list includes popular and familiar songs, with emphasis on the vocals and with limited “special musical effects”. The list was created utilizing parental advisory guidelines, so it can be used as a family's playlist. The lyrics are available, allowing users to follow along.

It can be a motivating experience to use the MED-EL Munich Music Questionnaire to Record Music Listening Habits of People with Post-lingual Deafness after Cochlear Implantation. http://www.medel.com/en/rehabilitation-downloads/ The questionnaire provides an interesting perspective about changes in your music listening habits as well as a means of improving your awareness of your own music listening skills. You can fill out this questionnaire two months after your switch-on, then 6 months later, as a means of documenting your progress.

This is a brief introduction to the topic and an overview of CI company music rehab tools. More content is available on the CI company websites.

To sum up…Music was important to many people prior to losing their hearing. With your cochlear implant, hard work and dedication, you may be able to regain this important part of your life. Best of luck!