Why doesn’t a sneeze blow the electrode array out of the ear?

Asked by yours truly when he came down with a cold on Friday, four nights after implant surgery. The speed of a sneeze has been reported as being anywhere between 100mph and 85% of the speed of sound. The ear is connected to the mouth via the eustachian tube, so air pressure changes in one carry over to the other. In diagrams of a cochlear implant (here, for example) it looks as if the electrode array is just sitting inside the cochlea, unanchored. And right after surgery, it’s all squishy and wet in there. So why isn’t a sneeze followed (metaphorically) by the kind of tinkling sounds that happen when a clock is dropped onto concrete?

Same question goes for nose-blowing. It’s got to cause a tremendous overpressure in the middle ear.

I asked Jerry Loeb, who was chief scientist at Advanced Bionics for a number of years, and he told me, “The only thing likely to dislodge a cochlear electrode is a large traction movement applied directly to the lead.” In other words, to move it, you have to pull directly on the electrode array. A sneeze doesn’t do that. Also, I figure, a medical device that could be blown loose by a sneeze wouldn’t be on the market. “Sneeze away,” Jerry told me. I got through my cold with no trouble, and I appear to be fully intact.

Today is the shortest day of the year. In 1633 John Donne wrote in his Nocturne,

The world’s whole sap is sunk;
The general balm th’ hydroptic earth hath drunk…

The word “hydroptic” sounds means the same thing as “hydrophilic”, the word on contact lens boxes: water-absorbing, thirsty. The balm of life has been so deeply absorbed into the earth that it isn’t visible; the world is quiescent, dormant — seemingly dead.

Today, the world’s whole sap is sunk. Except in San Francisco, it isn’t. Living in San Francisco is like living outside of time. We don’t really have seasons. We have beautiful sunny days and riotous wildlife year round, and it never snows. I’d neglected a plant for a few days because of my surgery, and it was looking rather sad and wilted. I watered it and put it under a lamp, and in an hour it had perked right up, making me feel like E.T. with his glowing finger.

So for me, at any rate, the main cue that we live on a planetary surface at all is the changing length of the days. Today, here, it will be dark by 4:54. In London, where Donne lived, it will be dark by 3:52.

Saint Lucy is the patron saint of blindness. According to legend, she was blinded but miraculously got her eyes, or at least her vision, back. Today, we make miracles like this happen all the time. My right ear’s sap has been sunk for 25 years. But a seed’s been planted in it: a seed bustling with silicon and electrodes. It’s dormant now, quiescent. But it’ll germinate on January 24th, when it’s saturated, not with water or sunlight, but with data.

In other news, my latest story, The Naked Ear, just came out in Technology Review‘s Jan/Feb 2008 print edition. This is an expanded version of my web story on Otologics’ fully implantable hearing aid — it’s twice the length, and it’s written from a personal point of view. There’s also a video of me explaining how it works. I think this is the best video I’ve done so far. I feel like I’m really getting the hang of working with the camera – how to enunciate, how to use my hands, how to be expressive.

I’m in my office, tapping away at my computer, answering emails, making phone calls, and doing all the things normal people do on a Thursday afternoon. That pretty much sums up my recovery from my second cochlear implant surgery.

The bandage came off this morning, so I look normal again, apart from rumpled hair and a right ear that’s bent outward a little bit. (It will return to place as the swelling subsides.) I haven’t needed to take Vicodin this morning and my ear hasn’t been ringing as much as it was yesterday. My appetite’s fine. I feel practically normal. My dad is sleeping on the couch, my cat is bugging me for food, and my inbox is continuing to fill up. I’m catching up on email and pitching articles: back to work. It’s a quiet, rainy day in San Francisco.

In an amazing bit of timing, my dad handed me a copy of December 17th’s Palo Alto Daily News as I was coming out of recovery. It has a front-page story about how the Let Them Hear Foundation persuaded Aetna and Blue Shield to cover bilateral implantation as a standard benefit. Take a look at the story here.

I’m still having some difficulty understanding voices with the Hi-Res 120 software. I had this problem when I tried it in beta back in 2004, and I’m having it now. People just sound fuzzy. To be sure, they sound more “natural” — Hi-Res 16 sounds electronic and tinny by comparison — and music sounds much better, but for speech it falls short of the clarity I want to have.

I’m planning to ask Annie Vranesic, my audiologist, to tweak my Hi-Res 120 map when I activate my other ear on January 24th, and that should help. I’ve only had one mapping session with Hi-Res 120, and I remember vividly that it took four or five mapping sessions with Hi-Res 16 to get it where I wanted it to be. With new algorithms, it often takes a while to fine-tune them. It’s also been suggested to me that I could have both programs on my processor and use them where they do best for me.

By the way, the Harmony has amazing battery life. With my CII BTE, I got about six hours out of each battery charge. With the Harmony, I’m getting something like 20 hours out of each charge. I change the battery every other day, instead of two times a day. It’s a very nice feature.

I’m back home now (it’s 2:30 pm) and feeling surprisingly good. The operation took about an hour and 40 minutes. I have no dizziness at all, and only mild soreness and a bit of tinnitus. Amazing. The whole thing went very smoothly. Now I’m officially bilateral — and I’m going to take a nap.

(11:30pm): My surgeon, Dr. Roberson, told me that things went very well in the OR. He said the electrodes went in perfectly, and that the device is flush with the surface of my skull. It took him just 43 minutes to get it in there, which probably accounts for why I feel so little hangover from the anesthesia. (I guess the total time of an hour and 40 minutes comes from setup and bandaging; I’m not quite sure how much time I actually spent under anesthesia.)

The area around my right ear feels sore, but Vicodin takes care of it. I’m having occasional ringing sounds in the ear — clearly the nerves in there are very surprised. But apart from that, and the vivid purple bandage on my head, I hardly feel like I’ve even had surgery. The incision is less than an inch long and it’s so close to the back of the ear that Dr. Roberson didn’t even shave off any hair. When the bandage comes off the incision won’t even be visible.

I’m walking around making phone calls (the bandage on my left side is so thin that my left implant sticks to me right through it.) No dizziness, no stomach upset; I’m eating my way through the fridge. My dad and my friend Judith brought in omelettes from Savor (a restaurant on 24th Street) and we watched “Little Miss Sunshine” afterward.

It’s so much easier this time, it’s amazing. Wow. It’s over. What a relief.

Tomorrow I’m going in to have my other ear implanted. I’m trying to think of it as a routine upgrade, not very successfully, I must admit. But it is a very unique kind of medical event. Most surgeries are to remove stuff or fix stuff; very few are about adding new stuff. I haven’t had a working right ear in well over twenty years, so it’ll be a very new experience for me to hear on both sides. That won’t happen right away, of course; activation is January 24th. Tomorrow is just about getting the device in there and me out of there in one piece. It should be fast; I go in at 8am, should be done by 9:30, and hope to be back home by 1 or 2pm. Wish me luck, y’all.

(For the background on my decision to do this, see the March 4, 2006 entry on the Archived News page.)

Additional Note: Joe Quirk, my dad, and I went for dinner to Barney’s, a burger place on 24th Street, and amazingly enough, Annie Vranesic, my programming audiologist, was having dinner there too. She’d just finished her comprehensive exams for her Au.D. degree. She joined us for the meal. If that isn’t a good omen, I don’t know what is.