 So now it's my great pleasure to introduce you to Alexander Chern and Alexander is at Johns Hopkins and his specialty is cochlear implants and hearing aids and music. And he's going to share with us today all of his latest research and what they're doing at Johns Hopkins. Thanks very much, Alexander. And you can now share your screen. All right, and thank you so much for the warm welcome. Can you all hear me OK? No, they can't hear you in this room. They didn't connect that, but they should be able to read the captions. OK, perfect. So I'm going to share my screen. Give me one second. So everybody, it's very nice to meet you. My name is Alex Chern. I'm a fellow in otology, neuropology, and school based surgery at Johns Hopkins. And this is a presentation that I made with the help of Isaac Alter, who's a medical student at Columbia University, where I was before starting my fellowship. And it's called hearing loss, hearing devices, and all that jazz effects on music enjoyment. Now I know today is the first day you all have this hybrid meeting, so if there are any technical difficulties, please let me know and I can pause. So and thank you for, again, organizing this and for such a warm welcome. And I'd like to share with you all some of the work I've been doing and also some of the up-to-date research that has been done. I have no conflicts of interest. So first I'll start with a little bit about me so we can all get to know each other a little bit better. I grew up in Jacksonville, Florida. That's me as a child with my mother. And I actually have hearing loss as well, starting from a very young age. And I received my first pair of hearing aids when I was seven. And I also grew up playing the violin. So music has always been very dear to my heart. I stopped wearing hearing aids when I was 18 for no other reason besides me being a dumb adolescent. So more on that later. This is a picture of me when I was in high school playing in the Jacksonville Symphony Youth Orchestra. I went to college. I Yale where I studied molecular biophysics and biochemistry. And I also studied with faculty at the School of Music as well. They have a great School of Music. I received my MD at Vanderbilt. And medical school was a little, and you all hear me, OK, so in medical school I had some interesting things happen to me. So in medical school, I got hit by a car when I was crossing a crosswalk. And I was hospitalized for a month. I was innovated for 10 days. I had a tracheostomy tube. This is a pic they did a piece on me where they took a photo where I actually got struck by a car which was right here. Following that, during my recovery, I started working in a music cognition lab at Vanderbilt headed by my PI named Raina Gordon. And that was one of the most wonderful things that ever happened to me. I really did rediscover my love for music. As a medical student, it can be sometimes difficult to find joys in life like that. But I was very happy to be able to rediscover my love for music with my research. And I also started wearing hearing aids again. One of my mentors, who is an ENT surgeon, who's also an ear surgeon, he recommended that I do. And I have started wearing them again. And they've been amazing, as I'm sure you all can test too. This is a video of me playing. I'm sorry for those of you in the room who cannot hear me. So in medical school, I started playing the violin again. And I found a lot of joy in that. And I still do that to this day. So it was all really great for me. Then began my residency training in otolaryngology head and neck surgery, otherwise known as ENT surgery at New York Presbyterian. My program was half at Columbia and half at Wild Cornell. And during this time, I did a lot of research in age-related hearing loss and cognition with Dr. Justin Gallo, and as well as hearing loss in music appreciation with Anil Lawani. And here are some pictures of me with some of the Columbia faculty. Here's Justin Gallo. This is me holding my favorite ear instrument, the rose and needle with him. This is Dr. Lawani and I in front of some work that we presented at a recent meeting. Currently, I'm a fellow in otology and neurotology. So that's ear and skull-based surgery at Johns Hopkins University. Here's some pictures here with my other co-fellows and other subspecialties. This is me and some visitors from Norway. That's my fellowship director, John Kerry. That's my co-fellow, Jenny Chen. That's Jenny Chen and I being silly in the operating room. So from all my life, I've always felt that music and hearing loss has really been my passion, my profession, and my life. That's a little bit about me. This is an outline of my talk today to you all. So first, I will talk a little bit about hearing loss, how hearing loss works, different hearing devices, and the different auditory components of music. I'll then talk about some of the effects of different hearing devices, including cochlear implants and hearing aids on how we perceive music. I'll then talk about music rehabilitation and what we can do to improve our music listening as people with hearing loss. And I'll also talk about some ongoing research that I'm involved in. So how do we hear? So this is a picture of an ear. You can see the outer ear. So that's your pinna. That's your outer ear with your ear canal. That's your eardrum, otherwise known as your tympanic membrane, your middle ear. These are the middle ear bones and here is your inner ear. The inner ear composed of different parts. There is the cochlea, which is the hearing part, as well as the vestibule and the semicircular canals. That's the balance part. Now, the way hearing works is we hear a sound. So you hear a clap. The sound wave travels through the outer ear. They get funneled through your ear canal. And then your eardrum, which is right here, then vibrates. When your eardrum vibrates, that mechanical energy is transferred through the ossicles, the middle ear bones, which help communicate that mechanical energy to the cochlea through the oval window. And the cochlea's job is to transfer this to convert this mechanical energy into a electrical signal, which then goes down your cochlear nerve, which goes to your brain and allows you to hear. This is an image of the cochlea. It's a very pretty image right here. There are different types of hearing loss, as you all probably know. We have conductive hearing loss. So that's, for example, when you put an ear plug on and you can't hear as well. That's a form of conductive hearing loss. Or if you have a lot of earwax, that's another form. Ear infections or fluid in your middle ear, those are also causes of conductive hearing loss. The other type of hearing loss is sensory neural hearing loss. So that is hearing loss related to the hearing nerve. So age-related hearing loss is an example of sensory neural hearing loss. Everybody, as we age, gets some degree of hearing loss. Just, you know, that's just how humans are. Everyone gets some sort of sensory decline based on just our bodies starting to degenerate and also just accumulated noise exposure over time. So there are different devices that are used to rehabilitate hearing loss, as you all know. And usually we think about hearing aids and cochlear implants. You can think of a hearing aid as a really, really, really fancy digital microphone that amplifies the sound that goes through your ear across the frequencies at which we have hearing loss. Now, usually hearing aids are good for people who have hearing loss but have pretty good speech discrimination. So as you all know, when you go to the audiologist, they test your pure tone audiometry and they also test your speech recognition. So if it's really just a volume issue, usually people who have hearing loss do very well. A cochlear implant is for individuals who have hearing loss so severe that they cannot benefit from a hearing aid anymore. So usually in order to be a candidate for a cochlear implant, you have to have a certain level of hearing loss and you'll have to have undergone a hearing aid trial that demonstrated that you no longer benefit. So the way the cochlear implant works is you bypass all the conductive aspects of the hearing mechanism and you directly stimulate the cochlear nerve through an electrode array that is threaded through the cochlea, which looks kind of like a snail as you can see here, a snail shell. So I'm just gonna go through some music terms just so we're all on the same page since not all of us musically have a lot of music training. So pitch, you can think of that as I think we all kind of have a good idea of what pitch is. So different pitches have different frequencies associated with them. So usually higher pitches have higher frequencies, lower pitches are lower. Something that is lower pitch just sounds lower in sound like for example, a bass and things that are higher pitched, I have a higher pitch sound. So for example, a bird squeaking. Rhythm, I think we all understand what rhythm is. Harmony, we can describe as the combination of pitches. And I think harmony, we have these simultaneously produced musical notes that are used to produce chords. And in Western music, especially harmony plays a great part of that. Camber can be described as the quality of character of a musical sound. So for example, the difference between how a violin sounds and how a flute sounds or how a trumpet sounds. Okay, I put harmony in here twice. The other thing that we can out bring up are music perception and music enjoyment. So I'd like to differentiate the two of these because music perception can be understood as how we understand music or how we perceive it or how we discriminate it. So for example, there are objective evaluations of music perception like whether or not you can tell the difference between a B and a B flat or whether you can identify the melodies of a particular song, et cetera. A lot of music perception depends on musical training. So sometimes those with more advanced musical training, whether as a child or it happens to be their perception or their profession, they often have better music perception. This is different from music enjoyment. Everybody can enjoy music. I think a small subset of individuals can for a certain reason, but music enjoyment is just whether we appreciate the sounds of music that we are listening to and whether we have a good time when we listen to music. So I'll talk a little bit about music perception and enjoyment with hearing devices. First, I'll cover music perception with cochlear implants. In my field, that's actually, I would call it the hot. This is a very popular field of study. I think because individuals with cochlear implants are in a very unique group of individuals because in some ways they have an artificial ceiling placed on their amount of music perception that it's just from having a cochlear implant. So people say that on average, we have maybe 30,000 or so cochlear nerve fibers. A standard cochlear implant may have anywhere from 16 to 24 electrodes. Now, how can 24 electrodes replace the entire richness of our auditory experience that is provided by 30,000 cochlear nerve fibers? It's really, really, really hard, okay? So it's a well-known fact that individuals with cochlear implants often have poor music perception and sometimes they can have poor music enjoyment as well. Now, people with cochlear implants typically have preserved rhythm perception. Having the cochlear implant shouldn't really infect your rhythm abilities, which makes sense. However, a lot of times you will have impaired pitch, harmony and timbre. So you may not be able to discriminate between different notes as well. You may not be able to foresee chords as well. And it might be difficult to distinguish between different voices with different qualities, whether telling the different between a violin and a trumpet or a man from a woman, et cetera. And as a result, a lot of times you may get this distorted sound quality. For those of you that have cochlear implants, I'm sure you can relate to this, but when you get a cochlear implant, it's not just a simply a magic pill where all of a sudden you're hearing a story. It takes a lot of time afterwards to train your brain to learn how to hear again. Now, cochlear implants, you can get very good speech output with that, but I think music perception and enjoyment is still something that we need to work with. So this is an example of how cochlear implants are better for speech than for music. Now, for those of you with cochlear implants, this may not sound exactly what you perceive. This is just a simulation, but for those who are hearing aid users or don't have any hearing devices, it's rather informative. My friend, Eliza Butaria, who is a PhD student from Vanderbilt, helped make this for one of the papers that we wrote together. But let me play it for you all. Sounds a bit stuck. The message was very clear. The message was very clear. For those of you that still don't have any audio, don't worry, I will send in this paper, which has a link to this video, so you can hear it for yourselves if you like. But basically the idea was that when you listen to music through a cochlear implant simulation, it sounds in this simulation very unidentifiable compared to the original sound clip. However, when you play a speech clip, it's still very understandable. These are some of the traits in music listening that CI users have trouble with. So like I mentioned, pitch, things like reduced pitch clarity and range, fused polyphonic tones, what that means is instead of an isolated chord, they hear a smearing of notes altogether, distorted melodic contour intervals, usually cochlear implant users, their rhythm is pretty intact, or timbre perception or instrument identification. A lot of times sound can be distorted, a compressed range of dynamics and also reduced ability to perceive emotion when we speak and also oftentimes reduced enjoyment of music as well. Now, music enjoyment across cochlear implant users vary depending on the individual, but I would say about maybe 50% on average would say they have decreased music enjoyment compared to their normal hearing peers and compared to when they had normal hearing. Research has shown that enjoyment in music with cochlear implants is often independent of their perception. So what that means is how well you can distinguish the notes or tell one note from another note or identify melodies, et cetera, is often not contributory to how much you enjoy the music. Another study by David Landsberger from NYU and his group found that even if you have a cochlear implant, music with two ears is better than one ear. So I think in this study, they tested individuals with single-sided deafness. So individuals have one normal hearing ear and one cochlear implant ear. And even in this group, I would have thought that hearing with just the normal hearing ear would be more enjoyable than hearing out of a normal hearing ear and a cochlear implant ear. But in their study, they found that hearing with the cochlear implant ear plus the normal hearing ear results in more enjoyable music compared to just one ear alone. Even if it's with this degraded signal. Now, other studies have shown that with cochlear implant users, they experience increased enjoyment of music with increased bass or obvious rhythm and reduced harmonics. And this makes a lot of sense because rhythm perception, as I just mentioned, is not impaired with a cochlear implant. However, harmony, pitch, camera, things like that are. I'd like to switch ears a little bit and talk a little bit about hearing aids and music. Now this is a lot of, you would think that, you know, there are so many individuals with hearing aids. There are much fewer people with cochlear implants. You would think that there's a large, there would be more research on this topic, but there's actually not. There is a lot less work that's done on hearing aids and music compared to cochlear implants in music. And I think that's for a variety of reasons. It's a very difficult group to study. And as you all know, hearing loss exists across a spectrum. There are people with a more mild hearing loss, but then there are individuals who are basically borderline cochlear implant candidates. So it's always very difficult to study in a very heterogeneous group. Now we do know that overall hearing aid users probably have much, have better music perception compared to cochlear implant users, which makes sense because the cochlear implant device almost placed in artificial ceiling over how well you can perceive music. Now studies have also shown, including work I've done with Dr. Neil Alwani, have shown that individuals who wear hearing aids, they still would experience reduced music enjoyment compared to their normal hearing peers, which I think makes sense. I've done some work, some epidemiologic work with Gordon and Shristi Nyak from Vanderbilt. And we looked at hearing aids and music engagement. So music engagement can mean a lot of things. It can mean listening to music. That's an example of passive engagement. When you listen to the radio or you go to a concert with your friends, it can also mean active engagement. So these would involve singing in a choir or playing a musical instrument. We've done a population level study looking at individuals with hearing loss. And we found that the worse your hearing loss, the more reduced your music engagement is. So the worse your hearing loss, the less these individuals would sing or play instruments. Now, it's not a causal thing. We don't know that, but it's an association that we detected. I also wanna share some of the work I've done with Dr. Neil Alwani and our group at Columbia, which I did before I started my fellowship at Hopkins. And in this study, we looked at adults with hearing loss treated with hearing aids across a wide spectrum of hearing loss. Now, in this group, which I think was about 100, 110 individuals, we found that increasing severity of hearing loss is associated with decreased music enjoyment. So what that means is the worse your hearing loss, then the more likely you are to not enjoy music as much. Now, in this study, we had individuals listen to sound clips of music with and without their hearing aids. And what we found is that hearing aids may improve music enjoyment, particularly in those with more of a moderate, moderately severe hearing loss. We found that those with more of a mild hearing loss didn't really benefit as much. And we think this is because if you have a mild hearing loss, you can simply just increase your speaker volume a little bit. And you may actually prefer your quote-unquote natural acoustic hearing over an additional layer of processing of your hearing aids because when you use hearing aids, the hearing aids microphone has to detect the sound before it plays the sound back to you through a microphone. I think the large, the benefits of hearing aids for music enjoyment can stem from a variety of reasons. If you do, certainly not everyone enjoys music as much as they used to with the hearing aid, but hearing aids can, number one, allow you to even hear the music, which I think is a start. Some people, they can't even hear the musical stimuli. The other thing a hearing aid can help do is allow you to hear a balanced sound. So it corrects, appropriately corrects for your hearing loss to a normal hearing threshold across all frequencies. Now, the other thing that individuals with hearing loss care about is sound quality. Now, I know a lot of you may think that, you know, music just doesn't sound the same to me with my hearing aids. And I can relate to that too. I play the violin and sometimes I will take my hearing aids out and I'll play my violin and I always am stricken by how beautiful it sounds without my hearing aids. So certainly there's a lot of work that still needs to be done, but I think we're getting somewhere with it. There's some more research on Baja's boning for hearing aids in music as well. So this study was done with Nikki Geon, who's my friend, with Dr. Charles Lin, who some of you may have heard of out of UCSF, where they found that boning for hearing aids perform just as well with their boning for hearing aid side as their normal hearing side and compared to their normal hearing control with major elements of music perception. And I think that's really nice, especially for those of you that are musicians and concerned about potentially wearing a bone anchored hearing device. Now, there are a lot of challenges in music enjoyment research. So one is, again, like I said, this is a hard thing to study, whether you study it in a soundproof booth, like when you get your hearing test or through a natural listing environment, such as at a concert or through your computer at home. There is oftentimes an issue with recruitment and diversity, especially when you only recruit out of one place. A lot of the work I've done, I've tried to recruit through the medical centers that I've worked at, and as well as with individuals who are part of the Hearing Loss Association of America. Like I mentioned before, there's a wide individual variability in how we perceive and enjoy music and also in the amount of hearing loss we have. So it makes it very challenging to study. There is a lot of individual variability in music as well. Some people may like a specific genre that may influence their music enjoyment. Some people may prefer live music or recorded music. And in general, I find that people tend to prefer more familiar music than novel music. And the other main question is, what is music enjoyment? I don't think anyone really knows. I'm sure there's an element of sound quality to that, but that's probably not the only thing there is. We all enjoy music more when we go to a concert with friends, so they're certainly a social element. Like I mentioned, there's definitely a musical preference element. Some people may like jazz music, some people may not like jazz music. I'm actually currently involved in a study where we're trying to explore the different domains that comprise music enjoyment for individuals with hearing loss. I wanna talk a little bit about music rehabilitation and what we can do. So music rehabilitation can improve music and speech perception. The two kind of go hand in hand. When I was a medical student, I did a lot of work with rhythm and music and language specifically with rhythm and grammar. A lot of people think that there are shared neural processes between how we process music and how we process language and speech. So it certainly makes a lot of sense that the two can go hand in hand when we talk about music rehabilitation. Certainly the music rehabilitation can be very beneficial for individuals with cochlear implants. As we know, when you get a cochlear implant, it takes time to get used to it, to how to perceive sound. And it really takes a village with a lot of support with your family or friends, your audiologists, et cetera, to really maximize your benefit as much as you can. So if you want to become better at listening to music with your cochlear implant, you really have to do it often and really work with your clinicians and other individuals to maximize your benefit. Studies have shown that the more you work on this, the more you benefit. And there are always different factors that can affect how well a cochlear implant user may respond to music rehabilitation and music listening. So the age at which they undergo implantation, so how long you've been profoundly deaf for, whether or not you have part of musical background, et cetera. So what can we do? So one thing I would recommend both hearing aid users and cochlear implant users to do, to maximize music perception and enjoyment, talk to your audiologists. Your audiologists can make programming adjustments, provide you with hardware and technology updates. A lot of current hearing aids, as you know, have different settings for listening to music or speech and quiet, et cetera, as I'm sure many of you know. I think if you communicate with your audiologists, they can help find to your tuner device so that you can benefit it from as much as you can. There are other things that we can do. I know you all are already taking advantage of direct streaming to your hearing aids or to your cochlear implants. There are apps on your smartphones these days that can help with that as well. The other thing is just maximizing your audio setup at home with speakers, tinkering with the bass, the treble, making sure you're in a favorable listening environment. You know, all of us with hearing loss a lot of times we struggle with listening, speech and noise. That's certainly true with enjoying music in a noisy environment too. So really controlling your environment and just really trying to listen in the most auditory, favorable environment that you can. When you're listening to music, I would start with listening something simple and familiar. A lot of times we get a lot of enjoyment from that alone. And if you can perceive it even just a little bit like it used to be, I find that it's very helpful as well. What else can we do? Well, play an instrument, sing. You know, I think music engagement across all ages of life has been shown to be a good thing for health. Certainly it can help you potentially enjoy music more. The more you do it, there are different music rehabilitation programs as well. This is one called the Cadenza Challenge out of the United Kingdom in England. I don't have any connection with these folks but I've tried it once and it's very interesting. The other thing you can do if you're considering cochlear implantation, just make sure you consider it carefully and think about your timeline. Another thing you can do is contact your manufacturer if you have any questions, contact your clinicians as well. And I would say the other thing that we can all do to help along with music listening research and individuals with hearing loss is to participate in research. It's really helpful for all of us researchers if we have enthusiastic participants and people that are helping drive the research that will ultimately help everybody with hearing loss have better music listening. I'm currently involved in some work understanding the effects of hearing loss and hearing devices on emotional responses to music. And like I mentioned earlier, I'm exploring the domains of music enjoyment for individuals with hearing loss. And I'm also working on some epidemiologic studies that involve hearing loss, music engagement and cognition. So in conclusion, hearing is a very complex mechanism that involves environmental stimuli, anatomy and also the brain. Cochlear implantation will, individuals with cochlear implants oftentimes have decreased music perception and enjoyment although these results can vary widely. Hearing aids may certainly improve music enjoyment for individuals with hearing loss, but again, these results also vary and they will probably not improve to the level of someone with normal hearing. There are different ways to improve music perception and enjoyment as I mentioned in research and technology developments ongoing. I'd like to acknowledge some of my collaborators, Dr. Lowani, Isaac Alter, Michael Denham, all the Columbia audiologists, Dr. Gordon, Dr. Nyag, Peyton Coleman for Vanderbilt and all of our research participants. And I'll certainly take any questions if you guys have any questions and you all are free to email me anytime. This is my Hopkins email, feel free to email me or send a note if you have any questions about anything. And thank you so much for inviting me to give a talk to this group and I've really had a great time doing it. I'll take any questions. So first of all, I'd like to thank you for being such a good sport and our hybrid trial. So I'm going to pass a microphone and then I'm going to repeat the question so that you can understand. I think, see how well it works. And I have one in the room. Thank you very much for the information. It's helpful. I have major hearing loss for one year. I have minimal hearing loss in another year. When I put on headphones, listen to music, the music sounds like it's all coming from my career and it's very distracting because I don't hear it in stereo more or less. Is there any way to make that adjustment without having my hearing aids in? I like to listen to the music without the hearing aids. Is there any way to adjust headphones? Wireless headphones such that I can compensate and make the bad hearing aid here better so that I can get that stereo? That's a really good question. I'm not sure what, if you're listening through your phone or your computer, but I do know for a fact that these days, especially on computers, you can control the amount of volume that is going through one headphone versus the other headphone. So what you may consider doing is drastically increasing the volume on your not-so-good ear and then see if it sounds more balanced for you. Then you can listen to music without hearing aids and in a more acoustic environment for sure, while still increasing the gain on your less-good ear. Does that answer the question for you? Yeah, without the computer, I just don't say who think the music coming from the iPhone. Is the iPhone capable of adjusting the hearing on the two sides? I haven't checked for myself, but I'm sure that I can look it up for you and then I can let you know how to do it once I figure it out. I wouldn't be surprised if it was, if you are able to do that. It sounds like a very reasonable and not terribly complex thing to do for sure. But that's why everybody attends our meetings because you get experts to help us hear better. I see that somebody, Alan Patsura told me that there are some questions in the chat. I'm gonna go ahead and open those questions to see. Alan, were you watching the chat and do you know what the questions were off the top of your head? Alan's gonna read the questions in the chat. He has another laptop going here and he's going to, on the hand, give him the microphone so that we can honor both people who are in the room and people who are on Zoom. You're not talking the mic. So Alan, hang on a second. So does anybody in the room here have another question? So Alex, Alan's finally got a good question. Okay, so I'm trying to get Norman King on, but it looks like he has his camera off. His question was, what are the most musical hearing aids available today? Norman, thank you for that question. I do not know the answer to that question and I'm sure it's a very subjective thing and I'm sure all the hearing aid companies would claim theirs is the most musical. What I would suggest is to reach out to your audiologist who is more familiar with the up-to-date hearing aids that are being used by people and by yourself and by others and they may have a better idea of what people find to be the most musical or the ones that are best for musical listening. Thanks, Alex. Alan, do you see any other questions in the chat? Yes, I do. So you can imagine if we can iron out the kinks in this, what an amazing technology this is for all of us everywhere. You can meet in a room, you can meet remotely, whatever happens, we can have presenters from all over the world come and give us presentations. Thanks for your patience today. Alan, do you have the next one? We have a lot of technical things going on here today, including videoing the people who are in the room. Okay. Paula Sutton says, have you conducted studies involving hearing loops and T-coilers and Bluetooth for correct input? I am interested in such studies and results. I have not personally conducted studies that are involved involving these devices and these technology. It would make sense to me, again, I haven't done any studies, but one great technology that hearing aid users can experience is having this type of these hearing loops and T-coils and whatnot for direct input. It's just another less layer of processing. They're unfrozen. Am I unfrozen? Yeah, you're unfrozen now. Okay, so it's another less layer of processing that your ear has to, that the sound signal has to go through before it hits your ear, right? Because if you wear hearing aids and you're listening through, let's say, speakers or headphones, that's like two layers of processing. When you can control that and directly play music to your hearing aid, I would imagine that it's probably a much better listening experience. Just my thoughts. Excuse me. Can you please show me your screen? Yes. Thank you. Hi, Dr. Chen. Can you hear me? I can hear you. Oh, yes. I was wondering if there's any updates on the CI technology in the future? Have you heard anything about what's coming up? You mean in terms of music listening or? No, just the CI technology in general. So I think these days in cochlear implant technology, I mean, people are always trying to make it so that the signal is a lot more clear. I don't know if there's any specific new device that is coming out as far as I know that is drastically different from what already exists on the market. Yeah, I have a question. Yes. Yes, I'm Ken Peters from the peninsula. I wanted to know, I've had very good experience with using earlens and it really has improved my music perception and enjoyment tremendously. I played drums in a rock and roll band and I wanted to know if you have any experience with earlens and any comments on that because it really does increase the frequency of the music and in terms of harmony and timbre was just, it's much improved than what I used to use in my Oticon hearing aids. Right, so I have heard those benefits. I've heard that about earlens for sure. I don't have any personal experience with it. My understanding of why the sound fidelity is so high and why you get a more natural sound or why the user's experience a more natural sound is because it works a little bit different from a conventional hearing aid. So instead of the normal hearing aid, you basically have a microphone that is going into your ear and you're basically like a microphone with a earlens device, you're actually directly stimulating the ear drum which is my understanding of how that works. And it makes sense that those devices, you may get a more natural sound. I think people have said similar things about the ear hearing aids which are actually technically the currently the only analog hearing aids on the market. Those are placed extremely close to the ear drum like about four millimeters away. So I think because of that it's also a very quote-unquote natural sound as well. We have a person in the room, Jim Schroeder, who has a question. Hi, yeah. I wanted to ask you about music rehabilitation in with the CI. I'm trying a couple of different things that with very mixed results. There's a couple of apps on their phone called Pitch Me and Relative Pitch. Apps where they play separate tones and exercises to try to improve your drum resolution. I have about a three half tone resolution. I can't see which close to the net. And I haven't really been able to do much to improve that. Also, I've tried listening to music while following along the score. A couple of, you know, there's, you know, many very, for example, they're very famous and available music, like for example, and indeed, you can go online and get the score for that. It's just four, four instruments, you know, or a quartet. So if I following along, you can actually see the notes you're not hearing. And I've struggled with that one a lot and just can't find those notes that I know are there. And so I was wondering if there's anything that you were aware of any research that's been done to help struggle with that kind of thing? That's a good question. And first of all, I applaud you for doing so much to try to optimize your cochlear implant, you know, reading with the score. I think that's a very smart thing to do or at least try to do for sure. You know, it's an ongoing area of research. I don't know of any, you know, there are people working on this. So for example, Raymond Goldsworthy from USC, who I've spoken with, he's actually a cochlear implant user himself. And he's doing a lot of work in this space. I can ask him if he has any specific suggestions, especially as a cochlear implant user and a musician himself to provide, you know, any kind of general public individual with a cochlear implant that might help with its rehabilitation. I think the other thing you might consider is, you know, I think Pocobel indeed is not a bad thing to try to listen to because it's not terribly polyphonic. Now, you know, there are studies that show that cochlear implant users often prefer more rhythmic music. So if you find music that is more rhythmic and heavy bass, you might be able to perceive that a little bit better and you also might be able to enjoy it a little bit better as a result. So. We had another question in the room here in a relationship to pitch. And I'll let her ask the question. A few years ago, Dr. Charles Flam had UCSF did a major research project on music with a CI. Pitch was the only one part of it, but it was my most visible failure as a volunteer on this project. I totally bombed out. Pitch in music, in my opinion, is the all-encompassing necessity because if you don't have pitch correct, you not only lose the melody, you lose the overtones, you lose the connection to other instruments that are playing. It's a total disaster. And for me, it has meant the loss of a terribly important part of my life. So I'm just wondering if you can bring in... I'm sorry, I'm not sounding... Can I stand up? What? Stand up. Oh. I'm just wondering if you were able to share with us anything new on the table in that area. I understand all of the stuff about you, the number of electrodes, the resistance, I mean, all that I've been through. Nothing has helped me. I turn on music and I turn it off because I can't stand it. Well, thank you for sharing your experience, and I'm very sorry that you are not having a great time listening to music with your device. This is why it's such a big area of research because we want to help people like you improve their music listening. As far as I know, I mean, I don't know if there are any big game changing things beyond making sure you go to your audiologist so he or she can optimize the programming of your device as well as just any kind of music rehabilitation options that there are. There's not really anything beyond that as far as I know, that can be done in like a reasonable time frame. If there is, I'll let you know. But so far, that's all I know of. Are there any other questions from people who are on Zoom? Over here. Jim came and a question. How does one learn about the research programs and the ability to participate in one? So that's a good question. A lot of times the low any kind of. So my studies, usually, especially if I recruit individuals from the Hearing Loss Association of America, I send them to the actual chapter for them to disseminate. So if you all want to participate in any study that I'm involved in, I'll definitely send them to Anne for sure and she can let you know. Otherwise, you know, simple Google search, a lot of these studies can be done online. And it's certainly very helpful for the scientists to have your, you know, your participation. Your local medical centers, especially if they have a strong research arm, you can always ask their. Any odor and colleges or audiologists who you may meet, they may have some ideas about people that are conducting any studies pertaining to music and hearing loss. I will say that it's somewhat of a niche field right now. There aren't a lot of people looking into it, but I think it's certainly something very important. But if you all are interested for sure, I'll let Anne know for any future studies that I conduct. And, you know, I would gladly love your participation for sure. So I don't know if all of you remember, but it seems like maybe three or four months ago, I just disseminated a research study that Alexander and Isaac are both conducting. And so we disseminate all of the information like that through our email marketing tool. So when you signed up for this meeting, one of the options was, did you want to be added to our e-news? And so if you check that, I'll add you. And so any future research that comes my way will be distributed to you. I think there was. Oh, I think there was one more question that somebody, I also have access to the meeting chat. Someone for rank from Diablo Valley was asking, how could one measure slash compare an individual's auditory experience and perception of an audio signal with respect to age time and the rest of the population? And that was the first half of this question. The second one was, has anyone tried to model and use things like M E M S nanotubes or other mammals physiology to deal with human hearing problems? Well, so to answer the first question about an individual's auditory experience of an auditory signal with respect to age and time. So make no mistake. Everybody gets some degree of age related hearing loss. Which results in a degraded signal to the brain. No one is immune to that. So how much hearing loss we get as we age, that depends on our own genetics and environmental tractors like noise and things like that. So I would say that an individual's auditory experience and perception over time probably degrades just like, you know, a lot of sensory things to as we age. The second question about how if anyone's trying to model and use things like M E M S nanotubes or other mammals physiology to deal with human hearing problems. I don't personally know what M E M S nanotubes are. So I can't really answer that. But I will see that sometimes people do, people are conducting animal studies to help inform us, especially because, you know, animals such as mice or chinchillas or guinea pigs, et cetera. We're able to study hearing physiology in a much more timely way than in humans for sure. So people definitely do that. I will say, and we've definitely gotten a lot of information from these studies. I hope that answers the question. So Frank, did your question get answered? I've been having some problems with my laptop and traveling a lot and things are kind of broken. I don't know if you guys can hear me, but yes and no, I was kind of considering more of a philosophical question regarding hearing. I mean, I can, um, with time, you kind of forget what things sounded like. You know, this is a gradual sort of gradual decline, like a lobster being boiled to death. You know, you don't necessarily notice the day to day changes, but the changes over an hour or two or three or four weeks. So in terms of what let's say Beethoven sound like when I was 20 versus when I'm 70, how that, how do I compare? How do I, how do I compare quality and perception of myself with respect to time and respect to other people that are maybe receiving hearing, having a hearing aid, you know, what they perceive, how do I know what they actually perceive and hear and experience versus what I hear and experience. I mean, the play, the musical piece, I think you played over that cochlear thing. I think it was, it was horrific. I mean, I don't see anybody want to listen to that. So I wonder after time, you get used to being boiled to death and not really realize it's about to die in terms of hearing. Well, Frank, that's a very interesting question, very philosophical question. I think I would say that everybody enjoys music in a different way. And, you know, how much you enjoy it, even the same signal varies across everybody. How I enjoy music may be different than how you enjoy music. There's no real way to know other than conducting studies and really trying to capture that subjective experience in a somewhat objective way. It's very difficult. I agree. So there's not really any great way to know. I think regarding your, what you mentioned about like that cochlear implant simulation, I will say that the brain is a remarkable organ. You know, when an individual first gets a cochlear implant, and I'm sure the cochlear implant users in the audience can attest to this, the day it gets turned on, that's not your final experience with a cochlear implant. It takes time and it takes a lot of effort to be able to use it the best way it can be used. So, and a lot of that is your brain just learning how to hear again. So, you know, I'm sure that is true for someone who is putting on hearing aids for the first time and listening to music. They have to get it adapted that sound as well. Someone who puts on glasses for the first time, etc. So it's a very philosophical and great question. But, you know, that's that's what I would say. Does your brain adapt or does your expectations adapt? That's part again. Do you, does your experience improve with time and training, or does your brain sort of recalibrate expectations every day as you age? I think your brain is adapting to the new signals. Versus the expectations change, adapting to expectations. I'm sure it's a little bit of both, to be honest, just as everything is a little bit of both. There's no way to measure that, is there? Quantify it. Probably could with survey studies, but those are also kind of, you know, hard to measure as well. So it's really hard to say. Yeah, well, it's a philosophical question. Is my yellow perception of yellow equal your perception through that perception and experience of yellow? It's interesting. But no answer to that, I imagine. Well, thank you. No problem. Any other questions from the chat? I'm going to ask a question. So actually, actually to answer, you answer your question about nanotubes. It's the very small particles that, if you think about hair cells waving in the, in the wind of sound, there are very small memory. NEMS devices, which are nanotubes called nanotubes, and they, they also wave with sound. They move the sound. And how much they move is it produce a piece of electrical effect and send an electrical signal out the, and so there's a sound you can sort of have different height of these nanotubes that respond to different frequencies. I can see them kind of vibrating, depending on what frequency is resonant coming in, and they could directly produce electrical impulses into the brain that would be somewhat converted to sound perception or sound rendering, sound, I guess perception. Yeah. So I was curious if anybody tried to, in addition to trying to use a, you know, another mammals ears or something to use, use mechanical devices that vibrate and send electrical signals. Well, to my knowledge, I have not heard of anyone using nanotubes in the inner year for this type of thing. So yeah, I have not heard of that. Thank you. Thank you. Just just amusing. So, Alex, do you go by Alexander or Alex? Alex is fine. Yeah, Alex, thanks very much. We've all really appreciated everything you had to say today. And in the room here, there are multiple people with C eyes. I don't know if you remember, I have two very successful ones that I am just madly in love with. So thanks again. We'll see you later. Welcome to say if you want, we have some other business things to take care of announcements. You can stay, you can leave, but you don't have to stay. All right. And thank you again. And I have some homework to do. I will send over the answer to that question regarding changing volumes for each side on the phone on your headphones for, for a phone for like an iPhone. And the other thing is I'll reach out to Ray Goldworthy to see if he has any kind of suggestion regarding different kind of rehabilitation program and things like that that he might use. So I'll send in these things this week. So I'll let you guys know. Thank you all for having me. Thanks. Something else that I actually thought of, I wondered whether Sonic cloud might help that question about music because you can adjust the individual frequencies. You can use your computer. Yeah, that's possible. Bye. Okay. Nice to meet you guys. Bye bye.