Dr. Cherisse Miller

Audiological history: I was in my early thirties when I discovered my hearing loss was probably caused by Chloramycetin, an ototoxic drug prescribed for pneumonia when I was eight years old. My parents thought my hearing loss was hereditary and were unaware of how or when my hearing loss occurred, which I naturally accepted. My most recent audiogram in August 2008 showed a 10-20 dB loss over the past four years. I have poor speech discrimination scores of 60% in both ears. Hearing loss in my “good” left ear is mild to moderately severe sloping to profound and my right ear is moderately severe sloping to profound. I’m also very much aware of recruitment issues now, which have not been a problem until recent months and now interferes significantly with the volume levels in speech, music and everyday sounds in general, even after a few professional adjustments. I find anything I do not want to hear as unwanted noise and find myself not wanting to wear my hearing aids when I’m working and need to concentrate. It is time for new hearing aids, but unaffordable at the present time.

Musical studies: Music has always been a major part of my life. My parents were professional musicians, so I grew up with music all around me. Today, I too am a professional musician – only I have a binaural sensorineural hearing loss. I teach piano in my studio at home, retired church organist and I enjoy accompanying choirs, vocalists, instrumentalists, collaborating with other musicians and pedagogues throughout the state and community. I earned a Master of Music in Piano Performance in 2005 and completed a Doctor of Musical Arts in Piano Pedagogy in 2009. I love what I do despite my hearing loss and accept the challenges and frustrations as a musician with hearing loss as who I am and try to make the best of it.

My story begins with sharing personal experiences over the past 45 years as a piano teacher, church musician and graduate student with progressive hearing loss. Despite my hearing loss, I never questioned that hearing loss would keep me from making music or teaching music. I learned to speak, acquired a basic vocabulary, became familiar with everyday sounds and was already playing the piano before my hearing loss became severe. My love of music was already in my heart long before I knew or understood my hearing loss. My parents reminded me every year on the first day of school to sit at the front of the class, which was always demeaning and embarrassing for me. I am sure I did not always do this, causing my grades and self-esteem to suffer. I assume my hearing loss was mild to moderate, since I made it through my senior year in high school in 1970 without hearing aids. I earned a BA in music wearing one BTE hearing aid and not telling a soul about my hearing loss, which remained a “secret” until almost twenty years ago. Without realizing, I developed many basic survival techniques for reading lips, watching people’s gestures, facial expressions, and any other visual clues that would help me connect words and meaning when I could not hear effectively.

I would evaluate my years of experience using hearing aids as sufficient. I do not recall the quality of sound being that much better each time I got new ones; except for regaining sounds lost when the old aids began losing power. My first experience with digital hearing aids during the mid-1990s was the most frustrating endured in trying a new hearing device, only to finally realize they were not made to hear music. The audiologist worked patiently with me for a couple of months, and I remember thinking I must be her first patient who was a musician. I was very disappointed, since for the first time in my life I could eavesdrop and understand people talking around me, behind me and across the room with clarity and seldom heard consonants. Yet the sounds of music I also wanted to hear were consumed by the same condensers that enabled me to understand speech. While waiting for technology that offered both speech and music, another audiologist introduced me to programmable hearing aids. They did not have the clarity as the digitals, yet offered three different programs: normal speech, the T-switch, and a party/restaurant mode for reducing background noise. Only after wearing two hearing aids, did I hear a few additional higher pitches on the piano and a gain a better balance between both ears. Only after binaural digital hearing aids, did I hear clarity and crisp consonants.

In 1990 after being fitted with an in-the-ear hearing aid in the left ear, used in combination with the behind-the-year in the right ear, I remember playing the 8 foot Yamaha grand piano at my church. I could hear at least 8-10 new pitches in the top two octave range of the keyboard. This was exciting because at one time I actually didn’t think anyone could hear the highest pitches on the piano. The organist and I played piano-organ duets every Sunday. Both instruments were fairly new and of excellent quality. The organ amplification was also excellent for the sanctuary. Although we were face to face on opposite sides of the sanctuary, a mini Peavey amp close by allowed me to hear myself as well as hear the speaker from the platform. Fortunately, the organist had great listening capabilities and listened musically. He let me lead in tempos and any fluctuations in tempo. When I got out of sync with him in tempo or playing expressively, he was able to follow my musical leading. This was fortunate for me and I realize that not all situations have this kind of flexibility. In similar situations problems occur in staying together because it is difficult to hear both instruments simultaneously, especially when a partner does not have equal musical abilities or keen listening skills. I cannot hear them well enough above my playing to make the musical adjustments necessary for a unified performance.

Up until 2001 I had never given my hearing loss much thought as to the specifics of my coping skills, strategies, understanding my audiogram, and a how hearing loss affected my life as a musician. I have always adapted and tried to do the best I could. Over time as my hearing loss progressed, I gradually began avoiding situations where it would be difficult to hear, unless accompanied by a family member or good friend. In a sense, I created a world where I did not have to be involved with groups of people on a daily or even weekly basis. I taught piano privately, since I could manage one-on-one conversations, played in churches, directed children’s choirs, which were difficult at times when I could not understand the children. These part-time activities enabled me to have periods of quiet time during my days to rest my ears, instead of working a full-time job, where I would constantly have to listen. I worked with children’s choirs over twenty years ago and would not be able to do that today because of the noise levels and my inability to multitask, all at the same time trying to remember my plans for teaching. I find it very frustrating and difficult to think and talk at the same time when one or more people are talking.

In my work as a piano teacher and church choir accompanist, communication problems usually outweigh any problems of hearing the music. Beginners and intermediate level students for the most part play a 3 to 3 ½ octave range in the middle of the piano keyboard and sound textures are fairly thin (single or two lines, melody with simple accompaniment). I am quite capable of hearing all of the pitches used in playing this level repertoire. I can match pitches, hear wrong notes away from the piano and tell which key is wrong within a chord. I am very sensitive to pianos being out of tune or performing on an unfamiliar piano with sound and tuning issues when playing from memory (which is not often). In choir rehearsals, I can identify the voice part singing the wrong notes. I am able to hear when choirs and vocalists sing off pitch. The piano accompaniments are not so difficult or complex for the majority of church choral music that cause any specific problems. As long as I am consistently focused on the director and learn to anticipate his actions, I am competent in doing a good job musically. I always explain my specific needs to a new director prior to rehearsals which are – to speak in my direction and to avoid talking before the choir stops singing. Most everyone I have worked with has been supportive and patient while adapting to my hearing loss. It does become difficult when a director speaks too fast in rehearsals, causing hesitation in my response while processing what I thought he said and finding the correct measure in the music. I am constantly looking for visual cues to help me anticipate his every move.

I recently retired from serving as the organist in a moderately large Baptist church for 21 years which gradually became more difficult as amplified contemporary praise bands were the more accepted musical accompaniment. I no longer participated in contemporary praise band due to the dangerous sound levels and the difficulty of not being able to keep up in following the beat without a traditional music director leading. Prior to retirement I played one traditional worship service on the organ along with the pianist, and occasionally play the piano for offertories. Of course there are sounds on the organ I could not hear, but the ensemble of selected registrations were excellent and congregational singing did not pose any problems until the worship leader changed his mind in the middle of a verse. With the present sound system and a 30 foot distance between the organ and the pulpit, it became very difficult to understand every word spoken from the pulpit when an unexpected change was made. Thoughts running through my mind as I try to keep the music going are “Do we sing another verse or just repeat the chorus? Do we go on to the next hymn? Does he want to sing <em>a capella</em>?” With each new worship leader, which were several, new visual signals had to be worked out. I realize for anyone it is an adjustment to getting used to someone new, but for me it takes more patience in developing relationships where we both have to adjust to my hearing loss. Bottom line, it is impossible for me to hear someone speaking over my playing and I cannot focus on both playing and listening to someone speaking simultaneously.

Returning to graduate school in 2002 was an endeavor that took me completely outside my small quiet world of controlled listening to many hours a day of constant music, talking and other environmental noises. I quickly realized the programmable aids were not working for me. My audiologist informed me of the music program available on the Widex Senso Divas and let me try them over the course of the semester. I doubt that I would have been able to continue past that first semester without these new digital hearing aids. They worked so well and contributed to my self-confidence and satisfaction as a teacher, performer and in my newfound ability of making mostly A’s, which was not something I achieved as a teenager. My piano teacher was eager to learn from me as a hearing impaired student, as his special interests included teaching young students with learning disabilities who were blind and/or autistic. He quickly adapted by not talking while he modeled correct technique at his piano and waited for the sound to decay before talking. As a piano major my music was much more advanced than what I played at church or taught. I soon realized, as far as sound was concerned, that Baroque and classical literature (Bach, Mozart) were not as difficult to hear due to the smaller range of the pianoforte, as some of the Romantic music (Chopin, Brahms) and especially the 20th century piano literature, because of the thicker textures and the extreme use of the upper and lower ranges of the piano. I constantly doubted myself when very low pitches were distorted because of volume and/or overtones, and in the extreme upper register I only heard thuds. I learned to practice small sections of music in a comfortable hearing range to learn the correct sounds and finger memory. While practicing without my hearing aids one day I discovered I could hear the clarity and clean even sounds in my playing from feeling and hearing the action of the keys. All of the resonance was gone which sometimes overlapped which I believe affected my perception of how I sounded. It was a good way to check my memory, but lacked the warmth and fullness I prefer when listening to myself play the piano with my hearing aids. Octaves are not as difficult even though I usually do not hear the top note in the upper register, but audiate it from the lower note. I learned to appreciate 20<sup>th</sup> century music, but found abstract music when lacking tonality and music with too much dissonance to be very difficult and even more tedious to learn. I made an effort to work on minimalist John Adam’s China Gates, with constant repetitious melodic patterns changing on irregular beats. It was hard to spend long periods of time practicing it, even though I did like the music, because repeated key patterns in the upper range produced bell-like oscillating sounds that did not sound like the piano. It was not comfortable to my ears as well.

The seven years spent as a graduate student were a rewarding musical and personal journey. It was a constant challenge to cultivate new listening skills while adapting to the rigorous schedule of classes, practicing, performing and teaching, not to mention family time. The bad news is – my hearing will continue to get worse. The good news is – new technology will continue to improve. My only hope is my story will offer inspiration and a realization of the growing need for quality sound technology for hearing music through hearing aids for musicians and anyone with hearing loss.