Effects of stimulus configuration on psychophysical operating levels and on speech recognition with cochlear implants

Tripolar configuration and pulse shape in cochlear implants reduce channel interactions in the temporal domain

The present study investigates effects of current focusing and pulse shape on threshold, dynamic range, spread of excitation and channel interaction in the time domain using cochlear implant stimulation. The study was performed on 20 adult guinea pigs using a 6-channel animal cochlear implant, recording was performed in the auditory midbrain using a multielectrode array. After determining the best frequencies for individual recording contacts with acoustic stimulation, the ear was deafened and a cochlear implant was inserted into the cochlea. The position of the implant was controlled by x-ray. Stimulation with biphasic, pseudomonophasic and monophasic stimuli was performed with monopolar, monopolar with common ground, bipolar and tripolar configuration in two sets of experiments, allowing comparison of the effects of the different stimulation strategies on threshold, dynamic range, spread of excitation and channel interaction. Channel interaction was studied in the temporal domain, where two electrodes were activated with pulse trains and phase locking to these pulse trains in the midbrain was quantified. The results documented multifactorial influences on the response properties, with significant interaction between factors. Thresholds increased with increasing current focusing, but decreased with pseudomonophasic and monophasic pulse shapes. The results documented that current focusing, particularly tripolar configuration, effectively reduces channel interaction, but that also pseudomonophasic and monophasic stimulation and phase duration intensity coding reduce channel interactions.

Apical Reference Stimulation: A Possible Solution to Facial Nerve Stimulation

OBJECTIVES

Postimplantation facial nerve stimulation is a common side-effect of intracochlear electrical stimulation. Facial nerve stimulation occurs when electric current intended to stimulate the auditory nerve, spread beyond the cochlea to excite the nearby facial nerve, causing involuntarily facial muscle contractions. Facial nerve stimulation can often be resolved through adjustments in speech processor fitting but, in some instances, these measures exhibit limited benefit or may have a detrimental effect on speech perception. In this study, apical reference stimulation mode was investigated as a potential intervention to facial nerve stimulation. Apical reference stimulation is a bipolar stimulation strategy in which the most apical electrode is used as the reference electrode for stimulation on all the other intracochlear electrodes.

DESIGN

A person-specific model of the human cochlea, facial nerve and electrode array, coupled with a neural model, was used to predict excitation of auditory and facial nerve fibers. These predictions were used to evaluate the effectiveness in reducing facial nerve stimulation using apical reference stimulation. Predictions were confirmed in psychoacoustic tests by determining auditory comfort and threshold levels for the apical reference stimulation mode while capturing electromyography data in two participants.

RESULTS

Models predicted a favorable outcome for apical reference stimulation, as facial nerve fiber thresholds were higher and auditory thresholds were lower, in direct comparison to conventional monopolar stimulation. Psychophysical tests also illustrated decreased auditory thresholds and increased dynamic range during apical reference stimulation. Furthermore, apical reference stimulation resulted in lower electromyography energy levels, compared to conventional monopolar stimulation, which suggests a reduction in facial nerve stimulation. Subjective feedback corroborated that apical reference stimulation alleviated facial nerve stimulation.

CONCLUSION

Apical reference stimulation may be a viable strategy to alleviate facial nerve stimulation considering the improvements in dynamic range and auditory thresholds, complemented with a reduction in facial nerve stimulation symptoms.

Perceptual learning of pitch provided by cochlear implant stimulation rate

Cochlear implant users hear pitch evoked by stimulation rate, but discrimination diminishes for rates above 300 Hz. This upper limit on rate pitch is surprising given the remarkable and specialized ability of the auditory nerve to respond synchronously to stimulation rates at least as high as 3 kHz and arguably as high as 10 kHz. Sensitivity to stimulation rate as a pitch cue varies widely across cochlear implant users and can be improved with training. The present study examines individual differences and perceptual learning of stimulation rate as a cue for pitch ranking. Adult cochlear implant users participated in electrode psychophysics that involved testing once per week for three weeks. Stimulation pulse rate discrimination was measured in bipolar and monopolar configurations for apical and basal electrodes. Base stimulation rates between 100 and 800 Hz were examined. Individual differences were quantified using psychophysically derived metrics of spatial tuning and temporal integration. This study examined distribution of measures across subjects, predictive power of psychophysically derived metrics of spatial tuning and temporal integration, and the effect of training on rate discrimination thresholds. Psychophysical metrics of spatial tuning and temporal integration were not predictive of stimulation rate discrimination, but discrimination thresholds improved at lower frequencies with training. Since most clinical devices do not use variable stimulation rates, it is unknown to what extent recipients may learn to use stimulation rate cues if provided in a clear and consistent manner.

The perception of emotion and focus prosody with varying acoustic cues in cochlear implant simulations with varying filter slopes

This study aimed to find the optimal filter slope for cochlear implant simulations (vocoding) by testing the effect of a wide range of slopes on the discrimination of emotional and linguistic (focus) prosody, with varying availability of F0 and duration cues. Forty normally hearing participants judged if (non-)vocoded sentences were pronounced with happy or sad emotion, or with adjectival or nominal focus. Sentences were recorded as natural stimuli and manipulated to contain only emotion- or focus-relevant segmental duration or F0 information or both, and then noise-vocoded with 5, 20, 80, 120, and 160 dB/octave filter slopes. Performance increased with steeper slopes, but only up to 120 dB/octave, with bigger effects for emotion than for focus perception. For emotion, results with both cues most closely resembled results with F0, while for focus results with both cues most closely resembled those with duration, showing emotion perception relies primarily on F0, and focus perception on duration. This suggests that filter slopes affect focus perception less than emotion perception because for emotion, F0 is both more informative and more affected. The performance increase until extreme filter slope values suggests that much performance improvement in prosody perception is still to be gained for CI users.

Effect of current focusing on the sensitivity of inferior colliculus neurons to amplitude-modulated stimulation

In multichannel cochlear implants (CIs), current is delivered to specific electrodes along the cochlea in the form of amplitude-modulated pulse trains, to convey temporal and spectral cues. Our previous studies have shown that focused multipolar (FMP) and tripolar (TP) stimulation produce more restricted neural activation and reduced channel interactions in the inferior colliculus (IC) compared with traditional monopolar (MP) stimulation, suggesting that focusing of stimulation could produce better transmission of spectral information. The present study explored the capability of IC neurons to detect modulated CI stimulation with FMP and TP stimulation compared with MP stimulation. The study examined multiunit responses of IC neurons in acutely deafened guinea pigs by systematically varying the stimulation configuration, modulation depth, and stimulation level. Stimuli were sinusoidal amplitude-modulated pulse trains (carrier rate of 120 pulses/s). Modulation sensitivity was quantified by measuring modulation detection thresholds (MDTs), defined as the lowest modulation depth required to differentiate the response of a modulated stimulus from an unmodulated one. Whereas MP stimulation showed significantly lower MDTs than FMP and TP stimulation (P values <0.05) at stimulation ≤2 dB above threshold, all stimulation configurations were found to have similar modulation sensitivities at 4 dB above threshold. There was no difference found in modulation sensitivity between FMP and TP stimulation. The present study demonstrates that current focusing techniques such as FMP and TP can adequately convey amplitude modulation and are comparable to MP stimulation, especially at higher stimulation levels, although there may be some trade-off between spectral and temporal fidelity with current focusing stimulation.

Evaluation of focused multipolar stimulation for cochlear implants in acutely deafened cats

OBJECTIVE

The conductive nature of the fluids and tissues of the cochlea can lead to broad activation of spiral ganglion neurons using contemporary cochlear implant stimulation configurations such as monopolar (MP) stimulation. The relatively poor spatial selectivity is thought to limit implant performance, particularly in noisy environments. Several current focusing techniques have been proposed to reduce the spread of activation with the aim towards achieving improved clinical performance.

APPROACH

The present research evaluated the efficacy of focused multipolar (FMP) stimulation, a relatively new focusing technique in the cochlea, and compared its efficacy to both MP stimulation and tripolar (TP) stimulation. The spread of neural activity across the inferior colliculus (IC), measured by recording the spatial tuning curve, was used as a measure of spatial selectivity. Adult cats (n = 6) were acutely deafened and implanted with an intracochlear electrode array before multi-unit responses were recorded across the cochleotopic gradient of the contralateral IC. Recordings were made in response to acoustic and electrical stimulation using the MP, TP and FMP configurations.

MAIN RESULTS

FMP and TP stimulation resulted in greater spatial selectivity than MP stimulation. However, thresholds were significantly higher (p < 0.001) for FMP and TP stimulation compared to MP stimulation. There were no differences found in spatial selectivity and threshold between FMP and TP stimulation.

SIGNIFICANCE

The greater spatial selectivity of FMP and TP stimulation would be expected to result in improved clinical performance. However, further research will be required to demonstrate the efficacy of these modes of stimulation after longer durations of deafness.

Simulating the dual-peak excitation pattern produced by bipolar stimulation of a cochlear implant: effects on speech intelligibility

Several electrophysiological and psychophysical studies have shown that the spatial excitation pattern produced by bipolar stimulation of a cochlear implant (CI) can have a dual-peak shape. The perceptual effects of this dual-peak shape were investigated using noise-vocoded CI simulations in which synthesis filters were designed to simulate the spread of neural activity produced by various electrode configurations, as predicted by a simple cochlear model. Experiments 1 and 2 tested speech recognition in the presence of a concurrent speech masker for various sets of single-peak and dual-peak synthesis filters and different numbers of channels. Similarly as results obtained in real CIs, both monopolar (MP, single-peak) and bipolar (BP + 1, dual-peak) simulations showed a plateau of performance above 8 channels. The benefit of increasing the number of channels was also lower for BP + 1 than for MP. This shows that channel interactions in BP + 1 become especially deleterious for speech intelligibility when a simulated electrode acts both as an active and as a return electrode for different channels because envelope information from two different analysis bands are being conveyed to the same spectral location. Experiment 3 shows that these channel interactions are even stronger in wide BP configuration (BP + 5), likely because the interfering speech envelopes are less correlated than in narrow BP + 1. Although the exact effects of dual- or multi-peak excitation in real CIs remain to be determined, this series of experiments suggest that multipolar stimulation strategies, such as bipolar or tripolar, should be controlled to avoid neural excitation in the vicinity of the return electrodes.

Measurements of monopolar and bipolar current spreads using forward-masking with a fixed probe

OBJECTIVES

This research employed a forward-masking paradigm to estimate the current spread of monopolar (MP) and bipolar (BP) maskers, with current amplitudes adjusted to elicit the same loudness. Since the spatial separation between active and return electrodes is smaller in BP than in MP configurations, the BP current spread is more localized and presumably superior in terms of speech intelligibility. Because matching the loudness requires higher current in BP than in MP stimulation, previous forward-masking studies show that BP current spread is not consistently narrower across subjects or electrodes within a subject.

METHODS

The present forward-masking measures of current spread differ from those of previous studies by using the same BP probe electrode configuration for both MP and BP masker configurations, and adjusting the current levels of the MP and BP maskers so as to match them in loudness. With this method, the estimate of masker current spread would not be contaminated by differences in probe current spread. Forward masking was studied in four cochlear implant patients, two females and two males, with speech recognition scores higher than 50%; that is, their auditory-nerve survival status was more than adequate to carry out the experiments.

RESULTS

The data showed that MP and BP masker configurations produce equivalent masking patterns (and current spreads) in three participants. A fourth participant displayed asymmetrical patterns with enhancement rather than masking in some cases, especially when the probe and masker were at the same location.

DISCUSSION

This study showed equivalent masking patterns for MP and BP maskers when the BP masker current amplitude was increased to match the loudness of the MP masker, and the same BP probe configuration is used with both maskers. This finding could help to explain why cochlear implant users often fail to accrue higher speech intelligibility benefit from BP stimulation.

Listening effort with cochlear implant simulations

PURPOSE

Fitting a cochlear implant (CI) for optimal speech perception does not necessarily optimize listening effort. This study aimed to show that listening effort may change between CI processing conditions for which speech intelligibility remains constant.

METHOD

Nineteen normal-hearing participants listened to CI simulations with varying numbers of spectral channels. A dual-task paradigm combining an intelligibility task with either a linguistic or nonlinguistic visual response-time (RT) task measured intelligibility and listening effort. The simultaneously performed tasks compete for limited cognitive resources; changes in effort associated with the intelligibility task are reflected in changes in RT on the visual task. A separate self-report scale provided a subjective measure of listening effort.

RESULTS

All measures showed significant improvements with increasing spectral resolution up to 6 channels. However, only the RT measure of listening effort continued improving up to 8 channels. The effects were stronger for RTs recorded during listening than for RTs recorded between listening.

CONCLUSION

The results suggest that listening effort decreases with increased spectral resolution. Moreover, these improvements are best reflected in objective measures of listening effort, such as RTs on a secondary task, rather than intelligibility scores or subjective effort measures.

Masking patterns for monopolar and phantom electrode stimulation in cochlear implants

Phantom electrode (PE) stimulation consists of out-of-phase stimulation of two electrodes. When presented at the apex of the electrode array, phantom stimulation is known to produce a lower pitch sensation than monopolar (MP) stimulation on the most apical electrode. The ratio of the current between the primary electrode (PEL) and the compensating electrode (CEL) is represented by the coefficient σ, which ranges from 0 (monopolar) to 1 (full bipolar). The exact mechanism by which PE stimulation produces a lower pitch sensation is unclear. In the present study, unmasked and masked thresholds were obtained using a forward masking paradigm to estimate the spread of current for MP and PE stimulation. Masked thresholds were measured for two phantom electrode configurations (1) PEL = 4, CEL = 5 (lower pitch phantom) and (2) PEL = 4, CEL = 3 (higher pitch phantom). The unmasked thresholds were subtracted from the masked thresholds to obtain masking patterns which were normalized to their peak. The masking patterns reveal (1) differences in the spread of excitation that are consistent with the direction of pitch shift produced by PE stimulation, and (2) narrower spread of electrical excitation for PE stimulation relative to MP stimulation.

Visual cortex responses to suprachoroidal electrical stimulation of the retina: effects of electrode return configuration

A clinically effective retinal prosthesis must evoke localized phosphenes in a retinotopic manner in response to stimulation of each of the retinal electrodes, evoke brightness cues over a wide dynamic range and function within safe stimulus limits. The effects of varying return configuration for retinal stimulation are currently unknown. To investigate this, we implanted a flexible, 7 × 12 electrode array into the suprachoroidal space of normally-sighted, anesthetized cats. Multi-unit activity in the primary visual cortex was recorded in response to electrical stimulation using various return configurations: monopolar vitreous (MPV), common ground (CG), hexagonal (HX), monopolar remote (MPR) and bipolar (BP_N). MPV stimulation was found to be the most charge efficient and was most likely to induce cortical activity within safe charge limits. HX and CG stimulation were found to exhibit greater retinal selectivity compared to the MPV return at the expense of lower cortical yield and higher P50 charge levels, while cortical selectivity was unaffected by choice of return. Responses using MPR and widely spaced BP_N configurations were similar to those using the MPV return. These results suggest that choice of return configuration for a retinal prosthesis will be balanced between resolution and stimulation within safe charge limits.

Binaural unmasking with multiple adjacent masking electrodes in bilateral cochlear implant users

Bilateral cochlear implant (BiCI) users gain an advantage in noisy situations from a second implant, but their bilateral performance falls short of normal hearing listeners. Channel interactions due to overlapping electrical fields between electrodes can impair speech perception, but its role in limiting binaural hearing performance has not been well characterized. To address the issue, binaural masking level differences (BMLD) for a 125 Hz tone in narrowband noise were measured using a pair of pitch-matched electrodes while simultaneously presenting the same masking noise to adjacent electrodes, representing a more realistic stimulation condition compared to prior studies that used only a single electrode pair. For five subjects, BMLDs averaged 8.9 ± 1.0 dB (mean ± s.e.) in single electrode pairs but dropped to 2.1 ± 0.4 dB when presenting noise on adjacent masking electrodes, demonstrating a negative impact of the additional maskers. Removing the masking noise from only the pitch-matched electrode pair not only lowered thresholds but also resulted in smaller BMLDs. The degree of channel interaction estimated from auditory nerve evoked potentials in three subjects was significantly and negatively correlated with BMLD. The data suggest that if the amount of channel interactions can be reduced, BiCI users may experience some performance improvements related to binaural hearing.

Effects of pulse phase duration and location of stimulation within the inferior colliculus on auditory cortical evoked potentials in a guinea pig model

The auditory midbrain implant (AMI), which consists of a single shank array designed for stimulation within the central nucleus of the inferior colliculus (ICC), has been developed for deaf patients who cannot benefit from a cochlear implant. Currently, performance levels in clinical trials for the AMI are far from those achieved by the cochlear implant and vary dramatically across patients, in part due to stimulation location effects. As an initial step towards improving the AMI, we investigated how stimulation of different regions along the isofrequency domain of the ICC as well as varying pulse phase durations and levels affected auditory cortical activity in anesthetized guinea pigs. This study was motivated by the need to determine in which region to implant the single shank array within a three-dimensional ICC structure and what stimulus parameters to use in patients. Our findings indicate that complex and unfavorable cortical activation properties are elicited by stimulation of caudal-dorsal ICC regions with the AMI array. Our results also confirm the existence of different functional regions along the isofrequency domain of the ICC (i.e., a caudal-dorsal and a rostral-ventral region), which has been traditionally unclassified. Based on our study as well as previous animal and human AMI findings, we may need to deliver more complex stimuli than currently used in the AMI patients to effectively activate the caudal ICC or ensure that the single shank AMI is only implanted into a rostral-ventral ICC region in future patients.

Forward-masking patterns produced by symmetric and asymmetric pulse shapes in electric hearing

Two forward-masking experiments were conducted with six cochlear implant listeners to test whether asymmetric pulse shapes would improve the place-specificity of stimulation compared to symmetric ones. The maskers were either cathodic-first symmetric biphasic, pseudomonophasic (i.e., with a second anodic phase longer and lower in amplitude than the first phase), or "delayed pseudomonophasic" (identical to pseudomonophasic but with an inter-phase gap) stimuli. In experiment 1, forward-masking patterns for monopolar maskers were obtained by keeping each masker fixed on a middle electrode of the array and measuring the masked thresholds of a monopolar signal presented on several other electrodes. The results were very variable, and no difference between pulse shapes was found. In experiment 2, six maskers were used in a wide bipolar (bipolar+9) configuration: the same three pulse shapes as in experiment 1, either cathodic-first relative to the most apical or relative to the most basal electrode of the bipolar channel. The pseudomonophasic masker showed a stronger excitation proximal to the electrode of the bipolar pair for which the short, high-amplitude phase was anodic. However, no difference was obtained with the symmetric and, more surprisingly, with the delayed pseudomonophasic maskers. Implications for cochlear implant design are discussed.

Auditory midbrain implant: a review

The auditory midbrain implant (AMI) is a new hearing prosthesis designed for stimulation of the inferior colliculus in deaf patients who cannot sufficiently benefit from cochlear implants. The authors have begun clinical trials in which five patients have been implanted with a single shank AMI array (20 electrodes). The goal of this review is to summarize the development and research that has led to the translation of the AMI from a concept into the first patients. This study presents the rationale and design concept for the AMI as well a summary of the animal safety and feasibility studies that were required for clinical approval. The authors also present the initial surgical, psychophysical, and speech results from the first three implanted patients. Overall, the results have been encouraging in terms of the safety and functionality of the implant. All patients obtain improvements in hearing capabilities on a daily basis. However, performance varies dramatically across patients depending on the implant location within the midbrain with the best performer still not able to achieve open set speech perception without lip-reading cues. Stimulation of the auditory midbrain provides a wide range of level, spectral, and temporal cues, all of which are important for speech understanding, but they do not appear to sufficiently fuse together to enable open set speech perception with the currently used stimulation strategies. Finally, several issues and hypotheses for why current patients obtain limited speech perception along with several feasible solutions for improving AMI implementation are presented.

Psychophysical versus physiological spatial forward masking and the relation to speech perception in cochlear implants

OBJECTIVES

The primary goal of this study was to determine if physiological forward masking patterns in cochlear implants are predictive of psychophysical forward masking (PFM) patterns. It was hypothesized that the normalized amount of physiological masking would be positively correlated with the normalized amount of psychophysical masking for different masker-probe electrode separations. A secondary goal was to examine the relation between the spatial forward masking patterns and speech perception performance. It was hypothesized that subjects with less channel interaction overall (either psychophysically or physiologically) would have better speech perception ability because of better spectral resolution.

DESIGN

Data were collected for 18 adult cochlear implant recipients [N = 9 Clarion CII or HiRes 90K, N = 9 Nucleus 24R(CS)]. Physiological spatial forward masking patterns were obtained with the electrically evoked compound action potential (ECAP) through the implant telemetry system. PFM patterns were obtained using a three-interval, two-alternative forced-choice adaptive procedure. Both measures used a fixed probe electrode with varied masker location. For each subject, spatial forward masking patterns were obtained for three probe electrodes with five masker locations per probe.

RESULTS

On an individual basis, the correlation between ECAP FM and PFM was strong for 10 subjects (r = 0.68-0.85, p <or= 0.02), moderately strong for two subjects (r = 0.54-0.55, p = 0.06-0.07), and poor for six subjects (r = 0.13-0.45, p > 0.14). Results across subjects and electrodes showed a highly significant correlation between ECAP FM and PFM (r = 0.55, p < 0.0001); the correlation was strongest for basal electrodes. There was no significant correlation between speech perception and ECAP FM or PFM. Subjects whose ECAP FM patterns correlated well with PFM patterns generally had the poorest speech perception and subjects with the poorest correlations had the best speech perception.

CONCLUSIONS

ECAP FM and PFM patterns correlated well for two-thirds of the subjects. Although the group correlation was statistically significant, ECAP FM patterns only accounted for 30% of the variance in the PFM measures. This suggests that the ECAP measures alone are not sufficient for accurately predicting PFM patterns for individual subjects.

Current steering and current focusing in cochlear implants: comparison of monopolar, tripolar, and virtual channel electrode configurations

OBJECTIVES

To compare the effects of Monopole (Mono), Tripole (Tri), and "Virtual channel" (Vchan) electrode configurations on spectral resolution and speech perception in a crossover design.

DESIGN

Nine experienced adults who received an Advanced Bionics CII/90K cochlear implant participated in a crossover design using three experimental strategies for 2 wk each. Three strategies were compared: (1) Mono; (2) Tri with current partly returning to adjacent electrodes and partly (25 or 75%) to the extracochlear reference; and (3) a monopolar "Vchan" strategy creating seven intermediate channels between two contacts. Each strategy was a variant of the standard "HiRes" processing strategy using 14 channels and 1105 pulses/sec/ channel, and a pulse duration of 32 microsec/phase. Spectral resolution was measured using broadband noise with a sinusoidally rippled spectral envelope with peaks evenly spaced on a logarithmic frequency scale. Speech perception was measured for monosyllables in quiet and in steady-state and fluctuating noises. Subjective comments on music experience and preferences in everyday use were assessed through questionnaires.

RESULTS

Thresholds and most comfortable levels with Mono and Vchan were both significantly lower than levels with Tri. Spectral resolution was significantly higher with Tri than with Mono; spectral resolution with Vchan did not differ significantly from the other configurations. Moderate but significant correlations between word recognition and spectral resolution were found in speech in quiet and fluctuating noise. For speech in quiet, word recognition was best with Mono and worst with Vchan; Tri did not significantly differ from the other configurations. Pooled across the noise conditions, word recognition was best with Tri and worst with Vchan (Mono did not significantly differ from the other configurations). These differences were small and insufficient to result in a clear increase in performance across subjects if the result from the best configuration per subject was compared with the result from Mono. Across all subjects, music appreciation and satisfaction in everyday use did not clearly differ between configurations.

CONCLUSIONS

(1) Although spectral resolution was improved with the tripolar configuration, differences in speech performance were too small in this limited group of subjects to justify clinical introduction. (2) Overall spectral resolution remained extremely poor compared with normal hearing; it remains to be seen whether further manipulations of the electrical field will be more effective.

Psychophysical assessment of stimulation sites in auditory prosthesis electrode arrays

Auditory prostheses use implanted electrode arrays that permit stimulation at many sites along the tonotopic axis of auditory neurons. Psychophysical studies demonstrate that measures of implant function, such as detection and discrimination thresholds, vary considerably across these sites, that the across-site patterns of these measures differ across subjects, and that the likely mechanisms underlying this variability differ across measures. Psychophysical and speech recognition studies suggest that not all stimulation sites contribute equally to perception with the prosthesis and that some sites might have negative effects on perception. Studies that reduce the number of active stimulation sites indicate that most cochlear implant users can effectively utilize a maximum of only about seven sites in their processors. These findings support a strategy for improving implant performance by selecting only the best stimulation sites for the processor map. Another approach is to revise stimulation parameters for ineffective sites in an effort to improve acuity at those sites. In this paper, we discuss data supporting these approaches and some potential pitfalls.

Cochlear-implant high pulse rate and narrow electrode configuration impair transmission of temporal information to the auditory cortex

In the most commonly used cochlear prosthesis systems, temporal features of sound are signaled by amplitude modulation of constant-rate pulse trains. Several convincing arguments predict that speech reception should be optimized by use of pulse rates > or approximately 2,000 pulses per second (pps) and by use of intracochlear electrode configurations that produce restricted current spread (e.g., bipolar rather than monopolar configurations). Neither of those predictions has been borne out in consistent improvements in speech reception. Neurons in the auditory cortex of anesthetized guinea pigs phase lock to the envelope of sine-modulated electric pulse trains presented through a cochlear implant. The present study used that animal model to quantify the effects of carrier pulse rate, electrode configuration, current level, and modulator wave shape on transmission of temporal information from a cochlear implant to the auditory cortex. Modulation sensitivity was computed using a signal-detection analysis of cortical phase-locking vector strengths. Increasing carrier pulse rate in 1-octave steps from 254 to 4,069 pps resulted in systematic decreases in sensitivity. Comparison of sine- versus square-wave modulator waveforms demonstrated that some, but not all, of the loss of modulation sensitivity at high pulse rates was a result of the decreasing size of pulse-to-pulse current steps at the higher rates. Use of a narrow bipolar electrode configuration, compared with the monopolar configuration, produced a marked decrease in modulation sensitivity. Results from this animal model suggest explanations for the failure of high pulse rates and/or bipolar electrode configurations to produce hoped-for improvements in speech reception.

Simulating the effect of spread of excitation in cochlear implants

A model was developed to simulate acoustically the effects of excitation spread in cochlear implants (CI). Based on neurophysiologic data, the proposed model simulates the electrical-current decay rate associated with broad and narrow types of excitation, such as those produced by monopolar and bipolar electrode configurations. The effect of excitation spread on speech intelligibility was simulated in normal-hearing subjects by varying the slopes of the synthesis bands in the noise vocoder. Sentences and monosyllabic words processed via 4-16 channels of stimulation with varying degrees of excitation spread were presented to normal-hearing listeners for identification. Results showed significant interaction between spectral resolution (number of channels) and spread of excitation. The effect of narrowing the excitation spread was minimal when the spectral resolution was sufficiently good (>8 channels) but it was significant when the spectral resolution was poor (4 channels). A significant decrement in performance was observed for extremely narrow excitation spread. This outcome is partly consistent with behavioral data obtained with cochlear implant studies in that CI users tend to do as well or better with monopolar stimulation than with bipolar stimulation.

Current focusing and steering: modeling, physiology, and psychophysics

Current steering and current focusing are stimulation techniques designed to increase the number of distinct perceptual channels available to cochlear implant (CI) users by adjusting currents applied simultaneously to multiple CI electrodes. Previous studies exploring current steering and current focusing stimulation strategies are reviewed, including results of research using computational models, animal neurophysiology, and human psychophysics. Preliminary results of additional neurophysiological and human psychophysical studies are presented that demonstrate the success of current steering strategies in stimulating auditory nerve regions lying between physical CI electrodes, as well as current focusing strategies that excite regions narrower than those stimulated using monopolar configurations. These results are interpreted in the context of perception and speech reception by CI users. Disparities between results of physiological and psychophysical studies are discussed. The differences in stimulation used for physiological and psychophysical studies are hypothesized to contribute to these disparities. Finally, application of current steering and focusing strategies to other types of auditory prostheses is also discussed.

Effects of phase duration and pulse rate on loudness and pitch percepts in the first auditory midbrain implant patients: Comparison to cochlear implant and auditory brainstem implant results

The auditory midbrain implant (AMI), which is designed for stimulation of the inferior colliculus (IC), is now in clinical trials. The AMI consists of a single shank array (20 contacts) and uses a stimulation strategy originally designed for cochlear implants since it is already approved for human use and we do not yet know how to optimally activate the auditory midbrain. The goal of this study was to investigate the effects of different pulse rates and phase durations on loudness and pitch percepts because these parameters are required to implement the AMI stimulation strategy. Although each patient was implanted into a different region (i.e. lateral lemniscus, central nucleus of IC, dorsal cortex of IC), they generally exhibited similar threshold versus phase duration, threshold versus pulse rate, and pitch versus pulse rate curves. In particular, stimulation with 100 mus/phase, 250 pulse per second (pps) pulse trains achieved an optimal balance among safety, energy, and current threshold requirements while avoiding rate pitch effects. However, we observed large differences across patients in loudness adaptation to continuous pulse stimulation over long time scales. One patient (implanted in dorsal cortex of IC) even experienced complete loudness decay and elevation of thresholds with daily stimulation. Comparing these results with those of cochlear implant and auditory brainstem implant patients, it appears that stimulation of higher order neurons exhibits less and even no loudness summation for higher rate stimuli and greater current leakage for longer phase durations than that of cochlear neurons. The fact that all midbrain regions we stimulated, which includes three distinctly different nuclei, exhibited similar loudness summation effects (i.e. none for pulse rates above 250 pps) suggests a possible shift in some coding properties that is affected more by which stage along the auditory pathway rather than the types of neurons are being stimulated. However, loudness adaptation occurs at multiple stages from the cochlea up to the midbrain.

The auditory midbrain implant: effects of electrode location

The auditory midbrain implant (AMI) is a new hearing prosthesis designed for stimulation of the inferior colliculus in patients who do not receive sufficient benefit from cochlear or brainstem prostheses. We have begun clinical trials in which three patients have been implanted with the AMI. Although the intended target was the central nucleus of the inferior colliculus (ICC), the electrode array was implanted into different locations across patients (i.e., ICC, dorsal cortex of inferior colliculus, lateral lemniscus). In this paper, we will summarize the effects of electrical stimulation of these different midbrain regions on various psychophysical properties and speech perception performance. The patient implanted within the intended target, the ICC, exhibited the greatest improvements in hearing performance. However, this patient has not yet achieved open-set speech perception to the performance level typically observed for cochlear implant patients, which we believe is partially due to the location of the array within the ICC. We will present findings from previous AMI studies in guinea pigs demonstrating the existence of spatially distinct functional output regions within the ICC and suggesting that further improvements in performance may be achieved by stimulating within a rostral-ventral region. Remaining questions include if a similar organization exists in the human ICC and if stimulation of its rostral-ventral region with currently available strategies (i.e., those designed for cochlear implants) can restore sufficient speech perception.

Electrical stimulation of the midbrain for hearing restoration: insight into the functional organization of the human central auditory system

The cochlear implant can restore speech perception in patients with sensorineural hearing loss. However, it is ineffective for those without an implantable cochlea or a functional auditory nerve. These patients can be implanted with the auditory brainstem implant (ABI), which stimulates the surface of the cochlear nucleus. Unfortunately, the ABI has achieved limited success in its main patient group [i.e., those with neurofibromatosis type 2 (NF2)] and requires a difficult surgical procedure. These limitations have motivated us to develop a new hearing prosthesis that stimulates the midbrain with a penetrating electrode array. We recently implanted three patients with the auditory midbrain implant (AMI), and it has proven to be safe with minimal movement over time. The AMI provides loudness, pitch, temporal, and directional cues, features that have shown to be important for speech perception and more complex sound processing. Thus far, all three patients obtain enhancements in lip reading capabilities and environmental awareness and some improvements in speech perception comparable with that of NF2 ABI patients. Considering that our midbrain target is more surgically exposable than the cochlear nucleus, this argues for the use of the AMI as an alternative to the ABI. Fortunately, we were able to stimulate different midbrain regions in our patients and investigate the functional organization of the human central auditory system. These findings provide some insight into how we may need to stimulate the midbrain to improve hearing performance with the AMI.

Auditory prosthesis with a penetrating nerve array

Contemporary auditory prostheses ("cochlear implants") employ arrays of stimulating electrodes implanted in the scala tympani of the cochlea. Such arrays have been implanted in some 100,000 profoundly or severely deaf people worldwide and arguably are the most successful of present-day neural prostheses. Nevertheless, most implant users show poor understanding of speech in noisy backgrounds, poor pitch recognition, and poor spatial hearing, even when using bilateral implants. Many of these limitations can be attributed to the remote location of stimulating electrodes relative to excitable cochlear neural elements. That is, a scala tympani electrode array lies within a bony compartment filled with electrically conductive fluid. Moreover, scala tympani arrays typically do not extend to the apical turn of the cochlea in which low frequencies are represented. In the present study, we have tested in an animal model an alternative to the conventional cochlear implant: a multielectrode array implanted directly into the auditory nerve. We monitored the specificity of stimulation of the auditory pathway by recording extracellular unit activity at 32 sites along the tonotopic axis of the inferior colliculus. The results demonstrate the activation of specific auditory nerve populations throughout essentially the entire frequency range that is represented by characteristic frequencies in the inferior colliculus. Compared to conventional scala tympani stimulation, thresholds for neural excitation are as much as 50-fold lower and interference between electrodes stimulated simultaneously is markedly reduced. The results suggest that if an intraneural stimulating array were incorporated into an auditory prosthesis system for humans, it could offer substantial improvement in hearing replacement compared to contemporary cochlear implants.

Focused intracochlear electric stimulation with phased array channels

A method is described for producing focused intracochlear electric stimulation using an array of N electrodes. For each electrode site, N weights are computed that define the ratios of positive and negative electrode currents required to produce cancellation of the voltage within scala tympani at all of the N-1 other sites. Multiple sites can be stimulated simultaneously by superposition of their respective current vectors. The method allows N independent stimulus waveforms to be delivered to each of the N electrode sites without spatial overlap. Channel interaction from current spread associated with monopolar stimulation is substantially eliminated. The method operates by inverting the spread functions of individual monopoles as measured with the other electrodes. The method was implemented and validated with data from three human subjects implanted with 22-electrode perimodiolar arrays. Results indicate that (1) focusing is realizable with realistic precision; (2) focusing comes at the cost of increased total stimulation current; (3) uncanceled voltages that arise beyond the ends of the array are weak except when stimulating the two end channels; and (4) close perimodiolar positioning of the electrodes may be important for minimizing stimulation current and sensitivity to measurement errors.

Effects of auditory pathway anatomy and deafness characteristics? Part 2: On electrically evoked late auditory responses

The purpose of this study was to distinguish the effects of different parameters on latencies of wave N1, wave P2, and inter-peak interval N1-P2 of electrical late auditory responses (ELARs). ELARs were recorded from four intra-cochlear electrodes in fourteen adult HiRes90K cochlear implant users who had at least three months of experience. The relationship between latencies and stimulation sites in the cochlea was characterized to assess the influence of the auditory pathway anatomy on ELARs, i.e., whether the speed of neural propagation varies according to the place that is activated in the cochlea. Audiograms before implantation, duration of deafness, and psychophysics at first fitting were used to describe the influence of deafness characteristics on latencies. The stimulation sites were found to have no effect on ELAR latency and, while there was no influence of psychophysics on latency, a strong relationship was shown with duration of deafness and the pre-implantation audiogram. Thus, ELAR latency was longer for poorer audiograms and longer durations of deafness and this relationship appeared to be independent of stimulation parameters such as stimulation site. Comparison between these findings and those from the equivalent study on EABR waves IIIe and Ve latency [Guiraud, J., Gallego, S., Arnold, L., Boyle, P., Truy, E., Collet, L., 2007. Effects of auditory pathway anatomy and deafness characteristics? (1): On electrically evoked auditory brainstem responses. Hear. Res. 223 (1-2), 48-60] shows that, while ELAR and EABR latencies are related with parameters that reflect the integrity of the auditory pathway, ELAR latency is less dependent on stimulation parameters than EABR latency.

Cochlear Implant Channel Separation and Its Influence on Speech Perception – Implications for a New Electrode Design

There are a variety of factors which can influence cochlear implantation outcome. Channel interaction is one of the variables responsible for audiological performance deterioration in multichannel implants. Electrode design is--among others--one way to decrease the incidence of channel interaction. At present, electrodes differ in overall length, diameter, contact design and distribution, but none of the electrodes available have a distinct variability in the amount of space between contacts across the length of the electrode. The aim of this study was to investigate whether a new electrode design featuring larger contact spacing in the apical part of deeply inserted electrodes would lead to an increase in speech perception. Eighteen postlingually deafened patients fitted with MedEl Combi 40+ or MedEl Pulsar cochlear implants using the MedEl implementation of continuous interleaved sampling participated in this study. Patients were tested in 6 conditions, in which the channel spacing and distribution of electrode contacts in each patient were artificially varied by activating or deactivating different channels. Performance was tested immediately after each change in setup with a monosyllable and sentence test (Hochmaier, Schultz and Moser). Our results showed that the condition with the highest distance between contacts in the apical part (up to 6.4 mm instead of 2.4 mm) is the most effective for the matched map condition: the results improved statistically significantly for the sentence test from 72% in the standard 12-channel condition to 83.2% and from 40.8 to 50% for the monosyllable test. Based on these findings, we present a new electrode design which can help achieve further increases in speech perception with cochlear implants.

Threshold and channel interaction in cochlear implant users: evaluation of the tripolar electrode configuration

The efficacy of cochlear implants is limited by spatial and temporal interactions among channels. This study explores the spatially restricted tripolar electrode configuration and compares it to bipolar and monopolar stimulation. Measures of threshold and channel interaction were obtained from nine subjects implanted with the Clarion HiFocus-I electrode array. Stimuli were biphasic pulses delivered at 1020 pulses/s. Threshold increased from monopolar to bipolar to tripolar stimulation and was most variable across channels with the tripolar configuration. Channel interaction, quantified by the shift in threshold between single- and two-channel stimulation, occurred for all three configurations but was largest for the monopolar and simultaneous conditions. The threshold shifts with simultaneous tripolar stimulation were slightly smaller than with bipolar and were not as strongly affected by the timing of the two channel stimulation as was monopolar. The subjects' performances on clinical speech tests were correlated with channel-to-channel variability in tripolar threshold, such that greater variability was related to poorer performance. The data suggest that tripolar channels with high thresholds may reveal cochlear regions of low neuron survival or poor electrode placement.

Effects of auditory pathway anatomy and deafness characteristics? (1): On electrically evoked auditory brainstem responses

The purpose of this study was to distinguish the effects of different parameters on latencies of wave IIIe, wave Ve, and interpeak interval IIIe-Ve of electrical auditory brainstem responses (EABRs). EABRs were recorded from all the intra-cochlear electrodes in eight adult HiRes90K((R)) cochlear implant users. The relationship between latencies and stimulation sites in the cochlea was characterized to assess activity along the auditory pathway. Audiograms before implantation, psychophysics at first fitting and duration of deafness were used to describe the influence of deafness on latencies. A decreasing baso-apical latency gradient was found for waves IIIe and Ve, while the interpeak interval IIIe-Ve remained the same along the electrode array. Electrical stimulation enabling to stimulate various parts of the cochlea at the same time, this could indicate an anatomical way of compensating for the delay the acoustic wave takes to reach the cochlea apex in a non-implanted ear. However, psychophysical levels were also found to increase at the cochlear base showing that the latency gradient could result from an increasing gradient of neural degeneration toward the base. Correlations of EABR latencies with psychophysics, audiometric data and duration of deafness show that factors linked to deafness have indeed an influence on EABR latencies. The possible explanations for the latency shift observed, whether they are anatomical and/or pathological, are exposed.

Speech recognition in normal hearing and sensorineural hearing loss as a function of the number of spectral channels

Speech recognition by normal-hearing listeners improves as a function of the number of spectral channels when tested with a noiseband vocoder simulating cochlear implant signal processing. Speech recognition by the best cochlear implant users, however, saturates around eight channels and does not improve when more electrodes are activated, presumably due to reduced frequency selectivity caused by channel interactions. Listeners with sensorineural hearing loss may also have reduced frequency selectivity due to cochlear damage and the resulting reduction in the nonlinear cochlear mechanisms. The present study investigates whether such a limitation in spectral information transmission would be observed with hearing-impaired listeners, similar to implant users. To test the hypothesis, hearing-impaired subjects were selected from a population of patients with moderate hearing loss of cochlear origin, where the frequency selectivity would be expected to be poorer compared to normal hearing. Hearing-impaired subjects were tested for vowel and consonant recognition in steady-state background noise of varying levels using a noiseband vocoder and as a function of the number of spectral channels. For comparison, normal-hearing subjects were tested with the same stimuli at different presentation levels. In quiet and low background noise, performance by normal-hearing and hearing-impaired subjects was similar. In higher background noise, performance by hearing-impaired subjects saturated around eight channels, while performance by normal-hearing subjects continued to increase up to 12-16 channels with vowels, and 10-12 channels with consonants. A similar trend was observed for most of the presentation levels at which the normal-hearing subjects were tested. Therefore, it is unlikely that the effects observed with hearing-impaired subjects were due to insufficient audibility or high presentation levels. Consequently, the results with hearing-impaired subjects were similar to previous results obtained with implant users, but only for background noise conditions.

Speech perception with mono- and quadrupolar electrode configurations: a crossover study

OBJECTIVE

To study the effect of two multipolar electrode configurations on speech perception, pitch perception, and the intracochlear electrical field.

STUDY DESIGN

Crossover design; within subject.

SETTING

Tertiary referral center.

PATIENTS

Eight experienced adult cochlear implant users.

INTERVENTION

Each subject used each of three experimental processors for 3 weeks. The following processors were compared that differed only in electrode configuration: 1) monopolar; 2) hybrid quadrupolar, in which half of the current returned to the extracochlear reference electrode and half to two electrodes immediately to the left and right of the active electrode; and 3) flat tripolar +2, which directed all the current to four reference electrodes (two on each side), separated from the active electrode by two inactive electrodes. All the processors used the standard Advanced Bionics HiRes speech-processing strategy, 12 channels, 1,220 pulses per second per channel, and with a pulse width of 33 (micros/phase).

RESULTS

The monopolar processors had the largest stimulation efficiency and the smallest dynamic range in linear current units. The reverse was true of flat tripolar +2 processor, whereas the hybrid quadrupolar processor fell in between. Insufficient loudness growth prevented the use of the flat tripolar +2 processor in three subjects. Word recognition did not differ between the clinically used 16-channel monopolar processor and the experimental monopolar processor, regardless of the differences in the number of channels, pulse rate, and duration of experience. Word recognition with the flat tripolar +2 processor was significantly poorer than with the monopolar and hybrid quadrupolar processors; monopolar and quadrupolar processors did not differ. There was no significant interaction between processor type and competing noise type (stationary or fluctuating), but performance at the higher level of fluctuating noise was best with the hybrid quadrupolar processor in almost all the subjects. Pitch scaling showed ceiling performance in five subjects and differed between processors in the two other subjects with imperfect tonotopy. Intracochlear current spread was considerable with the monopolar configuration; it was reduced with the hybrid quadrupolar configuration and virtually absent beyond the active electrodes with the tripolar configuration.

CONCLUSION

More confined configurations reduced the longitudinal width of the electrical field, which was expected to enhance channel separation, but no improvement in word recognition was found. More research is needed to test confined configurations that have enhanced efficiency and to evaluate the fundamental effects of configuration on channel discriminability.

Asymmetric pulses in cochlear implants: effects of pulse shape, polarity, and rate

Existing cochlear implants stimulate the auditory nerve with trains of symmetric biphasic (BP) pulses. Recent data have shown that modifying the pulse shape, while maintaining charge balance, may be beneficial in terms of reducing power consumption, increasing dynamic range, and limiting channel interactions. We measured thresholds and most comfortable levels (MCLs) for various 99-pulses-per-second (pps) stimuli. "Pseudomonophasic (PS)" pulses consist of a brief phase of one polarity followed immediately by a longer and lower-amplitude phase of the opposite polarity. We focused on a novel variant of PS pulses, termed the "delayed pseudomonophasic (DPS)" stimulus, in which the longer phase is presented midway between the short phases of two consecutive pulses. DPS pulse trains produced thresholds that were more than 10 dB lower than those obtained with BP pulses. This reduction was much greater than the 0- to 3-dB drop obtained with PS pulses and was still more than 6 dB when a pulse rate of 892 pps was used. A study of the relative contributions of the two phases of DPS suggested that the short, high-amplitude phase dominated the perceived loudness. This study showed major threshold and MCL reductions using a DPS stimulus compared to the widely used BP stimulus. These reductions, which were predicted by a simple linear filter model, might lead to considerable power savings if implemented in a cochlear implant speech processor.

Effect of electrode configuration on psychophysical forward masking in cochlear implant listeners

Bipolar stimulation has been thought to be more beneficial than monopolar stimulation for speech coding in cochlear implants, on the basis of its more restricted current flow. The present study examined whether bipolar stimulation would indeed lead to reduced channel interaction in a behavioral forward masking experiment tested in four Nucleus 24 users. The masker was fixed on one channel and three masker levels that were balanced for loudness between the configurations were chosen. As expected, masking was maximal when the masker and probe channels were spatially close and decreased as they were separated. However, overall masking patterns did not consistently demonstrate sharper tuning with bipolar stimulation than monopolar. This implies that the spatial extent of a bipolar current field is not consistently narrower than that of an equally loud monopolar stimulus; therefore, it should not be assumed that bipolar stimulation leads to reduced channel interaction. Notably, bipolar masking patterns appeared to display more variations across channels, possibly influenced more by anatomical and neural irregularities near electrode contacts than monopolar masking patterns. The present psychophysical results provide a theoretical basis regarding the widespread use (and success) of monopolar configurations by implant users.

Electrophysiologic channel interaction, electrode pitch ranking, and behavioral threshold in straight versus perimodiolar cochlear implant electrode arrays

The primary goal of this study was to examine electrophysiologic measures of channel interaction, electrode pitch discrimination ability using a pitch-ranking task, and behavioral threshold levels in individuals implanted with a straight electrode array versus a perimodiolar array. It was hypothesized that perimodiolar arrays should yield lower thresholds, less channel interaction as measured with the electrically evoked compound action potential (ECAP), and better electrode pitch-ranking ability. Results from ten adult Nucleus 24 recipients (N=5 straight array, N=5 perimodiolar Contour array) showed no significant difference in threshold between the two electrode designs; however, there was significantly better electrode pitch-ranking ability and less channel interaction as measured with the ECAP for perimodiolar electrodes. Additionally, there was a significant positive correlation between behavioral threshold and width of the ECAP interaction function for Contour group data. There was no significant correlation between behavioral threshold and electrode pitch-ranking ability. These data suggest that electrode design and/or perimodiolar position may reduce physiologic channel interaction in the cochlea and improve electrode pitch discrimination ability; however, this positive finding did not translate into significantly better speech perception ability for Contour subjects.

The relation between electrophysiologic channel interaction and electrode pitch ranking in cochlear implant recipients

The primary goal of this study was to examine the relation between electrophysiologic measures of channel interaction and the ability to discriminate pitch between electrodes in a psychophysical pitch-ranking task. It was hypothesized that cochlear implant recipients should perform better on an electrode pitch-ranking task when using electrodes with less channel interaction as measured with the electrically evoked compound action potential (ECAP). The width of the ECAP channel interaction function was compared with the slope of the pitch-ranking function for 10 adult Nucleus 24 recipients. Results showed no significant correlation between electrode pitch-ranking ability and width of the ECAP channel interaction function for individual subjects or for group data. Additionally, there was no significant correlation between speech perception performance and either pitch-ranking ability or width of the ECAP channel interaction function. These results suggest that the width of the ECAP interaction function may not be an accurate predictor of the ability to discriminate between electrodes on the basis of pitch.

Efficacy of a cochlear implant simultaneous analog stimulation strategy coupled with a monopolar electrode configuration

OBJECTIVES

The present study was performed to evaluate the efficacy and clinical feasibility of using monopolar stimulation with the Clarion Simultaneous Analog Stimulation (SAS) strategy in patients with cochlear implants.

METHODS

Speech recognition by 10 Clarion cochlear implant users was evaluated by means of 4 different speech processing strategy/electrode configuration combinations; ie, SAS and Continuous Interleaved Sampling (CIS) strategies were each used with monopolar (MP) and bipolar (BP) electrode configurations. The test measures included consonants, vowels, consonant-nucleus-consonant words, and Hearing in Noise Test sentences with a +10 dB signal-to-noise ratio. Additionally, subjective judgments of sound quality were obtained for each strategy/configuration combination.

RESULTS

All subjects but 1 demonstrated open-set speech recognition with the SAS/MP combination. The group mean Hearing in Noise Test sentence score for the SAS/MP combination was 31.6% (range, 0% to 92%) correct, as compared to 25.0%, 46.7%, and 37.8% correct for the CIS/BP, CIS/MP, and SAS/BP combinations, respectively. Intersubject variability was high, and there were no significant differences in mean speech recognition scores or mean preference ratings among the 4 strategy/configuration combinations tested. Individually, the best speech recognition performance was with the subject's everyday strategy/configuration combination in 72% of the applicable cases. If the everyday strategy was excluded from the analysis, the subjects performed best with the SAS/MP combination in 37.5% of the remaining cases.

CONCLUSIONS

The SAS processing strategy with an MP electrode configuration gave reasonable speech recognition in most subjects, even though subjects had minimal previous experience with this strategy/configuration combination. The SAS/MP combination might be particularly appropriate for patients for whom a full dynamic range of electrical hearing could not be achieved with a BP configuration.

Effects of electrode design and configuration on channel interactions

A potential shortcoming of existing multichannel cochlear implants is electrical-field summation during simultaneous electrode stimulation. Electrical-field interactions can disrupt the stimulus waveform prior to neural activation. To test whether speech intelligibility can be degraded by electrical-field interaction, speech recognition performance and interaction were examined for three Clarion electrode arrays: the pre-curved, enhanced bipolar electrode array, the enhanced bipolar electrode with an electrode positioner, and the Hi-Focus electrode with a positioner. Channel interaction was measured by comparing stimulus detection thresholds for a probe signal in the presence of a sub-threshold perturbation signal as a function of the separation between the two simultaneously stimulated electrodes. Correct identification of vowels, consonants, and words in sentences was measured with two speech strategies: one which used simultaneous stimulation and another which used sequential stimulation. Speech recognition scores were correlated with measured electrical-field interaction for the strategy which used simultaneous stimulation but not the strategy which used sequential stimulation. Higher speech recognition scores with the simultaneous strategy were generally associated with lower levels of electrical-field interaction. Electrical-field interaction accounted for as much as 70% of the variance in speech recognition scores, suggesting that electrical-field interaction is a significant contributor to the variability found across patients who use simultaneous strategies.

Effects of stimulation mode, level and location on forward-masked excitation patterns in cochlear implant patients

In multi-channel cochlear implants, electrical current is delivered to appropriate electrodes in the cochlea to approximate the spatial representation of speech. Theoretically, electrode configurations that restrict the current spread within the cochlea (e.g., bi- or tri-polar stimulation) may provide better spatial selectivity, and in turn, better speech recognition than configurations that produce a broader current spread (e.g., monopolar stimulation). However, the effects of electrode configuration on supra-threshold excitation patterns have not been systematically studied in cochlear implant patients. In the present study, forward-masked excitation patterns were measured in cochlear implant patients as functions of stimulation mode, level and location within the cochlea. All stimuli were 500 pulses-per-second biphasic pulse trains (200 micros/phase, 20 micros inter-phase gap). Masker stimuli were 200 ms in duration; the bi-polar configuration was varied from narrow (BP+1) to wide (BP+17), depending on the test condition. Probe stimuli were 20 ms in duration and the masker-probe delay was 5 ms; the probe configuration was fixed at BP+1. The results indicated that as the distance between the active and return electrodes in a bi-polar pair was increased, the excitation pattern broadened within the cochlea. When the distance between active and return electrodes was sufficiently wide, two peaks were often observed in the excitation pattern, comparable to non-overlapping electric fields produced by widely separated dipoles. Analyses of the normalized data showed little effect of stimulation level on the shape of the excitation pattern.

Effects of waveform shape on human sensitivity to electrical stimulation of the inner ear

Psychophysical measures of the electrically stimulated human auditory system were obtained for different types of symmetric and asymmetric charge-balanced waveforms. Absolute detection thresholds of biphasic, pseudomonophasic, and 'alternating monophasic' current waveforms delivered by a bipolar intra-cochlear electrode pair were determined for four subjects implanted with the LAURA device. Thresholds for alternating monophasic stimuli, in which anodic and cathodic phases alternated every 5 ms, were 5-8 dB lower than for the biphasic waveforms for all four subjects. For two of the four subjects, thresholds for the pseudomonophasic waveforms were also significantly lower than for the biphasic waveforms. These pseudomonophasic thresholds were greatly affected neither by a 500-micros gap inserted between the two phases, nor by whether the shorter phase preceded or followed the longer one. Loudness balancing measures performed at the most comfortable levels also showed that, for equal loudness, alternating monophasic stimuli required a lower level than biphasic and pseudomonophasic waveforms. For three of the four subjects, the dynamic ranges of the pseudomonophasic (but not alternating monophasic) waveforms were greater than those of the biphasic waveforms. The results demonstrate that thresholds and dynamic ranges of human cochlear implant users can be controlled by manipulating the way in which the charge produced by the initial phase of an electrical pulse is recovered.

Across-site variation in detection thresholds and maximum comfortable loudness levels for cochlear implants

In cochlear implants, variation across stimulation sites in psychophysical detection thresholds (T levels) and maximum comfortable loudness levels (C levels) can be large when narrow-bipolar (BP) stimulation is used. This across-site variation is typically smaller when monopolar (MP) stimulation is used. At least two models can account for across-site variation and the effects of electrode configuration on the magnitude of the variation. According to one model, across-site variation reflects site-to-site differences in the distances between the stimulating electrodes and the sites of action-potential initiation. Under this model, the lower across-site variation with MP stimulation is due to shallower current versus distance gradients. An alternative model assumes that T and C levels depend on integration of activity across the whole population of neurons and that MP stimulation activates neurons over a larger spatial extent than does BP stimulation. If T and C levels are determined by integration of activity across large overlapping populations of neurons, then their values at adjacent sites should be more similar than if these levels result from integration across smaller, more independent populations. We tested the models by examining the effects on across-site variation of three variables believed to affect the spatial extent of activation: electrode configuration, stimulus level within the dynamic range, and electrode-array design. T levels and C levels were measured in 13 subjects with Nucleus CI24M (straight array) and 9 subjects with Nucleus CI24R(CS) (Contour) cochlear implants using bipolar (BP) and monopolar (MP) electrode configurations. Site-to-site variation in T and C levels for BP stimulation was 2.1-3.3 times larger than that for MP stimulation. Contrary to the across-neuron integration hypothesis, no significant differences were found between across-site variation for T levels and that for C levels for the BP configuration. There was considerable overlap in site-to-site variation values for the two types of implants but mean site-to-site variation in C levels for CI24M implants was significantly lower than that for CI24R(CS) implants. Control studies suggested that these results were not an artifact of the scale, and not due to differences in inherent variability of the psychophysical measures, or to the method of quantifying across-site variation.

Intensity discrimination and increment detection in cochlear-implant users

Intensity difference limens (DLs) were measured in users of the Nucleus 22 and Clarion v1.2 cochlear implants and in normal-hearing listeners to better understand mechanisms of intensity discrimination in electric and acoustic hearing and to evaluate the possible role of neural adaptation. Intensity DLs were measured for three modes of presentation: gated (intensity increments gated synchronously with the pedestal), fringe (intensity increments delayed 250 or 650 ms relative to the onset of the pedestal), and continuous (intensity increments occur in the presence of a pedestal that is played throughout the experimental run). Stimuli for cochlear-implant listeners were trains of biphasic pulses; stimuli for normal-hearing listeners were a 1-kHz tone and a wideband noise. Clarion cochlear-implant listeners showed level-dependent effects of presentation mode. At low pedestal levels, gated thresholds were generally similar to thresholds obtained in the fringe and continuous conditions. At higher pedestal levels, however, the fringe and continuous conditions produced smaller intensity DLs than the gated condition, similar to the gated-continuous difference in intensity DLs observed in acoustic hearing. Nucleus cochlear-implant listeners did not show consistent threshold differences for the gated and fringe conditions, and were not tested in the continuous condition. It is not clear why a difference between gated and fringe thresholds occurred for the Clarion but not the Nucleus subjects. Normal-hearing listeners showed improved thresholds for the continuous condition relative to the gated condition, but the effect was larger for the 1-kHz tonal carrier than for the noise carrier. Findings suggest that adaptation occurring central to the inner hair cell synapse mediates the gated-continuous difference observed in Clarion cochlear-implant listeners and may also contribute to the gated-continuous difference in acoustic hearing.

Electrode configuration influences action potential initiation site and ensemble stochastic response properties

The configuration of intracochlear electrodes used to electrically stimulate the auditory nerve influences the ensemble fiber response. For example, monopolar stimulation produces lower thresholds and greater spread of excitation than does bipolar stimulation. We used two approaches to investigate how the ensemble of auditory-nerve fibers responds to stimulation delivered by different electrode configurations. As the electrically evoked compound action potential (ECAP) reflects the ensemble response of the nerve, we used its morphology and changes with stimulus level to assess issues related to site-of-excitation and fiber recruitment. In our first approach, feline ECAPs were obtained using a nucleus-style banded electrode array. ECAP latency functions indicated that bipolar stimulation can initiate action potentials at more peripheral sites than does monopolar stimulation. We observed double-peaked ECAPs with bipolar and tripolar stimulation, suggesting excitation of both peripheral and central neural processes. Finally, we observed in some cases a tendency for monopolar stimulation to produce wider ECAP potentials, consistent with the notion that monopolar stimulation excites a broader spatial extent of the fiber population. In our second approach, we applied a simple model to published surveys of single-fiber responses to provide insight into the stochastic properties of the ensemble response. Our results suggest that broader recruitment of fiber activity produced by monopolar stimulation results in a population response with more probabilistic response characteristics and ensemble spike jitter. These observations and our ECAP results are consistent with reports of perceptual advantages attributed to monopolar or other less-focused modes of stimulation.

Cochlear implants in young children

The past 20 years have seen the cochlear implant evolve from an innovative but radical concept to the standard of care in the management of children with severe to profound hearing loss. All children receiving the cochlear implant achieve substantial benefit; however, performance gains are optimized by a team approach to the evaluation and management of these children. The critical elements of this team include audiologists, speech pathologists, and surgeons with specific interest, expertise, and dedication to the management of children with cochlear implants. Children are not well served by practitioners who delegate follow-up to educational programs not experienced in children with implants. Long-term involvement and dedication on the part of teachers, speech pathologists, audiologists, surgeons, and family are critical to maximizing the benefit the child receives.

The effects of chronic intracochlear electrical stimulation on inferior colliculus spatial representation in adult deafened cats

Previous studies have shown that chronic electrical stimulation through a cochlear implant causes significant alterations in the central auditory system of neonatally deafened cats. The goal of this study was to investigate the effects of chronic stimulation in the mature auditory system. Normal hearing adult animals were deafened by ototoxic drugs and received daily electrical stimulation over periods of 4-6 months. In terminal physiology experiments, response thresholds to pulsatile and sinusoidal signals were recorded within the inferior colliculus (IC). Using previously established methods, spatial tuning curves (STCs; threshold vs. IC depth functions) were constructed, and their widths measured to infer spatial selectivity. The IC spatial representations were similar for pulsatile and sinusoidal stimulation when phase duration was taken into consideration. However, sinusoidal signals consistently elicited much lower thresholds than pulsatile signals, a difference not solely attributable to differences in charge/phase. The average STC width was significantly broader in the adult deafened/stimulated animals than in controls (adult deafened/unstimulated cats), suggesting that electrical stimulation can induce spatial expansion of the IC representation of the chronically stimulated cochlear sector. Further, results in these adult animals were not significantly different from results in neonatally deafened, early stimulated animals, suggesting that a similar degree of plasticity was induced within the auditory midbrains of mature animals.