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Arjmandi MK, Jahn KN, Hem CB, Arenberg JG. Relationship Between Psychophysical Tuning Curves and Vowel Identification in Noise in Children and Adults With Cochlear Implants. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2025; 68:2623-2633. [PMID: 40268737 DOI: 10.1044/2025_jslhr-24-00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
PURPOSE Perceptual outcomes in cochlear implant (CI) listeners are influenced by the quality of the interface between individual CI electrodes and their target auditory neurons (i.e., electrode-neuron interface [ENI]). Poor ENI increases the likelihood of CI channel interaction, which may lead to the smearing of sound frequency information, reduced spectral resolution, and, thus, errors in identifying speech sounds, particularly when there is background noise. This research note aims to present preliminary data on whether psychophysical tuning curves (PTCs), as a measure of channel interaction and an indirect measure of ENI, relate to vowel identification in noise in children and adults with CIs. METHOD PTCs and medial vowel identification in four-talker babble noise were obtained for eight children (12 ears) and eight adults (eight ears) with CIs. PTCs were measured for one electrode in the middle of the array using direct stimulation and a standard two-interval, two-alternative forced choice procedure. RESULTS Adults and children with sharper PTCs performed better on vowel identification in noise (F = 6.63, p = .02), demonstrating an association between less channel interaction and better vowel identification in noise in CI listeners irrespective of age. Although no statistically significant difference was found between children and adults in their PTC sharpness, children performed better than adults on vowel identification in noise (F = 5.38, p = .034). CONCLUSIONS The findings provide evidence that the sharpness of the PTC on a mid-array electrode is related to vowel identification in noise for CI listeners. Vowel identification in noise and PTC sharpness could be further investigated for use in developing personalized programming strategies that enhance the transmission of spectral cues crucial for recognizing vowel sounds.
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Affiliation(s)
- Meisam K Arjmandi
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
- Institute for Mind and Brain, University of South Carolina, Columbia
| | - Kelly N Jahn
- Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson
- Callier Center for Communication Disorders, The University of Texas at Dallas, Richardson
| | - Charles B Hem
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Julie G Arenberg
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
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Jahn KN, Wiegand-Shahani BM, Moturi V, Kashiwagura ST, Doak KR. Cochlear-implant simulated spectral degradation attenuates emotional responses to environmental sounds. Int J Audiol 2025; 64:518-524. [PMID: 39146030 PMCID: PMC11833750 DOI: 10.1080/14992027.2024.2385552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Cochlear implants (CI) provide users with a spectrally degraded acoustic signal that could impact their auditory emotional experiences. This study evaluated the effects of CI-simulated spectral degradation on emotional valence and arousal elicited by environmental sounds. DESIGN Thirty emotionally evocative sounds were filtered through a noise-band vocoder. Participants rated the perceived valence and arousal elicited by each of the full-spectrum and vocoded stimuli. These ratings were compared across acoustic conditions (full-spectrum, vocoded) and as a function of stimulus type (unpleasant, neutral, pleasant). STUDY SAMPLE Twenty-five young adults (age 19 to 34 years) with normal hearing. RESULTS Emotional responses were less extreme for spectrally degraded (i.e., vocoded) sounds than for full-spectrum sounds. Specifically, spectrally degraded stimuli were perceived as more negative and less arousing than full-spectrum stimuli. CONCLUSION By meticulously replicating CI spectral degradation while controlling for variables that are confounded within CI users, these findings indicate that CI spectral degradation can compress the range of sound-induced emotion independent of hearing loss and other idiosyncratic device- or person-level variables. Future work will characterize emotional reactions to sound in CI users via objective, psychoacoustic, and subjective measures.
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Affiliation(s)
- Kelly N. Jahn
- Department of Speech, Language, and Hearing, The University
of Texas at Dallas, Richardson, TX 75080, USA
- Callier Center for Communication Disorders, The University
of Texas at Dallas, Dallas, TX 75235, USA
| | - Braden M. Wiegand-Shahani
- Department of Speech, Language, and Hearing, The University
of Texas at Dallas, Richardson, TX 75080, USA
- Callier Center for Communication Disorders, The University
of Texas at Dallas, Dallas, TX 75235, USA
| | - Vaishnavi Moturi
- Department of Speech, Language, and Hearing, The University
of Texas at Dallas, Richardson, TX 75080, USA
| | - Sean Takamoto Kashiwagura
- Department of Speech, Language, and Hearing, The University
of Texas at Dallas, Richardson, TX 75080, USA
- Callier Center for Communication Disorders, The University
of Texas at Dallas, Dallas, TX 75235, USA
| | - Karlee R. Doak
- Department of Speech, Language, and Hearing, The University
of Texas at Dallas, Richardson, TX 75080, USA
- Callier Center for Communication Disorders, The University
of Texas at Dallas, Dallas, TX 75235, USA
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Sokolov M, Raveh E, Yaniv D, Reuven Y, Ulanovski D, Barkan N, Greenstein T, Lipshitz N, Attias J. Long-term outcomes and electrophysiological measures of children with inner ear malformations and cochlear implants. Int J Pediatr Otorhinolaryngol 2024; 178:111875. [PMID: 38364548 DOI: 10.1016/j.ijporl.2024.111875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To compared auditory and speech performance outcomes of children with cochlear implants (CI), between those with inner ear malformations (IEMs) and with normal ear anatomy; and to describe differences in electrophysiological measurements. STUDY DESIGN A retrospective study. SETTING A tertiary care pediatric medical center. PATIENTS Forty-one children with IEMs who underwent CI during 2003-2017, and 41 age-matched CI recipients with normal ear anatomy (control group). MAIN OUTCOME MEASURES Post-CI auditory performance outcomes including educational setting, Categories of Auditory Performance (CAP), and Speech Intelligibility Rating (SIR); and electrophysiological measurements, Including maximal comfortable electrical levels (CLs) and impedances along CI electrodes. RESULTS The ANOVA on ranks revealed lower CAP scores in the study than control group: H3 = 18.8, P < 0.001. Among children with IEMs, CAP scores were better in children with enlarged vestibular aqueduct (EVA) (P < 0.04). SIR scores of the control group did not differ from those with isolated EVA; however, SIR scores of the IEMs without EVA subgroup were lower than all the other study subgroups (P < 0.01). The proportion of the control group that was integrated with full inclusion educational settings into the regular mainstream schools was higher than for those with IEMs without EVA (47 % vs. 15 %, P < 0.05), but similar to those with isolated EVA. For the study group versus control group, maximal comfortable electrical levels (CLs) were higher)P > 0.03) while impedance measurements were similar. CONCLUSIONS Outcomes of pediatric recipients with normal anatomy were better than those with IEMs. Among pediatric recipients of CI with IEMs, auditory performance was better and CLs were lower among children with isolated EVA than all other IEM subgroups.
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Affiliation(s)
- Meirav Sokolov
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | - Eyal Raveh
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dan Yaniv
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - David Ulanovski
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Neta Barkan
- Institute for Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Israel
| | - Tally Greenstein
- Institute for Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Israel
| | - Noga Lipshitz
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Joseph Attias
- Institute for Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Israel; Department of Communication Sciences & Disorders, University of Haifa, Haifa, Israel
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Konrad S, Büchner A, Lenarz T, Paasche G. Impedance development after implantation of hybrid-L24 cochlear implant electrodes. Int J Audiol 2023; 62:1137-1144. [PMID: 36193989 DOI: 10.1080/14992027.2022.2125914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Shorter and thinner electrodes were developed for preserving residual hearing after cochlear implantation by minimising trauma. As trauma is regarded as one of the causes of fibrous tissue formation after implantation, and increase in impedance is considered to be connected to fibrous tissue formation, the aim of the current study was to evaluate impedance development after implantation of Hybrid-L electrodes. DESIGN Impedance values were retrospectively collected from our clinical database and evaluated for all active contacts and basal, middle and apical contacts separately for up to 10 years. STUDY SAMPLES All 137 adult patients received a Hybrid-L electrode and had to be implanted for at least 1 year. RESULTS On average impedances increased to 13 kOhm before first fitting and dropped to 5-7 kOhm under electrical stimulation with lower values measured on apical contacts. Mean values remained stable over years, but variability increased. Values before first fitting were independent of age at implantation whereas lower values were found later in patients of higher age at implantation. CONCLUSION Despite smaller contacts, impedance values after start of electrical stimulation were comparable to published values of Contour electrodes. This might suggest less tissue growth with the Hybrid-L electrode array.
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Affiliation(s)
- Simon Konrad
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andreas Büchner
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - Gerrit Paasche
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Hearing4all Cluster of Excellence, Hannover Medical School, Hannover, Germany
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Jahn KN, Morse-Fortier C, Griffin AM, Faller D, Cohen MS, Kenna MA, Doney E, Arenberg JG. Programming Levels and Speech Perception in Pediatric Cochlear Implant Recipients With Enlarged Vestibular Aqueduct or GJB2 Mutation. Otol Neurotol 2023; 44:e273-e280. [PMID: 37167444 PMCID: PMC10176457 DOI: 10.1097/mao.0000000000003879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To determine the relationship between hearing loss etiology, cochlear implant (CI) programming levels, and speech perception performance in a large clinical cohort of pediatric CI recipients. STUDY DESIGN Retrospective chart review. SETTING Tertiary care hospitals. PATIENTS A total of 136 pediatric CI recipients (218 ears) were included in this study. All patients had diagnoses of either enlarged vestibular aqueduct (EVA) or GJB2 (Connexin-26) mutation confirmed via radiographic data and/or genetic reports. All patients received audiologic care at either Boston Children's Hospital or Massachusetts Eye and Ear in Boston, MA, between the years 1999 and 2020. MAIN OUTCOME MEASURES Electrode impedances and programming levels for each active electrode and speech perception scores were evaluated as a function of etiology (EVA or GJB2 mutation). RESULTS Children with EVA had significantly higher impedances and programming levels (thresholds and upper stimulation levels) than the children with GJB2 mutation. Speech perception scores did not differ as a function of etiology in this sample; rather, they were positively correlated with duration of CI experience (time since implantation). CONCLUSIONS Differences in electrode impedances and CI programming levels suggest that the electrode-neuron interface varies systematically as a function of hearing loss etiology in pediatric CI recipients with EVA and those with GJB2 mutation. Time with the CI was a better predictor of speech perception scores than etiology, suggesting that children can adapt to CI stimulation with experience.
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Affiliation(s)
- Kelly N Jahn
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, Texas
| | | | | | - David Faller
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
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Schvartz-Leyzac KC, Colesa DJ, Swiderski DL, Raphael Y, Pfingst BE. Cochlear Health and Cochlear-implant Function. J Assoc Res Otolaryngol 2023; 24:5-29. [PMID: 36600147 PMCID: PMC9971430 DOI: 10.1007/s10162-022-00882-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
The cochlear implant (CI) is widely considered to be one of the most innovative and successful neuroprosthetic treatments developed to date. Although outcomes vary, CIs are able to effectively improve hearing in nearly all recipients and can substantially improve speech understanding and quality of life for patients with significant hearing loss. A wealth of research has focused on underlying factors that contribute to success with a CI, and recent evidence suggests that the overall health of the cochlea could potentially play a larger role than previously recognized. This article defines and reviews attributes of cochlear health and describes procedures to evaluate cochlear health in humans and animal models in order to examine the effects of cochlear health on performance with a CI. Lastly, we describe how future biologic approaches can be used to preserve and/or enhance cochlear health in order to maximize performance for individual CI recipients.
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Affiliation(s)
- Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Deborah J Colesa
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Donald L Swiderski
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Yehoash Raphael
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Bryan E Pfingst
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA.
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Jahn KN, Arenberg JG, Horn DL. Spectral Resolution Development in Children With Normal Hearing and With Cochlear Implants: A Review of Behavioral Studies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1646-1658. [PMID: 35201848 PMCID: PMC9499384 DOI: 10.1044/2021_jslhr-21-00307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/09/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE This review article provides a theoretical overview of the development of spectral resolution in children with normal hearing (cNH) and in those who use cochlear implants (CIs), with an emphasis on methodological considerations. The aim was to identify key directions for future research on spectral resolution development in children with CIs. METHOD A comprehensive literature review was conducted to summarize and synthesize previously published behavioral research on spectral resolution development in normal and impaired auditory systems. CONCLUSIONS In cNH, performance on spectral resolution tasks continues to improve through the teenage years and is likely driven by gradual maturation of across-channel intensity resolution. A small but growing body of evidence from children with CIs suggests a more complex relationship between spectral resolution development, patient demographics, and the quality of the CI electrode-neuron interface. Future research should aim to distinguish between the effects of patient-specific variables and the underlying physiology on spectral resolution abilities in children of all ages who are hard of hearing and use auditory prostheses.
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Affiliation(s)
- Kelly N. Jahn
- Department of Speech, Language, and Hearing, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson
- Callier Center for Communication Disorders, The University of Texas at Dallas
| | - Julie G. Arenberg
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston
| | - David L. Horn
- Virginia Merrill Bloedel Hearing Research Center, Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle
- Division of Otolaryngology, Seattle Children's Hospital, WA
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Caswell-Midwinter B, Doney EM, Arjmandi MK, Jahn KN, Herrmann BS, Arenberg JG. The Relationship Between Impedance, Programming and Word Recognition in a Large Clinical Dataset of Cochlear Implant Recipients. Trends Hear 2022; 26:23312165211060983. [PMID: 35018875 PMCID: PMC8761885 DOI: 10.1177/23312165211060983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cochlear implant programming typically involves measuring electrode impedance, selecting a speech processing strategy and fitting the dynamic range of electrical stimulation. This study retrospectively analyzed a clinical dataset of adult cochlear implant recipients to understand how these variables relate to speech recognition. Data from 425 implanted post-lingually deafened ears with Advanced Bionics devices were analyzed. A linear mixed-effects model was used to infer how impedance, programming and patient factors were associated with monosyllabic word recognition scores measured in quiet. Additional analyses were conducted on subsets of data to examine the role of speech processing strategy on scores, and the time taken for the scores of unilaterally implanted patients to plateau. Variation in basal impedance was negatively associated with word score, suggesting importance in evaluating the profile of impedance. While there were small, negative bivariate correlations between programming level metrics and word scores, these relationships were not clearly supported by the model that accounted for other factors. Age at implantation was negatively associated with word score, and duration of implant experience was positively associated with word score, which could help to inform candidature and guide expectations. Electrode array type was also associated with word score. Word scores measured with traditional continuous interleaved sampling and current steering speech processing strategies were similar. The word scores of unilaterally implanted patients largely plateaued within 6-months of activation. However, there was individual variation which was not related to initially measured impedance and programming levels.
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Affiliation(s)
- Benjamin Caswell-Midwinter
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | | | - Meisam K Arjmandi
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Kelly N Jahn
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA
| | - Barbara S Herrmann
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Julie G Arenberg
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
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Abstract
OBJECTIVES This study aimed to determine the effect of advanced age on how effectively a cochlear implant (CI) electrode stimulates the targeted cochlear nerve fibers (i.e., the electrode-neuron interface [ENI]) in postlingually deafened adult CI users. The study tested the hypothesis that the quality of the ENI declined with advanced age. It also tested the hypothesis that the effect of advanced age on the quality of the ENI would be greater in basal regions of the cochlea compared to apical regions. DESIGN Study participants included 40 postlingually deafened adult CI users. The participants were separated into two age groups based on age at testing in accordance with age classification terms used by the World Health Organization and the Medical Literature Analysis and Retrieval System Online bibliographic database. The middle-aged group included 16 participants between the ages of 45 and 64 years and the elderly group included 24 participants older than 65 years. Results were included from one ear for each participant. All participants used Cochlear Nucleus CIs in their test ears. For each participant, electrophysiological measures of the electrically evoked compound action potential (eCAP) were used to measure refractory recovery functions and amplitude growth functions (AGFs) at three to seven electrode sites across the electrode array. The eCAP parameters used in this study included the refractory recovery time estimated based on the eCAP refractory recovery function, the eCAP threshold, the slope of the eCAP AGF, and the negative-peak (i.e., N1) latency. The electrode-specific ENI was evaluated using an optimized combination of the eCAP parameters that represented the responsiveness of cochlear nerve fibers to electrical stimulation delivered by individual electrodes along the electrode array. The quality of the electrode-specific ENI was quantified by the local ENI index, a value between 0 and 100 where 0 and 100 represented the lowest- and the highest-quality ENI across all participants and electrodes in the study dataset, respectively. RESULTS There were no significant age group differences in refractory times, eCAP thresholds, N1 latencies or local ENI indices. Slopes of the eCAP AGF were significantly larger in the middle-aged group compared to the elderly group. There was a significant effect of electrode location on each eCAP parameter, except for N1 latency. In addition, the local ENI index was significantly larger (i.e., better ENI) in the apical region than in the basal and middle regions of the cochlea for both age groups. CONCLUSIONS The model developed in this study can be used to estimate the quality of the ENI at individual electrode locations in CI users. The quality of the ENI is affected by the location of the electrode along the length of the cochlea. The method for estimating the quality of the ENI developed in this study holds promise for identifying electrodes with poor ENIs that could be deactivated from the clinical programming map. The ENI is not strongly affected by advanced age in middle-aged and elderly CI users.
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