Preliminary results of the relationship between the binaural interaction component of the electrically evoked auditory brainstem response and interaural pitch comparisons in bilateral cochlear implant recipients

Interaural frequency mismatch jointly modulates neural brainstem binaural interaction and behavioral interaural time difference sensitivity in humans

The binaural interaction component (BIC) of the auditory brainstem response (ABR) is the difference obtained after subtracting the sum of right and left ear ABRs from binaurally evoked ABRs. The BIC has attracted interest as a biomarker of binaural processing abilities. Best binaural processing is presumed to require spectrally-matched inputs at the two ears, but peripheral pathology and/or impacts of hearing devices can lead to mismatched inputs. Such mismatching can degrade behavioral sensitivity to interaural time difference (ITD) cues, but might be detected using the BIC. Here, we examine the effect of interaural frequency mismatch (IFM) on BIC and behavioral ITD sensitivity in audiometrically normal adult human subjects (both sexes). Binaural and monaural ABRs were recorded and BICs computed from subjects in response to narrowband tones. Left ear stimuli were fixed at 4000 Hz while right ear stimuli varied over a ∼2-octave range (re: 4000 Hz). Separately, subjects performed psychophysical lateralization tasks using the same stimuli to determine ITD discrimination thresholds jointly as a function of IFM and sound level. Results demonstrated significant effects of IFM on BIC amplitudes, with lower amplitudes in mismatched conditions than frequency-matched. Behavioral ITD discrimination thresholds were elevated at mismatched frequencies and lower sound levels, but also more sharply modulated by IFM at lower sound levels. Combinations of ITD, IFM and overall sound level that resulted in fused and lateralized percepts were bound by the empirically-measured BIC, and also by model predictions simulated using an established computational model of the brainstem circuit thought to generate the BIC.

Computed-Tomography Estimates of Interaural Mismatch in Insertion Depth and Scalar Location in Bilateral Cochlear-Implant Users

HYPOTHESIS

Bilateral cochlear-implant (BI-CI) users will have a range of interaural insertion-depth mismatch because of different array placement or characteristics. Mismatch will be larger for electrodes located near the apex or outside scala tympani, or for arrays that are a mix of precurved and straight types.

BACKGROUND

Brainstem superior olivary-complex neurons are exquisitely sensitive to interaural-difference cues for sound localization. Because these neurons rely on interaurally place-of-stimulation-matched inputs, interaural insertion-depth or scalar-location differences for BI-CI users could cause interaural place-of-stimulation mismatch that impairs binaural abilities.

METHODS

Insertion depths and scalar locations were calculated from temporal-bone computed-tomography scans for 107 BI-CI users (27 Advanced Bionics, 62 Cochlear, 18 MED-EL).

RESULTS

Median interaural insertion-depth mismatch was 23.4 degrees or 1.3 mm. Mismatch in the estimated clinically relevant range expected to impair binaural processing (>75 degrees or 3 mm) occurred for 13 to 19% of electrode pairs overall, and for at least three electrode pairs for 23 to 37% of subjects. There was a significant three-way interaction between insertion depth, scalar location, and array type. Interaural insertion-depth mismatch was largest for apical electrodes, for electrode pairs in two different scala, and for arrays that were both-precurved.

CONCLUSION

Average BI-CI interaural insertion-depth mismatch was small; however, large interaural insertion-depth mismatch-with the potential to degrade spatial hearing-occurred frequently enough to warrant attention. For new BICI users, improved surgical techniques to avoid interaural insertion-depth and scalar mismatch are recommended. For existing BI-CI users with interaural insertion-depth mismatch, interaural alignment of clinical frequency tables might reduce negative spatial-hearing consequences.

Simulation of ITD-Dependent Single-Neuron Responses Under Electrical Stimulation and with Amplitude-Modulated Acoustic Stimuli

Interaural time difference (ITD) sensitivity with cochlear implant stimulation is remarkably similar to envelope ITD sensitivity using conventional acoustic stimulation. This holds true for human perception, as well as for neural response rates recorded in the inferior colliculus of several mammalian species. We hypothesize that robust excitatory-inhibitory (EI) interaction is the dominant mechanism. Therefore, we connected the same single EI-model neuron to either a model of the normal acoustic auditory periphery or to a model of the electrically stimulated auditory nerve. The model captured most features of the experimentally obtained response properties with electric stimulation, such as the shape of rate-ITD functions, the dependence on stimulation level, and the pulse rate or modulation-frequency dependence. Rate-ITD functions with high-rate, amplitude-modulated electric stimuli were very similar to their acoustic counterparts. Responses obtained with unmodulated electric pulse trains most resembled acoustic filtered clicks. The fairly rapid decline of ITD sensitivity at rates above 300 pulses or cycles per second is correctly simulated by the 3.1-ms time constant of the inhibitory post-synaptic conductance. As the model accounts for these basic properties, it is expected to help in understanding and quantifying the binaural hearing abilities with electric stimulation when integrated in bigger simulation frameworks.

Normative Study of the Binaural Interaction Component of the Human Auditory Brainstem Response as a Function of Interaural Time Differences

OBJECTIVES

The binaural interaction component (BIC) of the auditory brainstem response (ABR) is obtained by subtracting the sum of the monaural right and left ear ABRs from the binaurally evoked ABR. The result is a small but prominent negative peak (herein called "DN1"), indicating a smaller binaural than summed ABR, which occurs around the latency of wave V or its roll-off slope. The BIC has been proposed to have diagnostic value as a biomarker of binaural processing abilities; however, there have been conflicting reports regarding the reliability of BIC measures in human subjects. The objectives of the current study were to: (1) examine prevalence of BIC across a large group of normal-hearing young adults; (2) determine effects of interaural time differences (ITDs) on BIC; and (3) examine any relationship between BIC and behavioral ITD discrimination acuity.

DESIGN

Subjects were 40 normal-hearing adults (20 males and 20 females), aged 21 to 48 years, with no history of otologic or neurologic disorders. Midline ABRs were recorded from electrodes at high forehead (Fz) referenced to the nape of the neck (near the seventh cervical vertebra), with Fpz (low forehead) as the ground. ABRs were also recorded with a conventional earlobe reference for comparison to midline results. Stimuli were 90 dB peSPL biphasic clicks. For BIC measurements, stimuli were presented in a block as interleaved right monaural, left monaural, and binaural stimuli with 2000+ presentations per condition. Four measurements were averaged for a total of 8000+ stimuli per analyzed waveform. BIC was measured for ITD = 0 (simultaneous bilateral) and for ITDs of ±500 and ±750 µs. Subjects separately performed a lateralization task, using the same stimuli, to determine ITD discrimination thresholds.

RESULTS

An identifiable BIC DN1 was obtained in 39 of 40 subjects at ITD = 0 µs in at least one of two measurement sessions, but was seen in lesser numbers of subjects in a single session or as ITD increased. BIC was most often seen when a subject was relaxed or sleeping, and less often when they fidgeted or reported neck tension, suggesting myogenic activity as a possible factor in disrupting BIC measurements. Mean BIC latencies systematically increased with increasing ITD, and mean BIC amplitudes tended to decrease. However, across subjects, there was no significant relationship between the amplitude or latency of the BIC and behavioral ITD thresholds.

CONCLUSIONS

Consistent with previous studies, measurement of the BIC was time consuming and a BIC was sometimes difficult to obtain in awake normal-hearing subjects. The BIC will thus continue to be of limited clinical utility unless stimulus parameters and measurement techniques can be identified that produce a more robust response. Nonetheless, modulation of BIC characteristics by ITD supports the concept that the ABR BIC indexes aspects of binaural brainstem processing and thus may prove useful in selected research applications, e.g. in the examination of populations expected to have aberrant binaural signal processing ability.

Between-ear sound frequency disparity modulates a brain stem biomarker of binaural hearing

The auditory brain stem response (ABR) is an evoked potential that indexes a cascade of neural events elicited by sound. In the present study we evaluated the influence of sound frequency on a derived component of the ABR known as the binaural interaction component (BIC). Specifically, we evaluated the effect of acoustic interaural (between-ear) frequency mismatch on BIC amplitude. Goals were to 1) increase basic understanding of sound features that influence this long-studied auditory potential and 2) gain insight about the persistence of the BIC with interaural electrode mismatch in human users of bilateral cochlear implants, presently a limitation on the prospective utility of the BIC in audiological settings. Data were collected in an animal model that is audiometrically similar to humans, the chinchilla (Chinchilla lanigera; 6 females). Frequency disparities and amplitudes of acoustic stimuli were varied over broad ranges, and associated variation of BIC amplitude was quantified. Subsequently, responses were simulated with the use of established models of the brain stem pathway thought to underlie the BIC. Collectively, the data demonstrate that at high sound intensities (≥85 dB SPL), the acoustically elicited BIC persisted with interaurally disparate stimulation (click frequencies ≥1.5 octaves apart). However, sharper tuning emerged at moderate sound intensities (65 dB SPL), with the largest BIC occurring for stimulus frequencies within ~0.8 octaves, equivalent to ±1 mm in cochlear place. Such responses were consistent with simulated responses of the presumed brain stem generator of the BIC, the lateral superior olive. The data suggest that leveraging focused electrical stimulation strategies could improve BIC-based bilateral cochlear implant fitting outcomes.NEW & NOTEWORTHY Traditional hearing tests evaluate each ear independently. Diagnosis and treatment of binaural hearing dysfunction remains a basic challenge for hearing clinicians. We demonstrate in an animal model that the prospective utility of a noninvasive electrophysiological signature of binaural function, the binaural interaction component (BIC), depends strongly on the intensity of auditory stimulation. Data suggest that more informative BIC measurements could be obtained with clinical protocols leveraging stimuli restricted in effective bandwidth.

Neural Processing of Acoustic and Electric Interaural Time Differences in Normal-Hearing Gerbils

Bilateral cochlear implants (CIs) provide benefits for speech perception in noise and directional hearing, but users typically show poor sensitivity to interaural time differences (ITDs). Possible explanations for this deficit are deafness-induced degradations in neural ITD sensitivity, between-ear mismatches in electrode positions or activation sites, or differences in binaural brain circuits activated by electric versus acoustic stimulation. To identify potential limitations of electric ITD coding in the normal-hearing system, responses of single neurons in the dorsal nucleus of the lateral lemniscus and in the inferior colliculus to ITDs of electric (biphasic pulses) and acoustic (noise, clicks, chirps, and tones) stimuli were recorded in normal-hearing gerbils of either sex. To maintain acoustic sensitivity, electric stimuli were delivered to the round window. ITD tuning metrics (e.g., best ITD) and ITD discrimination thresholds for electric versus transient acoustic stimuli (clicks, chirps) obtained from the same neurons were not significantly correlated. Across populations of neurons with similar characteristic frequencies, however, ITD tuning metrics and ITD discrimination thresholds were similar for electric and acoustic stimuli and largely independent of the spectrotemporal properties of the acoustic stimuli when measured in the central range of ITDs. The similarity of acoustic and electric ITD coding on the population level in animals with normal hearing experience suggests that poorer ITD sensitivity in bilateral CI users compared with normal-hearing listeners is likely due to deprivation-induced changes in neural ITD coding rather than to differences in the binaural brain circuits involved in the processing of electric and acoustic ITDs.SIGNIFICANCE STATEMENT Small differences in the arrival time of sound at the two ears (interaural time differences, ITDs) provide important cues for speech understanding in noise and directional hearing. Deaf subjects with bilateral cochlear implants obtain only little benefit from ITDs. It is unclear whether these limitations are due to between-ear mismatches in activation sites, differences in binaural brain circuits activated by electric versus acoustic stimulation, or deafness-induced degradations in neural ITD processing. This study is the first to directly compare electric and acoustic ITD coding in neurons of known characteristic frequencies. In animals with normal hearing, populations of auditory brainstem and midbrain neurons demonstrate general similarities in electric and acoustic ITD coding, suggesting similar underlying central auditory processing mechanisms.

Self-Selection of Frequency Tables with Bilateral Mismatches in an Acoustic Simulation of a Cochlear Implant

BACKGROUND

Many recipients of bilateral cochlear implants (CIs) may have differences in electrode insertion depth. Previous reports indicate that when a bilateral mismatch is imposed, performance on tests of speech understanding or sound localization becomes worse. If recipients of bilateral CIs cannot adjust to a difference in insertion depth, adjustments to the frequency table may be necessary to maximize bilateral performance.

PURPOSE

The purpose of this study was to examine the feasibility of using real-time manipulations of the frequency table to offset any decrements in performance resulting from a bilateral mismatch.

RESEARCH DESIGN

A simulation of a CI was used because it allows for explicit control of the size of a bilateral mismatch. Such control is not available with users of CIs.

STUDY SAMPLE

A total of 31 normal-hearing young adults participated in this study.

DATA COLLECTION AND ANALYSIS

Using a CI simulation, four bilateral mismatch conditions (0, 0.75, 1.5, and 3 mm) were created. In the left ear, the analysis filters and noise bands of the CI simulation were the same. In the right ear, the noise bands were shifted higher in frequency to simulate a bilateral mismatch. Then, listeners selected a frequency table in the right ear that was perceived as maximizing bilateral speech intelligibility. Word-recognition scores were then assessed for each bilateral mismatch condition. Listeners were tested with both a standard frequency table, which preserved a bilateral mismatch, or with their self-selected frequency table.

RESULTS

Consistent with previous reports, bilateral mismatches of 1.5 and 3 mm yielded decrements in word recognition when the standard table was used in both ears. However, when listeners used the self-selected frequency table, performance was the same regardless of the size of the bilateral mismatch.

CONCLUSIONS

Self-selection of a frequency table appears to be a feasible method for ameliorating the negative effects of a bilateral mismatch. These data may have implications for recipients of bilateral CIs who cannot adapt to a bilateral mismatch, because they suggest that (1) such individuals may benefit from modification of the frequency table in one ear and (2) self-selection of a "most intelligible" frequency table may be a useful tool for determining how the frequency table should be altered to optimize speech recognition.

Neural Representation of Interaural Time Differences in Humans-an Objective Measure that Matches Behavioural Performance

Humans, and many other species, exploit small differences in the timing of sounds at the two ears (interaural time difference, ITD) to locate their source and to enhance their detection in background noise. Despite their importance in everyday listening tasks, however, the neural representation of ITDs in human listeners remains poorly understood, and few studies have assessed ITD sensitivity to a similar resolution to that reported perceptually. Here, we report an objective measure of ITD sensitivity in electroencephalography (EEG) signals to abrupt modulations in the interaural phase of amplitude-modulated low-frequency tones. Specifically, we measured following responses to amplitude-modulated sinusoidal signals (520-Hz carrier) in which the stimulus phase at each ear was manipulated to produce discrete interaural phase modulations at minima in the modulation cycle-interaural phase modulation following responses (IPM-FRs). The depth of the interaural phase modulation (IPM) was defined by the sign and the magnitude of the interaural phase difference (IPD) transition which was symmetric around zero. Seven IPM depths were assessed over the range of ±22 ° to ±157 °, corresponding to ITDs largely within the range experienced by human listeners under natural listening conditions (120 to 841 μs). The magnitude of the IPM-FR was maximal for IPM depths in the range of ±67.6 ° to ±112.6 ° and correlated well with performance in a behavioural experiment in which listeners were required to discriminate sounds containing IPMs from those with only static IPDs. The IPM-FR provides a sensitive measure of binaural processing in the human brain and has a potential to assess temporal binaural processing.

Bilateral cochlear implants in children: Effects of auditory experience and deprivation on auditory perception

Spatial hearing skills are essential for children as they grow, learn and play. These skills provide critical cues for determining the locations of sources in the environment, and enable segregation of important sounds, such as speech, from background maskers or interferers. Spatial hearing depends on availability of monaural cues and binaural cues. The latter result from integration of inputs arriving at the two ears from sounds that vary in location. The binaural system has exquisite mechanisms for capturing differences between the ears in both time of arrival and intensity. The major cues that are thus referred to as being vital for binaural hearing are: interaural differences in time (ITDs) and interaural differences in levels (ILDs). In children with normal hearing (NH), spatial hearing abilities are fairly well developed by age 4-5 years. In contrast, most children who are deaf and hear through cochlear implants (CIs) do not have an opportunity to experience normal, binaural acoustic hearing early in life. These children may function by having to utilize auditory cues that are degraded with regard to numerous stimulus features. In recent years there has been a notable increase in the number of children receiving bilateral CIs, and evidence suggests that while having two CIs helps them function better than when listening through a single CI, these children generally perform worse than their NH peers. This paper reviews some of the recent work on bilaterally implanted children. The focus is on measures of spatial hearing, including sound localization, release from masking for speech understanding in noise and binaural sensitivity using research processors. Data from behavioral and electrophysiological studies are included, with a focus on the recent work of the authors and their collaborators. The effects of auditory plasticity and deprivation on the emergence of binaural and spatial hearing are discussed along with evidence for reorganized processing from both behavioral and electrophysiological studies. The consequences of both unilateral and bilateral auditory deprivation during development suggest that the relevant set of issues is highly complex with regard to successes and the limitations experienced by children receiving bilateral cochlear implants. This article is part of a Special Issue entitled .

Effects of interaural pitch matching and auditory image centering on binaural sensitivity in cochlear implant users

OBJECTIVES

In bilateral cochlear implant users, electrodes mapped to the same frequency range in each ear may stimulate different places in each cochlea due to an insertion depth difference of electrode arrays. This interaural place of stimulation mismatch can lead to problems with auditory image fusion and sensitivity to binaural cues, which may explain the large localization errors seen in many patients. Previous work has shown that interaural place of stimulation mismatch can lead to off-centered auditory images being perceived even though interaural time and level differences (ITD and ILD, respectively) were zero. Large interaural mismatches reduced the ability to use ITDs for auditory image lateralization. In contrast, lateralization with ILDs was still possible but the mapping of ILDs to spatial locations was distorted. This study extends the previous work by systematically investigating the effect of interaural place of stimulation mismatch on ITD and ILD sensitivity directly and examining whether "centering" methods can be used to mitigate some of the negative effects of interaural place of stimulation mismatch.

DESIGN

Interaural place of stimulation mismatch was deliberately introduced for this study. Interaural pitch-matching techniques were used to identify a pitch-matched pair of electrodes across the ears approximately at the center of the array. Mismatched pairs were then created by maintaining one of the pitch-matched electrodes constant, and systematically varying the contralateral electrode by two, four, or eight electrode positions (corresponding to approximately 1.5, 3, and 6 mm of interaural place of excitation differences). The stimuli were 300 msec, constant amplitude pulse trains presented at 100 pulses per second. ITD and ILD just noticeable differences (JNDs) were measured using a method of constant stimuli with a two-interval, two-alternative forced choice task. The results were fit with a psychometric function to obtain the JNDs. In experiment I, ITD and ILD JNDs were measured as a function of the simulated place of stimulation mismatch. In experiment II, the auditory image of mismatched pair was centered by adjusting the stimulation level according to a lateralization task. ITD and ILD JNDs were then remeasured and compared with the results of experiment I.

RESULTS

ITD and ILD JNDs were best (lowest thresholds) for pairs of electrodes at or near the pitch-matched pair. Thresholds increased systematically with increasing amounts of interaural mismatch. Deliberate and careful centering of auditory images did not significantly improve ITD JNDs but did improve ILD JNDs at very large amounts of simulated mismatch.

CONCLUSIONS

Interaural place of stimulation mismatch decreases sensitivity to binaural cues that are important for accurate sound localization. However, deliberate and careful centering of auditory images does not seem to significantly counteract the effects of mismatch. Hence, to obtain maximal sound localization benefits of bilateral implantation, clinical and surgical techniques are needed that take into account differences in electrode array insertion depths across the ears.

Suitability of the Binaural Interaction Component for Interaural Electrode Pairing of Bilateral Cochlear Implants

Although bilateral cochlear implants (BiCIs) have succeeded in improving the spatial hearing performance of bilateral CI users, the overall performance is still not comparable with normal hearing listeners. Limited success can be partially caused by an interaural mismatch of the place-of-stimulation in each cochlea. Pairing matched interaural CI electrodes and stimulating them with the same frequency band is expected to facilitate binaural functions such as binaural fusion, localization, or spatial release from masking. It has been shown in animal experiments that the magnitude of the binaural interaction component (BIC) derived from the wave-eV decreases for increasing interaural place of stimulation mismatch. This motivated the investigation of the suitability of an electroencephalography-based objective electrode-frequency fitting procedure based on the BIC for BiCI users. A 61 channel monaural and binaural electrically evoked auditory brainstem response (eABR) recording was performed in 7 MED-EL BiCI subjects so far. These BiCI subjects were directly stimulated at 60% dynamic range with 19.9 pulses per second via a research platform provided by the University of Innsbruck (RIB II). The BIC was derived for several interaural electrode pairs by subtracting the response from binaural stimulation from their summed monaural responses. The BIC based pairing results are compared with two psychoacoustic pairing methods: interaural pulse time difference sensitivity and interaural pitch matching. The results for all three methods analyzed as a function of probe electrode allow for determining a matched pair in more than half of the subjects, with a typical accuracy of ± 1 electrode. This includes evidence for statistically significant tuning of the BIC as a function of probe electrode in human subjects. However, results across the three conditions were sometimes not consistent. These discrepancies will be discussed in the light of pitch plasticity versus less plastic brainstem processing.

Comparison of Interaural Electrode Pairing Methods for Bilateral Cochlear Implants

In patients with bilateral cochlear implants (CIs), pairing matched interaural electrodes and stimulating them with the same frequency band is expected to facilitate binaural functions such as binaural fusion, localization, and spatial release from masking. Because clinical procedures typically do not include patient-specific interaural electrode pairing, it remains the case that each electrode is allocated to a generic frequency range, based simply on the electrode number. Two psychoacoustic techniques for determining interaurally paired electrodes have been demonstrated in several studies: interaural pitch comparison and interaural time difference (ITD) sensitivity. However, these two methods are rarely, if ever, compared directly. A third, more objective method is to assess the amplitude of the binaural interaction component (BIC) derived from electrically evoked auditory brainstem responses for different electrode pairings; a method has been demonstrated to be a potential candidate for bilateral CI users. Here, we tested all three measures in the same eight CI users. We found good correspondence between the electrode pair producing the largest BIC and the electrode pair producing the maximum ITD sensitivity. The correspondence between the pairs producing the largest BIC and the pitch-matched electrode pairs was considerably weaker, supporting the previously proposed hypothesis that whilst place pitch might adapt over time to accommodate mismatched inputs, sensitivity to ITDs does not adapt to the same degree.

Investigating interaural frequency-place mismatches via bimodal vowel integration

For patients having residual hearing in one ear and a cochlear implant (CI) in the opposite ear, interaural place-pitch mismatches might be partly responsible for the large variability in individual benefit. Behavioral pitch-matching between the two ears has been suggested as a way to individualize the fitting of the frequency-to-electrode map but is rather tedious and unreliable. Here, an alternative method using two-formant vowels was developed and tested. The interaural spectral shift was inferred by comparing vowel spaces, measured by presenting the first formant (F1) to the nonimplanted ear and the second (F2) on either side. The method was first evaluated with eight normal-hearing listeners and vocoder simulations, before being tested with 11 CI users. Average vowel distributions across subjects showed a similar pattern when presenting F2 on either side, suggesting acclimatization to the frequency map. However, individual vowel spaces with F2 presented to the implant did not allow a reliable estimation of the interaural mismatch. These results suggest that interaural frequency-place mismatches can be derived from such vowel spaces. However, the method remains limited by difficulties in bimodal fusion of the two formants.

Towards a closed-loop cochlear implant system: application of embedded monitoring of peripheral and central neural activity

Although the cochlear implant (CI) is widely considered the most successful neural prosthesis, it is essentially an open-loop system that requires extensive initial fitting and frequent tuning to maintain a high, but not necessarily optimal, level of performance. Two developments in neuroscience and neuroengineering now make it feasible to design a closed-loop CI. One development is the recording and interpretation of evoked potentials (EPs) from the peripheral to the central nervous system. The other is the embedded hardware and software of a modern CI that allows recording of EPs. We review EPs that are pertinent to behavioral functions from simple signal detection and loudness growth to speech discrimination and recognition. We also describe signal processing algorithms used for electric artifact reduction and cancellation, critical to the recording of electric EPs. We then present a conceptual design for a closed-loop CI that utilizes in an innovative way the embedded implant receiver and stimulators to record short latency compound action potentials ( ~1 ms), auditory brainstem responses (1-10 ms) and mid-to-late cortical potentials (20-300 ms). We compare EPs recorded using the CI to EPs obtained using standard scalp electrodes recording techniques. Future applications and capabilities are discussed in terms of the development of a new generation of closed-loop CIs and other neural prostheses.