The relationship between speech perception and electrode discrimination in cochlear implantees

Channel crosstalk detected using ECAP measurements is associated with poorer speech perception in cochlear implant users

The number and independence of channels in cochlear implants (CI) has long been considered to influence speech recognition, particularly in competing background noise. Measures of channel independence have been obtained via psychophysical and objective means, relying on interactions between probe and masker signals delivered on different channels. In the current study, electrically evoked compound action potentials (ECAP) obtained from 32 Nucleus CI recipients tested at one basal and one apical position were performed using a standard spread-of-excitation procedure. An alternative analysis method, comparing masked responses only, revealed distant maskers as effective or more effective than same-electrode maskers in 13/32 cases. This appears to indicate substantial crosstalk between channels, covering up to nine intracochlear electrodes in one subject. Subjects with atypical responses and no other limiting factors had significantly poorer sentence recognition in noise compared with those with no detected peripheral or cognitive limiting factors. We propose that channel crosstalk detected via ECAPs may be a biomarker for poor or patchy neural survival that leads to poorer speech perception in CI recipients.

How to vocode: Using channel vocoders for cochlear-implant research

The channel vocoder has become a useful tool to understand the impact of specific forms of auditory degradation-particularly the spectral and temporal degradation that reflect cochlear-implant processing. Vocoders have many parameters that allow researchers to answer questions about cochlear-implant processing in ways that overcome some logistical complications of controlling for factors in individual cochlear implant users. However, there is such a large variety in the implementation of vocoders that the term "vocoder" is not specific enough to describe the signal processing used in these experiments. Misunderstanding vocoder parameters can result in experimental confounds or unexpected stimulus distortions. This paper highlights the signal processing parameters that should be specified when describing vocoder construction. The paper also provides guidance on how to determine vocoder parameters within perception experiments, given the experimenter's goals and research questions, to avoid common signal processing mistakes. Throughout, we will assume that experimenters are interested in vocoders with the specific goal of better understanding cochlear implants.

Effects of spectral smearing on speech understanding and masking release in simulated bilateral cochlear implants

Differences in spectro-temporal degradation may explain some variability in cochlear implant users' speech outcomes. The present study employs vocoder simulations on listeners with typical hearing to evaluate how differences in degree of channel interaction across ears affects spatial speech recognition. Speech recognition thresholds and spatial release from masking were measured in 16 normal-hearing subjects listening to simulated bilateral cochlear implants. 16-channel sine-vocoded speech simulated limited, broad, or mixed channel interaction, in dichotic and diotic target-masker conditions, across ears. Thresholds were highest with broad channel interaction in both ears but improved when interaction decreased in one ear and again in both ears. Masking release was apparent across conditions. Results from this simulation study on listeners with typical hearing show that channel interaction may impact speech recognition more than masking release, and may have implications for the effects of channel interaction on cochlear implant users' speech recognition outcomes.

Nanocatalysts as fast and powerful medical intervention: Bridging cochlear implant therapies and advanced modelling using Hidden Markov Models (HMMs) for effective treatment of infections

As human population growth and waste from technologically advanced industries threaten to destabilise our delicate ecological equilibrium, the global spotlight intensifies on environmental contamination and climate-related changes. These challenges extend beyond our external environment and have significant effects on our internal ecosystems. The inner ear, which is responsible for balance and auditory perception, is a prime example. When these sensory mechanisms are impaired, disorders such as deafness can develop. Traditional treatment methods, including systemic antibiotics, are frequently ineffective due to inadequate inner ear penetration. Conventional techniques for administering substances to the inner ear fail to obtain adequate concentrations as well. In this context, cochlear implants laden with nanocatalysts emerge as a promising strategy for the targeted treatment of inner ear infections. Coated with biocompatible nanoparticles containing specific nanocatalysts, these implants can degrade or neutralise contaminants linked to inner ear infections. This method enables the controlled release of nanocatalysts directly at the infection site, thereby maximising therapeutic efficacy and minimising adverse effects. In vivo and in vitro studies have demonstrated that these implants are effective at eliminating infections, reducing inflammation, and fostering tissue regeneration in the ear. This study investigates the application of hidden Markov models (HMMs) to nanocatalyst-loaded cochlear implants. The HMM is trained on surgical phases in order to accurately identify the various phases associated with implant utilisation. This facilitates the precision placement of surgical instruments within the ear, with a location accuracy between 91% and 95% and a standard deviation between 1% and 5% for both sites. In conclusion, nanocatalysts serve as potent medicinal instruments, bridging cochlear implant therapies and advanced modelling utilising hidden Markov models for the effective treatment of inner ear infections. Cochlear implants loaded with nanocatalysts offer a promising method to combat inner ear infections and enhance patient outcomes by addressing the limitations of conventional treatments.

Frequency Fitting Optimization Using Evolutionary Algorithm in Cochlear Implant Users with Bimodal Binaural Hearing

Optimizing hearing in patients with a unilateral cochlear implant (CI) and contralateral acoustic hearing is a challenge. Evolutionary algorithms (EA) can explore a large set of potential solutions in a stochastic manner to approach the optimum of a minimization problem. The objective of this study was to develop and evaluate an EA-based protocol to modify the default frequency settings of a MAP (fMAP) of the CI in patients with bimodal hearing. Methods: This monocentric prospective study included 27 adult CI users (with post-lingual deafness and contralateral functional hearing). A fitting program based on EA was developed to approach the best fMAP. Generated fMAPs were tested by speech recognition (word recognition score, WRS) in noise and free-field-like conditions. By combining these first fMAPs and adding some random changes, a total of 13 fMAPs over 3 generations were produced. Participants were evaluated before and 45 to 60 days after the fitting by WRS in noise and questionnaires on global sound quality and music perception in bimodal binaural conditions. Results: WRS in noise improved with the EA-based fitting in comparison to the default fMAP (41.67 ± 9.70% versus 64.63 ± 16.34%, respectively, p = 0.0001, signed-rank test). The global sound quality and music perception were also improved, as judged by ratings on questionnaires and scales. Finally, most patients chose to keep the new fitting definitively. Conclusions: By modifying the default fMAPs, the EA improved the speech discrimination in noise and the sound quality in bimodal binaural conditions.

Co-Occurrence of Hypernasality and Voice Impairment in Amyotrophic Lateral Sclerosis: Acoustic Quantification

PURPOSE

Hypernasality and atypical voice characteristics are common features of dysarthric speech due to amyotrophic lateral sclerosis (ALS). Existing acoustic measures have been developed to primarily target either hypernasality or voice impairment, and the effects of co-occurring hypernasality-voice problems on these measures are unknown. This report explores (a) the extent to which acoustic measures are affected by concurrent perceptually identified hypernasality and voice impairment due to ALS and (b) candidate acoustic measures of early indicators of hypernasality and voice impairment in the presence of multisystem involvement in individuals with ALS.

METHOD

Two expert listeners rated severity of hypernasality and voice impairment in sentences produced by individuals with ALS (n = 27). The samples were stratified based on perceptual ratings: voice/hypernasality asymptomatic, predominantly hypernasal, predominantly voice impairment, and mixed (co-occurring hypernasality and voice impairment). Groups were compared using established acoustic measures of hypernasality (one-third octave analysis) and voice (cepstral/spectral analysis) impairment.

RESULTS

The one-third octave analysis differentiated all groups; the cepstral peak prominence differentiated all groups except asymptomatic versus mixed, whereas the low-to-high spectral ratio did not differ among groups. Additionally, one-third octave analyses demonstrated promising speech diagnostic potential.

CONCLUSIONS

The results highlight the need to consider the validity of measures in the context of multisubsystem involvement. Our preliminary findings further suggest that the one-third octave analysis may be an optimal approach to quantify hypernasality and voice abnormalities in the presence of multisystem speech impairment. Future evaluation of the diagnostic accuracy of the one-third octave analysis is warranted.

Intra-Cochlear Current Spread Correlates with Speech Perception in Experienced Adult Cochlear Implant Users

Broader intra-cochlear current spread (ICCS) implies higher cochlear implant (CI) channel interactions. This study aimed to investigate the relationship between ICCS and speech intelligibility in experienced CI users. Using voltage matrices collected for impedance measurements, an individual exponential spread coefficient (ESC) was computed. Speech audiometry was performed to determine the intelligibility at 40 dB Sound Pressure Level (SPL) and the 50% speech reception threshold: I40 and SRT50 respectively. Correlations between ESC and either I40 or SRT50 were assessed. A total of 36 adults (mean age: 50 years) with more than 11 months (mean: 34 months) of CI experience were included. In the 21 subjects for whom all electrodes were active, ESC was moderately correlated with both I40 (r = −0.557, p = 0.009) and SRT50 (r = 0.569, p = 0.007). The results indicate that speech perception performance is negatively affected by the ICCS. Estimates of current spread at the closest vicinity of CI electrodes and prior to any activation of auditory neurons are indispensable to better characterize the relationship between CI stimulation and auditory perception in cochlear implantees.

Unifying information theory and machine learning in a model of electrode discrimination in cochlear implants

Despite the development and success of cochlear implants over several decades, wide inter-subject variability in speech perception is reported. This suggests that cochlear implant user-dependent factors limit speech perception at the individual level. Clinical studies have demonstrated the importance of the number, placement, and insertion depths of electrodes on speech recognition abilities. However, these do not account for all inter-subject variability and to what extent these factors affect speech recognition abilities has not been studied. In this paper, an information theoretic method and machine learning technique are unified in a model to investigate the extent to which key factors limit cochlear implant electrode discrimination. The framework uses a neural network classifier to predict which electrode is stimulated for a given simulated activation pattern of the auditory nerve, and mutual information is then estimated between the actual stimulated electrode and predicted ones. We also investigate how and to what extent the choices of parameters affect the performance of the model. The advantages of this framework include i) electrode discrimination ability is quantified using information theory, ii) it provides a flexible framework that may be used to investigate the key factors that limit the performance of cochlear implant users, and iii) it provides insights for future modeling studies of other types of neural prostheses.

Analysis of Neural Interface When Using Modiolar Electrode Stimulation. Radiological Evaluation, Trans-Impedance Matrix Analysis and Effect on Listening Effort in Cochlear Implantation

Background: The proximity of the electrode to the modiolar wall may be of interest to investigate the effect of pitch discrimination. This research establishes the relation between these factors and whether perimodiolar positions may provide benefits regarding improved electrode discrimination. Methods: A prospective randomized study including 24 post-lingual deaf adults was performed. A psychoacoustic study was done by using a psychoacoustic research platform. Radiological study, and a cone-beam computed tomography was used to assess post cochlear implantation electrodes’ position. Trans-impedance matrix (TIM) analysis was performed after cochlear implant insertion in all cases, and pupillometry test was also performed. Results: 12 patients received a slim perimodiolar electrode array, and 12 patients received a straight electrode array. Although all the patients showed similar speech test results after 12 months follow-up, those implanted with a perimodiolar electrode obtained better scores in electrode discrimination test and pupillometry test, and showed more homogenous TIM patterns. Conclusions: The better positioning of the electrode array seams to provide a better hearing resolution and less listening effort trans-impedance matrix seems to be a useful tool to analyze positioning of the perimodiolar array.

Transplantation of adipose-derived stromal cells protects functional and morphological auditory nerve integrity in a model of cochlear implantation

Cochlear implants are considered the gold standard therapy for subjects with severe hearing loss and deafness. Cochlear implants bypass the damaged hair cells and directly stimulate spiral ganglion neurons (SGNs) of the auditory nerve. Hence, the presence of functional SGNs is crucial for speech perception in electric hearing with a cochlear implant. In deaf individuals, SGNs progressively degenerate due to the lack of neurotrophic support, normally provided by sensory cells of the inner ear. Adipose-derived stromal cells (ASCs) are known to produce neurotrophic factors. In a guinea pig model of sensory hearing loss and cochlear implantation, ASCs were autologously transplanted into the scala tympani prior to insertion of a cochlear implant on one side. Electrically evoked auditory brain stem responses (eABR) were recorded 8 weeks after cochlear implantation. At conclusion of the experiment, the cochleae were histologically evaluated. Compared to untreated control animals, transplantation of ASCs resulted in an increased number of SGNs and their peripheral neurites. In ASC-transplanted animals, mean eABR thresholds were lower and suprathreshold amplitudes larger, suggesting a larger population of intact auditory nerve fibers. Moreover, when compared to controls, amplitude-level functions of eABRs in ASC transplanted animals demonstrated steeper slopes in response to increasing interphase gaps (IPGs), indicative of better functionality of the auditory nerve. In summary, results suggest that transplantation of autologous ASCs into the deaf inner ear may have protective effects on the survival of SGNs and their peripheral processes and may thus contribute to long-term benefits in speech discrimination performance in cochlear implant subjects.

The effect of increased channel interaction on speech perception with cochlear implants

Cochlear implants (CIs) are neuroprostheses that partially restore hearing for people with severe-to-profound hearing loss. While CIs can provide good speech perception in quiet listening situations for many, they fail to do so in environments with interfering sounds for most listeners. Previous research suggests that this is due to detrimental interaction effects between CI electrode channels, limiting their function to convey frequency-specific information, but evidence is still scarce. In this study, an experimental manipulation called spectral blurring was used to increase channel interaction in CI listeners using Advanced Bionics devices with HiFocus 1J and MS electrode arrays to directly investigate its causal effect on speech perception. Instead of using a single electrode per channel as in standard CI processing, spectral blurring used up to 6 electrodes per channel simultaneously to increase the overlap between adjacent frequency channels as would occur in cases with severe channel interaction. Results demonstrated that this manipulation significantly degraded CI speech perception in quiet by 15% and speech reception thresholds in babble noise by 5 dB when all channels were blurred by a factor of 6. Importantly, when channel interaction was increased just on a subset of electrodes, speech scores were mostly unaffected and were only significantly degraded when the 5 most apical channels were blurred. These apical channels convey information up to 1 kHz at the apical end of the electrode array and are typically located at angular insertion depths of about 250 up to 500°. These results confirm and extend earlier findings indicating that CI speech perception may not benefit from deactivating individual channels along the array and that efforts should instead be directed towards reducing channel interaction per se and in particular for the most-apical electrodes. Hereby, causal methods such as spectral blurring could be used in future research to control channel interaction effects within listeners for evaluating compensation strategies.

Channel Interaction During Infrared Light Stimulation in the Cochlea

BACKGROUND AND OBJECTIVES

The number of perceptually independent channels to encode acoustic information is limited in contemporary cochlear implants (CIs) because of the current spread in the tissue. It has been suggested that neighboring electrodes have to be separated in humans by a distance of more than 2 mm to eliminate significant overlap of the electric current fields and subsequent interaction between the channels. It has also been argued that an increase in the number of independent channels could improve CI user performance in challenging listening environments, such as speech in noise, tonal languages, or music perception. Optical stimulation has been suggested as an alternative modality for neural stimulation because it is spatially selective. This study reports the results of experiments designed to quantify the interaction between neighboring optical sources in the cochlea during stimulation with infrared radiation.

STUDY DESIGN/MATERIALS AND METHODS

In seven adult albino guinea pigs, a forward masking method was used to quantify the interaction between two neighboring optical sources during stimulation. Two optical fibers were placed through cochleostomies into the scala tympani of the basal cochlear turn. The radiation beams were directed towards different neuron populations along the spiral ganglion. Optically evoked compound action potentials were recorded for different radiant energies and distances between the optical fibers. The outcome measure was the radiant energy of a masker pulse delivered 3 milliseconds before a probe pulse to reduce the response evoked by the probe pulse by 3 dB. Results were compared for different distances between the fibers placed along the cochlea.

RESULTS

The energy required to reduce the probe's response by 3 dB increased by 20.4 dB/mm and by 26.0 dB/octave. The inhibition was symmetrical for the masker placed basal to the probe (base-to-apex) and the masker placed apical to the probe (apex-to-base).

CONCLUSION

The interaction between neighboring optical sources during infrared laser stimulation is less than the interaction between neighboring electrical contacts during electrical stimulation. Previously published data for electrical stimulation reported an average current spread in human and cat cochleae of 2.8 dB/mm. With the increased number of independent channels for optical stimulation, it is anticipated that speech and music performance will improve. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Neural encoding of spectro-temporal cues at slow and near speech-rate in cochlear implant users

The ability to process rapid modulations in the spectro-temporal structure of sounds is critical for speech comprehension. For users of cochlear implants (CIs), spectral cues in speech are conveyed by differential stimulation of electrode contacts along the cochlea, and temporal cues in terms of the amplitude of stimulating electrical pulses, which track the amplitude-modulated (AM'ed) envelope of speech sounds. Whilst survival of inner-ear neurons and spread of electrical current are known factors that limit the representation of speech information in CI listeners, limitations in the neural representation of dynamic spectro-temporal cues common to speech are also likely to play a role. We assessed the ability of CI listeners to process spectro-temporal cues varying at rates typically present in human speech. Employing an auditory change complex (ACC) paradigm, and a slow (0.5Hz) alternating rate between stimulating electrodes, or different AM frequencies, to evoke a transient cortical ACC, we demonstrate that CI listeners-like normal-hearing listeners-are sensitive to transitions in the spectral- and temporal-domain. However, CI listeners showed impaired cortical responses when either spectral or temporal cues were alternated at faster, speech-like (6-7Hz), rates. Specifically, auditory change following responses-reliably obtained in normal-hearing listeners-were small or absent in CI users, indicating that cortical adaptation to alternating cues at speech-like rates is stronger under electrical stimulation. In CI listeners, temporal processing was also influenced by the polarity-behaviourally-and rate of presentation of electrical pulses-both neurally and behaviorally. Limitations in the ability to process dynamic spectro-temporal cues will likely impact speech comprehension in CI users.

Using Spectral Blurring to Assess Effects of Channel Interaction on Speech-in-Noise Perception with Cochlear Implants

Cochlear implant (CI) listeners struggle to understand speech in background noise. Interactions between electrode channels due to current spread increase the masking of speech by noise and lead to difficulties with speech perception. Strategies that reduce channel interaction therefore have the potential to improve speech-in-noise perception by CI listeners, but previous results have been mixed. We investigated the effects of channel interaction on speech-in-noise perception and its association with spectro-temporal acuity in a listening study with 12 experienced CI users. Instead of attempting to reduce channel interaction, we introduced spectral blurring to simulate some of the effects of channel interaction by adjusting the overlap between electrode channels at the input level of the analysis filters or at the output by using several simultaneously stimulated electrodes per channel. We measured speech reception thresholds in noise as a function of the amount of blurring applied to either all 15 electrode channels or to 5 evenly spaced channels. Performance remained roughly constant as the amount of blurring applied to all channels increased up to some knee point, above which it deteriorated. This knee point differed across listeners in a way that correlated with performance on a non-speech spectro-temporal task, and is proposed here as an individual measure of channel interaction. Surprisingly, even extreme amounts of blurring applied to 5 channels did not affect performance. The effects on speech perception in noise were similar for blurring at the input and at the output of the CI. The results are in line with the assumption that experienced CI users can make use of a limited number of effective channels of information and tolerate some deviations from their everyday settings when identifying speech in the presence of a masker. Furthermore, these findings may explain the mixed results by strategies that optimized or deactivated a small number of electrodes evenly distributed along the array by showing that blurring or deactivating one-third of the electrodes did not harm speech-in-noise performance.

Longitudinal effect of deactivating stimulation sites based on low-rate thresholds on speech recognition in cochlear implant users

Objective: The objective of the current study was to examine the longitudinal effect of deactivating stimulation sites estimated to produce broad neural excitation on speech recognition. Design: Spatial patterns of neural excitation were estimated based on a previously established psychophysical measure, that is, detection threshold for low-rate pulse trains. Stimulation sites with relatively poor thresholds were deactivated in an experimental map. The acute effect was evaluated, in quiet and in noise, immediately after the experimental map was created (baseline), after the subjects practiced with the experimental map for two months (treatment), and after the subjects' daily map was switched back again to the clinical map for another two months (withdrawal). Study sample: Eight Cochlear Nucleus device users participated in the study. Results: For both listening in noise and in quiet, the greatest effect of deactivation was observed after the subjects were given time to adapt to the new frequency allocations. The effect was comparable for listening in fluctuating and steady-state noises. All subjects benefited from deactivation for listening in noise, but subjects with greater variability in thresholds were more likely to benefit from deactivation for listening in quiet. Conclusion: The benefit of electrode deactivation for speech recognition can increase with practice.

The effects of electrical field spatial spread and some cognitive factors on speech-in-noise performance of individual cochlear implant users-A computer model study

The relation of the individual speech-in-noise performance differences in cochlear implant (CI) users to underlying physiological factors is currently poorly understood. This study approached this research question by a step-wise individualization of a computer model of speech intelligibility mimicking the details of CI signal processing and some details of the physiology present in CI users. Two factors, the electrical field spatial spread and internal noise (as a coarse model of the individual cognitive performance) were incorporated. Internal representations of speech-in-noise mixtures calculated by the model were classified using an automatic speech recognizer backend employing Hidden Markov Models with a Gaussian probability distribution. One-dimensional electric field spatial spread functions were inferred from electrical field imaging data of 14 CI users. Simplified assumptions of homogenously distributed auditory nerve fibers along the cochlear array and equal distance between electrode array and nerve tissue were assumed in the model. Internal noise, whose standard deviation was adjusted based on either anamnesis data, or text-reception-threshold data, or a combination thereof, was applied to the internal representations before classification. A systematic model evaluation showed that predicted speech-reception-thresholds (SRTs) in stationary noise improved (decreased) with decreasing internal noise standard deviation and with narrower electric field spatial spreads. The model version that was individualized to actual listeners using internal noise alone (containing average spatial spread) showed significant correlations to measured SRTs, reflecting the high correlation of the text-reception threshold data with SRTs. However, neither individualization to spatial spread functions alone, nor a combined individualization based on spatial spread functions and internal noise standard deviation did produce significant correlations with measured SRTs.

Imaging evaluation of electrode placement and effect on electrode discrimination on different cochlear implant electrode arrays

OBJECTIVE

The aim of the present study is to evaluate the effect of electrode discrimination based on electrode to modiolus distance in different cochlear implant models, using image information to estimate the outcomes after an implantation on electrode discrimination METHODS: A descriptive prospective randomized study performed during 16 months. A psychoacoustic platform was used to evaluate patients' electrode discrimination capabilities of patients. For the acquisition of the images, a cone beam computed tomography was used to assess postcochlear implantation of electrodes' position. We considered two other new measurements: the intracochlear position index, which indicates how far is the electrode from the modiolar wall, and the homogeneity factor (HF), which provides us with information about the distance between the electrodes and the modiolus RESULTS: 21 postlingually deaf adults showing different CI models [CI522 (n = 7), CI512 (n = 7), and CI532 (n = 7)] that corresponded to the lateral and perimodiolar array electrodes. The average success rate of the CI522 group was 47%, of the CI512 group was 48%, and of the CI532 group was 77%. There is statistically significant difference between groups CI532-CI522 (p = 0.0033) and CI532-CI512 (p = 0.0027) CONCLUSION: The Nucleus CI532 offers a better perimodiolar placement. HF and IPI measurements provide information about the electrodes location inside the cochlea, being related to electrode discrimination.

Derivation of frequency importance functions for the AzBio sentences

Although the AzBio test is well validated, has effective standardization data available, and is highly recommended for Cochlear Implant (CI) evaluation, no attempt has been made to derive a Frequency Importance Function (FIF) for its stimuli. This study derived FIFs for the AzBio sentence lists using listeners with normal hearing. Traditional procedures described in studies by Studebaker and Sherbecoe [(1991). J. Speech. Lang. Hear. Res. 34, 427-438] were applied for this purpose. Participants with normal hearing listened to a large number of AzBio sentences that were high- and low-pass filtered under speech-spectrum shaped noise at various signal-to-noise ratios. Frequency weights for the AzBio sentences were greatest in the 1.5 to 2 kHz frequency regions as is the case with other speech materials. A cross-procedure comparison was conducted between the traditional procedure [Studebaker and Sherbecoe (1991). J. Speech. Lang. Hear. Res. 34, 427-438] and the nonlinear optimization procedure [Kates (2013). J. Acoust. Soc. Am. 134, EL459-EL464]. Consecutive data analyses provided speech recognition scores for the AzBio sentences in relation to the Speech Intelligibility Index (SII). The findings of the authors provide empirically derived FIFs for the AzBio test that can be used for future studies. It is anticipated that the accuracy of predicting SIIs for CI patients will be improved when using these derived FIFs for the AzBio test.

Reversible p53 inhibition prevents cisplatin ototoxicity without blocking chemotherapeutic efficacy

Cisplatin is a widely used chemotherapy drug, despite its significant ototoxic side effects. To date, the mechanism of cisplatin‐induced ototoxicity remains unclear, and hearing preservation during cisplatin‐based chemotherapy in patients is lacking. We found activation of the ATM‐Chk2‐p53 pathway to be a major determinant of cisplatin ototoxicity. However, prevention of cisplatin‐induced ototoxicity is hampered by opposite effects of ATM activation upon sensory hair cells: promoting both outer hair cell death and inner hair cell survival. Encouragingly, however, genetic or pharmacological ablation of p53 substantially attenuated cochlear cell apoptosis, thus preserving hearing. Importantly, systemic administration of a p53 inhibitor in mice bearing patient‐derived triple‐negative breast cancer protected auditory function, without compromising the anti‐tumor efficacy of cisplatin. Altogether, these findings highlight a novel and effective strategy for hearing protection in cisplatin‐based chemotherapy.

The Electrically Evoked Compound Action Potential: From Laboratory to Clinic

The electrically evoked compound action potential (eCAP) represents the synchronous firing of a population of electrically stimulated auditory nerve fibers. It can be directly recorded on a surgically exposed nerve trunk in animals or from an intra-cochlear electrode of a cochlear implant. In the past two decades, the eCAP has been widely recorded in both animals and clinical patient populations using different testing paradigms. This paper provides an overview of recording methodologies and response characteristics of the eCAP, as well as its potential applications in research and clinical situations. Relevant studies are reviewed and implications for clinicians are discussed.

Spectro-temporal cues enhance modulation sensitivity in cochlear implant users

Although speech understanding is highly variable amongst cochlear implants (CIs) subjects, the remarkably high speech recognition performance of many CI users is unexpected and not well understood. Numerous factors, including neural health and degradation of the spectral information in the speech signal of CIs, likely contribute to speech understanding. We studied the ability to use spectro-temporal modulations, which may be critical for speech understanding and discrimination, and hypothesize that CI users adopt a different perceptual strategy than normal-hearing (NH) individuals, whereby they rely more heavily on joint spectro-temporal cues to enhance detection of auditory cues. Modulation detection sensitivity was studied in CI users and NH subjects using broadband "ripple" stimuli that were modulated spectrally, temporally, or jointly, i.e., spectro-temporally. The spectro-temporal modulation transfer functions of CI users and NH subjects was decomposed into spectral and temporal dimensions and compared to those subjects' spectral-only and temporal-only modulation transfer functions. In CI users, the joint spectro-temporal sensitivity was better than that predicted by spectral-only and temporal-only sensitivity, indicating a heightened spectro-temporal sensitivity. Such an enhancement through the combined integration of spectral and temporal cues was not observed in NH subjects. The unique use of spectro-temporal cues by CI patients can yield benefits for use of cues that are important for speech understanding. This finding has implications for developing sound processing strategies that may rely on joint spectro-temporal modulations to improve speech comprehension of CI users, and the findings of this study may be valuable for developing clinical assessment tools to optimize CI processor performance.

Loudness and pitch perception using Dynamically Compensated Virtual Channels

Reducing power consumption is important for the development of smaller cochlear implant (CI) speech processors. Simultaneous electrode stimulation may improve power efficiency by minimizing the required current applied to a given electrode. Simultaneous in-phase stimulation on adjacent electrodes (i.e. virtual channels) can be used to elicit pitch percepts intermediate to the ones provided by each of the physical electrodes in isolation. Virtual channels are typically implemented in monopolar stimulation mode, producing broad excitation patterns. Focused stimulation may reduce the excitation patterns, but is inefficient in terms of power consumption. To create a more power efficient virtual channel, we developed the Dynamically Compensated Virtual Channel (DC-VC) using four adjacent electrodes. The two central electrodes are current steered using the coefficient α (0<α<1 ) whereas the two flanking electrodes are used to focus/unfocus the stimulation with the coefficient σ (-1<σ<1). With increasing values of σ, power can be saved at the potential expense of generating broader electric fields. Additionally, reshaping the electric fields might also alter place pitch coding. The goal of the present study is to investigate the tradeoff between place pitch encoding and power savings using simultaneous electrode stimulation in the DC-VC configuration. A computational model and psychophysical experiments in CI users have been used for that purpose. Results from 10 adult Advanced Bionics CI users have been collected. Results show that the required current to produce comfortable levels is significantly reduced with increasing σ as predicted by the computational model. Moreover, no significant differences in the estimated number of discriminable steps were detected for the different values of σ. From these results, we conclude that DC-VCs can reduce power consumption without decreasing the number of discriminable place pitch steps.

Band importance functions of listeners with cochlear implants using clinical maps

Band importance functions estimate the relative contribution of individual acoustic frequency bands to speech intelligibility. Previous studies of band importance in listeners with cochlear implants have used experimental maps and direct stimulation. Here, band importance was estimated for clinical maps with acoustic stimulation. Listeners with cochlear implants had band importance functions that relied more heavily on lower frequencies and showed less cross-listener consistency than in listeners with normal hearing. The intersubject variability observed here indicates that averaging band importance functions across listeners with cochlear implants, as has been done in previous studies, may not be meaningful. Additionally, band importance functions of listeners with normal hearing for vocoded speech that either did or did not simulate spread of excitation were not different from one another, suggesting that additional factors beyond spread of excitation are necessary to account for changes in band importance in listeners with cochlear implants.

Fitting prelingually deafened adult cochlear implant users based on electrode discrimination performance

OBJECTIVE

This study investigated the hypotheses that (1) prelingually deafened CI users do not have perfect electrode discrimination ability and (2) the deactivation of non-discriminable electrodes can improve auditory performance.

DESIGN

Electrode discrimination difference limens were determined for all electrodes of the array. The subjects' basic map was subsequently compared to an experimental map, which contained only discriminable electrodes, with respect to speech understanding in quiet and in noise, listening effort, spectral ripple discrimination and subjective appreciation.

STUDY SAMPLE

Subjects were six prelingually deafened, late implanted adults using the Nucleus cochlear implant.

RESULTS

Electrode discrimination difference limens across all subjects and electrodes ranged from 0.5 to 7.125, with significantly larger limens for basal electrodes. No significant differences were found between the basic map and the experimental map on auditory tests. Subjective appreciation was found to be significantly poorer for the experimental map.

CONCLUSIONS

Prelingually deafened CI users were unable to discriminate between all adjacent electrodes. There was no difference in auditory performance between the basic and experimental map. Potential factors contributing to the absence of improvement with the experimental map include the reduced number of maxima, incomplete adaptation to the new frequency allocation, and the mainly basal location of deactivated electrodes.

Multichannel cochlear implant for selective neuronal activation and chronic use in the free-moving Mongolian gerbil

BACKGROUND

Animal models for chronic multichannel cochlear implant stimulation and selective neuronal activation contribute to a better understanding of auditory signal processing and central neural plasticity.

NEW METHOD

This paper describes the design and surgical implantation of a multichannel cochlear implant (CI) system for chronic use in the free-moving gerbil. For chronic stimulation, adult-deafened gerbils were connected to a multichannel commutator that allowed low resistance cable rotation and stable electric connectivity to the current source.

RESULTS

Despite the small scale of the gerbil cochlea and auditory brain regions, final electrophysiological mapping experiments revealed selective and tonotopically organized neuronal activation in the auditory cortex. Contact impedances and electrically evoked auditory brainstem responses were stable over several weeks demonstrating the long-term integrity of the implant and the efficacy of the stimulation.

COMPARISON WITH EXISTING METHODS

Most animal models on multichannel signal processing and stimulation-induced plasticity are limited to larger animals such as ferrets, cats and primates. Multichannel CI stimulation in the free-moving rodent and evidence for selective neuronal activation in gerbil auditory cortex have not been previously reported.

CONCLUSIONS

Overall, our results show that the gerbil is a robust rodent model for selective and tonotopically organized multichannel CI stimulation. We anticipate that this model provides a useful tool to develop and test both passive stimulation and behavioral training strategies for plastic reorganization and restoration of degraded unilateral and bilateral central auditory signal processing in the hearing impaired and deaf central auditory system.

Pitch Discrimination: An Independent Factor in Cochlear Implant Performance Outcomes

Objective:

To assess differences in pitch-ranking ability across a range of speech understanding performance levels and as a function of electrode position.

Study Design:

An observational study of a cross-section of cochlear implantees.

Setting:

Tertiary referral center for cochlear implantation.

Patients:

A total of 22 patients were recruited. All three manufacturers’ devices were included (MED-EL, Innsbruck, Austria, n = 10; Advanced Bionics, California, USA, n = 8; and Cochlear, Sydney, Australia, n = 4) and all patients were long-term users (more than 18 months). Twelve of these were poor performers (scores on BKB sentence lists <60%) and 10 were excellent performers (BKB >90%).

Intervention:

After measurement of threshold and comfort levels, and loudness balancing across the array, all patients underwent thorough pitch-ranking assessments at 80% of comfort levels.

Main Outcome Measure:

Ability to discriminate pitch across the electrode array, measured by consistency in discrimination of adjacent pairs of electrodes, as well as an assessment of the pitch order across the array using the midpoint comparison task.

Results:

Within the poor performing group there was wide variability in ability to pitch rank, from no errors, to a complete inability to reliably and consistently differentiate pitch change across the electrode array. Good performers were overall significantly more accurate at pitch ranking (p = 0.026). Consistent pitch ranking was found to be a significant independent predictor of BKB score, even after adjusting for age. Users of the MED-EL implant experienced significantly more pitch confusions at the apex than at more basal parts of the electrode array.

Conclusions:

Many cochlear implant users struggle to discriminate pitch effectively. Accurate pitch ranking appears to be an independent predictor of overall outcome. Future work will concentrate on manipulating maps based upon pitch discrimination findings in an attempt to improve speech understanding.

Pitch adaptation patterns in bimodal cochlear implant users: over time and after experience

OBJECTIVES

Pitch plasticity has been observed in Hybrid cochlear implant (CI) users. Does pitch plasticity also occur in bimodal CI users with traditional long-electrode CIs, and is pitch adaptation pattern associated with electrode discrimination or speech recognition performance? The goals of this study were to characterize pitch adaptation patterns in long-electrode CI users, to correlate these patterns with electrode discrimination and speech perception outcomes, and to analyze which subject factors are associated with the different patterns.

DESIGN

Electric-to-acoustic pitch matches were obtained in 19 subjects over time from CI activation to at least 12 months after activation, and in a separate group of 18 subjects in a single visit after at least 24 months of CI experience. Audiometric thresholds, electrode discrimination performance, and speech perception scores were also measured.

RESULTS

Subjects measured over time had pitch adaptation patterns that fit one of the following categories: (1) "Pitch-adapting," that is, the mismatch between perceived electrode pitch and the corresponding frequency-to-electrode allocations decreased; (2) "Pitch-dropping," that is, the pitches of multiple electrodes dropped and converged to a similar low-pitch; and (3) "Pitch-unchanging," that is, the electrode pitches did not change. Subjects measured after CI experience had a parallel set of adaptation patterns: (1) "Matched-pitch," that is, the electrode pitch was matched to the frequency allocation; (2) "Low-pitch," that is, the pitches of multiple electrodes were all around the lowest frequency allocation; and (3) "Nonmatched-pitch," that is, the pitch patterns were compressed relative to the frequency allocations and did not fit either the matched-pitch or low-pitch categories. Unlike Hybrid CI users which were mostly in the pitch-adapting or matched-pitch category, the majority of bimodal CI users were in the latter two categories, pitch-dropping/low-pitch or pitch-unchanging/nonmatched-pitch. Subjects with pitch-adapting or matched-pitch patterns tended to have better low-frequency thresholds than subjects in the latter categories. Changes in electrode discrimination over time were not associated with changes in pitch differences between electrodes. Reductions in speech perception scores over time showed a weak but nonsignificant association with dropping-pitch patterns.

CONCLUSIONS

Bimodal CI users with more residual hearing may have somewhat greater similarity to Hybrid CI users and be more likely to adapt pitch perception to reduce mismatch with the frequencies allocated to the electrodes and the acoustic hearing. In contrast, bimodal CI users with less residual hearing exhibit either no adaptation, or surprisingly, a third pattern in which the pitches of the basal electrodes drop to match the frequency range allocated to the most apical electrode. The lack of association of electrode discrimination changes with pitch changes suggests that electrode discrimination does not depend on perceived pitch differences between electrodes, but rather on some other characteristics such as timbre. In contrast, speech perception may depend more on pitch perception and the ability to distinguish pitch between electrodes, especially since during multielectrode stimulation, cues such as timbre may be less useful for discrimination.

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.

Correlations Between Pitch and Phoneme Perception in Cochlear Implant Users and Their Normal Hearing Peers

This study examined correlations between pitch and phoneme perception for nine cochlear implant users and nine normal hearing listeners. Pure tone frequency discrimination thresholds were measured for frequencies of 500, 1000, and 2000 Hz. Complex tone fundamental frequency (F0) discrimination thresholds were measured for F0s of 110, 220, and 440 Hz. The effects of amplitude and frequency roving were measured under the rationale that individuals who are robust to such perturbations would perform better on phoneme perception measures. Phoneme identification was measured using consonant and vowel materials in quiet, in stationary speech-shaped noise (SSN), in spectrally notched SSN, and in temporally gated SSN. Cochlear implant pure tone frequency discrimination thresholds ranged between 1.5 and 9.9 %, while cochlear implant complex tone F0 discrimination thresholds ranged between 2.6 and 28.5 %. On average, cochlear implant users had 5.3 dB of masking release for consonants and 8.4 dB of masking release for vowels when measured in temporally gated SSN compared to stationary SSN. Correlations with phoneme identification measures were generally higher for complex tone discrimination measures than for pure tone discrimination measures. Correlations with phoneme identification measures were also generally higher for pitch perception measures that included amplitude and frequency roving. The strongest correlations were observed for measures of complex tone F0 discrimination with phoneme identification in temporally gated SSN. The results of this study suggest that musical training or signal processing strategies that improve F0 discrimination should improve consonant identification in fluctuating noise.

Relationships Among Peripheral and Central Electrophysiological Measures of Spatial and Spectral Selectivity and Speech Perception in Cochlear Implant Users

OBJECTIVES

The ability to perceive speech is related to the listener's ability to differentiate among frequencies (i.e., spectral resolution). Cochlear implant (CI) users exhibit variable speech-perception and spectral-resolution abilities, which can be attributed in part to the extent of electrode interactions at the periphery (i.e., spatial selectivity). However, electrophysiological measures of peripheral spatial selectivity have not been found to correlate with speech perception. The purpose of this study was to evaluate auditory processing at the periphery and cortex using both simple and spectrally complex stimuli to better understand the stages of neural processing underlying speech perception. The hypotheses were that (1) by more completely characterizing peripheral excitation patterns than in previous studies, significant correlations with measures of spectral selectivity and speech perception would be observed, (2) adding information about processing at a level central to the auditory nerve would account for additional variability in speech perception, and (3) responses elicited with spectrally complex stimuli would be more strongly correlated with speech perception than responses elicited with spectrally simple stimuli.

DESIGN

Eleven adult CI users participated. Three experimental processor programs (MAPs) were created to vary the likelihood of electrode interactions within each participant. For each MAP, a subset of 7 of 22 intracochlear electrodes was activated: adjacent (MAP 1), every other (MAP 2), or every third (MAP 3). Peripheral spatial selectivity was assessed using the electrically evoked compound action potential (ECAP) to obtain channel-interaction functions for all activated electrodes (13 functions total). Central processing was assessed by eliciting the auditory change complex with both spatial (electrode pairs) and spectral (rippled noise) stimulus changes. Speech-perception measures included vowel discrimination and the Bamford-Kowal-Bench Speech-in-Noise test. Spatial and spectral selectivity and speech perception were expected to be poorest with MAP 1 (closest electrode spacing) and best with MAP 3 (widest electrode spacing). Relationships among the electrophysiological and speech-perception measures were evaluated using mixed-model and simple linear regression analyses.

RESULTS

All electrophysiological measures were significantly correlated with each other and with speech scores for the mixed-model analysis, which takes into account multiple measures per person (i.e., experimental MAPs). The ECAP measures were the best predictor. In the simple linear regression analysis on MAP 3 data, only the cortical measures were significantly correlated with speech scores; spectral auditory change complex amplitude was the strongest predictor.

CONCLUSIONS

The results suggest that both peripheral and central electrophysiological measures of spatial and spectral selectivity provide valuable information about speech perception. Clinically, it is often desirable to optimize performance for individual CI users. These results suggest that ECAP measures may be most useful for within-subject applications when multiple measures are performed to make decisions about processor options. They also suggest that if the goal is to compare performance across individuals based on a single measure, then processing central to the auditory nerve (specifically, cortical measures of discriminability) should be considered.

Evaluation of focused multipolar stimulation for cochlear implants in long-term deafened cats

OBJECTIVE

Focused multipolar (FMP) stimulation has been shown to produce restricted neural activation using intracochlear stimulation in animals with a normal population of spiral ganglion neurons (SGNs). However, in a clinical setting, the widespread loss of SGNs and peripheral fibres following deafness is expected to influence the effectiveness of FMP.

APPROACH

We compared the efficacy of FMP stimulation to both monopolar (MP) and tripolar (TP) stimulation in long-term deafened cat cochleae (n = 8). Unlike our previous study, these cochleae contained <10% of the normal SGN population adjacent to the electrode array. We also evaluated the effect of electrode position on stimulation modes by using either modiolar facing or lateral wall facing half-band electrodes. The spread of neural activity across the inferior colliculus, a major nucleus within the central auditory pathway, was used as a measure of spatial selectivity.

MAIN RESULTS

In cochleae with significant SGN degeneration, we observed that FMP and TP stimulation resulted in greater spatial selectivity than MP stimulation (p < 0.001). However, thresholds were significantly higher for FMP and TP stimulation compared to MP stimulation (p < 0.001). No difference between FMP and TP stimulation was found in any measures. The high threshold levels for FMP stimulation was significantly reduced without compromising spatial selectivity by varying the degree of current focusing (referred as 'partial-FMP' stimulation). Spatial selectivity of all stimulation modes was unaffected by the electrode position. Finally, spatial selectivity in long-term deafened cochleae was significantly less than that of cochleae with normal SGN population (George S S et al 2014 J. Neural Eng. 11 065003).

SIGNIFICANCE

The present results indicate that the greater spatial selectivity of FMP and TP stimulation over MP stimulation is maintained in cochleae with significant neural degeneration and is not adversely affected by electrode position. The greater spatial selectivity of FMP and TP stimulation would be expected to result in improved clinical performance.

Acoustic temporal modulation detection in normal-hearing and cochlear implanted listeners: effects of hearing mechanism and development

Temporal modulation detection ability matures over many years after birth and may be particularly sensitive to experience during this period. Profound hearing loss during early childhood might result in greater perceptual deficits than a similar loss beginning in adulthood. We tested this idea by measuring performance in temporal modulation detection in profoundly deaf children and adults fitted with cochlear implants (CIs). At least two independent variables could constrain temporal modulation detection performance in children with CIs: altered encoding of modulation information due to the CI-auditory nerve interface, and atypical development of central processing of sound information provided by CIs. The effect of altered encoding was investigated by testing subjects with one of two different hearing mechanisms (normal hearing vs. CI) and the effect of atypical development was studied by testing two different age groups. All subjects were tested for their ability to detect acoustic temporal modulations of sound amplitude. A comparison of the slope, or cutoff frequency, of the temporal modulation transfer functions (TMTFs) among the four subject groups revealed that temporal resolution was mainly constrained by hearing mechanism: normal-hearing listeners could detect smaller amplitude modulations at high modulation frequencies than CI users. In contrast, a comparison of the height of the TMTFs revealed a significant interaction between hearing mechanism and age group on overall sensitivity to temporal modulation: sensitivity was significantly poorer in children with CIs, relative to the other three groups. Results suggest that there is an age-specific vulnerability of intensity discrimination or non-sensory factors, which subsequently affects sensitivity to temporal modulation in prelingually deaf children who use CIs.

Objective measures of electrode discrimination with electrically evoked auditory change complex and speech-perception abilities in children with auditory neuropathy spectrum disorder

OBJECTIVES

This study aimed to (1) determine the sensitivity of the electrically evoked auditory change complex (eACC) to changes in stimulating electrode position; and (2) investigate the association between results of eACC measures and behavioral electrode discrimination and their association with speech-perception performance in pediatric cochlear implant (CI) users who have auditory neuropathy spectrum disorder (ANSD).

DESIGN

Fifteen children with ANSD ranging in age between 5.4 and 18.6 years participated in this study. All subjects used Cochlear Nucleus devices. For each subject, open-set speech-perception ability was assessed using the Phonetically Balanced Kindergarten word lists presented at 60 dB SPL, using monitored live voice in a sound booth. Behavioral and objective measures of electrode discrimination were assessed in a nonclinical test environment. The stimuli used to elicit these measures were 800 msec biphasic pulse trains delivered by a direct interface to the CI. Data were collected from two basic stimulation conditions. In the standard condition, the entire pulse train was delivered to a mid-array electrode (electrode 11 or 12) at the maximum comfortable level (C level). In the change condition, the stimulus was split into two 400 msec pulse train segments presented sequentially on two different electrodes. The stimulation level of the second 400 msec pulse train was loudness balanced to the C level of the mid-array electrode used in the standard condition. The separation between the pair of stimulating electrodes was systematically varied. For behavioral electrode-discrimination measures, each subject was required to determine whether he or she heard one or two sounds for stimuli presented in different stimulation conditions. For the eACC measures, two replicates of 100 artifact-free sweeps were recorded for each stimulation condition.

RESULTS

The eACC in response to changes in stimulating electrode position was recorded from all subjects with ANSD using direct electrical stimulation. Electrode-discrimination thresholds determined with the eACC and behavioral measures were consistent. Children with ANSD using CIs who showed poorer speech performance also required larger separations between the stimulating electrode pair to reliably elicit the eACC than subjects with better speech-perception performance. There was a robust correlation between electrode-discrimination capacities and speech-perception performances in subjects tested in this study. The effect of electrode separation on eACC amplitudes was not monotonic.

CONCLUSIONS

These results demonstrate the feasibility of using eACC to evaluate electrode-discrimination capacities in children with ANSD. These results suggest that the eACC elicited by changes in stimulating electrode position holds great promise as an objective tool for evaluating spectral-pattern detection in such subjects, which may be predictive of their potential speech-perception performance.

Effects of envelope bandwidth on importance functions for cochlear implant simulations

Frequency-importance functions (FIFs) quantify intelligibility contributions of spectral regions of speech. In previous work, FIFs were considered as instruments for characterizing intelligibility contributions of individual cochlear implant electrode channels. Comparisons of FIFs for natural speech and vocoder-simulated implant processed speech showed that vocoding shifted peak importance regions downward in frequency by 0.5 octaves. These shifts were attributed to voicing cue changes, and may reflect increased reliance on low-frequency information (apart from periodicity cues) for correct voicing perception. The purpose of this study was to determine whether increasing channel envelope bandwidth would reverse these shifts by improving access to voicing and pitch cues. Importance functions were measured for 48 subjects with normal hearing, who listened to vowel-consonant-vowel tokens either as recorded or as output from five different vocoders that simulated implant processing. Envelopes were constructed using filters that either included or excluded pitch information. Results indicate that vocoding-based shifts are only partially counteracted by including pitch information; moreover, a substantial baseline shift is present even for vocoders with high spectral resolution. The results also suggest that vocoded speech intelligibility is most sensitive to a loss of spectral resolution in high-importance regions, a finding with possible implications for cochlear implant electrode mapping.

Relationship among the physiologic channel interactions, spectral-ripple discrimination, and vowel identification in cochlear implant users

The hypothesis of this study was that broader patterns of physiological channel interactions in the local region of the cochlea are associated with poorer spectral resolution in the same region. Electrically evoked compound action potentials (ECAPs) were measured for three to six probe electrodes per subject to examine the channel interactions in different regions across the electrode array. To evaluate spectral resolution at a confined location within the cochlea, spectral-ripple discrimination (SRD) was measured using narrowband ripple stimuli with the bandwidth spanning five electrodes: Two electrodes apical and basal to the ECAP probe electrode. The relationship between the physiological channel interactions, spectral resolution in the local cochlear region, and vowel identification was evaluated. Results showed that (1) there was within- and across-subject variability in the widths of ECAP channel interaction functions and in narrowband SRD performance, (2) significant correlations were found between the widths of the ECAP functions and narrowband SRD thresholds, and between mean bandwidths of ECAP functions averaged across multiple probe electrodes and broadband SRD performance across subjects, and (3) the global spectral resolution reflecting the entire electrode array, not the local region, predicts vowel identification.

Pitch ranking, electrode discrimination, and physiological spread-of-excitation using Cochlear's dual-electrode mode

This study compared pitch ranking, electrode discrimination, and electrically evoked compound action potential (ECAP) spatial excitation patterns for adjacent physical electrodes (PEs) and the corresponding dual electrodes (DEs) for newer-generation Cochlear devices (Cochlear Ltd., Macquarie, New South Wales, Australia). The first goal was to determine whether pitch ranking and electrode discrimination yield similar outcomes for PEs and DEs. The second goal was to determine if the amount of spatial separation among ECAP excitation patterns (separation index, Σ) between adjacent PEs and the PE-DE pairs can predict performance on the psychophysical tasks. Using non-adaptive procedures, 13 subjects completed pitch ranking and electrode discrimination for adjacent PEs and the corresponding PE-DE pairs (DE versus each flanking PE) from the basal, middle, and apical electrode regions. Analysis of d' scores indicated that pitch-ranking and electrode-discrimination scores were not significantly different, but rather produced similar levels of performance. As expected, accuracy was significantly better for the PE-PE comparison than either PE-DE comparison. Correlations of the psychophysical versus ECAP Σ measures were positive; however, not all test/region correlations were significant across the array. Thus, the ECAP separation index is not sensitive enough to predict performance on behavioral tasks of pitch ranking or electrode discrimination for adjacent PEs or corresponding DEs.

Chronic neurotrophin delivery promotes ectopic neurite growth from the spiral ganglion of deafened cochleae without compromising the spatial selectivity of cochlear implants

Cochlear implants restore hearing cues in the severe-profoundly deaf by electrically stimulating spiral ganglion neurons (SGNs). However, SGNs degenerate following loss of cochlear hair cells, due at least in part to a reduction in the endogenous neurotrophin (NT) supply, normally provided by hair cells and supporting cells of the organ of Corti. Delivering exogenous NTs to the cochlea can rescue SGNs from degeneration and can also promote the ectopic growth of SGN neurites. This resprouting may disrupt the cochleotopic organization upon which cochlear implants rely to impart pitch cues. Using retrograde labeling and confocal imaging of SGNs, we determined the extent of neurite growth following 28 days of exogenous NT treatment in deafened guinea pigs with and without chronic electrical stimulation (ES). On completion of this treatment, we measured the spread of neural activation to intracochlear ES by recording neural responses across the cochleotopically organized inferior colliculus using multichannel recording techniques. Although NT treatment significantly increased both the length and the lateral extent of growth of neurites along the cochlea compared with deafened controls, these anatomical changes did not affect the spread of neural activation when examined immediately after 28 days of NT treatment. NT treatment did, however, result in lower excitation thresholds compared with deafened controls. These data support the application of NTs for improved clinical outcomes for cochlear implant patients.

Relationship between channel interaction and spectral-ripple discrimination in cochlear implant users

Cochlear implant (CI) users can achieve remarkable speech understanding, but there is great variability in outcomes that is only partially accounted for by age, residual hearing, and duration of deafness. Results might be improved with the use of psychophysical tests to predict which sound processing strategies offer the best potential outcomes. In particular, the spectral-ripple discrimination test offers a time-efficient, nonlinguistic measure that is correlated with perception of both speech and music by CI users. Features that make this "one-point" test time-efficient, and thus potentially clinically useful, are also connected to controversy within the CI field about what the test measures. The current work examined the relationship between thresholds in the one-point spectral-ripple test, in which stimuli are presented acoustically, and interaction indices measured under the controlled conditions afforded by direct stimulation with a research processor. Results of these studies include the following: (1) within individual subjects there were large variations in the interaction index along the electrode array, (2) interaction indices generally decreased with increasing electrode separation, and (3) spectral-ripple discrimination improved with decreasing mean interaction index at electrode separations of one, three, and five electrodes. These results indicate that spectral-ripple discrimination thresholds can provide a useful metric of the spectral resolution of CI users.

Consonant recognition as a function of the number of stimulation channels in the Hybrid short-electrode cochlear implant

Consonant recognition was measured as a function of the number of stimulation channels for Hybrid short-electrode cochlear implant (CI) users, long-electrode CI users, and normal-hearing (NH) listeners in quiet and background noise. Short-electrode CI subjects were tested with 1-6 channels allocated to a frequency range of 1063-7938 Hz. Long-electrode CI subjects were tested with 1-6, 8, or 22 channels allocated to 188-7938 Hz, or 1-6 or 15 channels from the basal 15 electrodes allocated to 1063-7938 Hz. NH listeners were tested with simulations of each CI group/condition. Despite differences in intracochlear electrode spacing for equivalent channel conditions, all CI subject groups performed similarly at each channel condition and improved up to at least four channels in quiet and noise. All CI subject groups underperformed relative to NH subjects. These preliminary findings suggest that the limited channel benefit seen for CI users may not be due solely to increases in channel interactions as a function of electrode density. Other factors such as pre-operative patient history, location of stimulation in the base versus apex, or a limit on the number of electric channels that can be processed cognitively, may also interact with the effects of electrode contact spacing along the cochlea.

Improving virtual channel discrimination in a multi-channel context

Improving spectral resolution in cochlear implants is key to improving performance in difficult listening conditions (e.g. speech in noise, music, etc.). Current focusing might reduce channel interaction, thereby increasing spectral resolution. Previous studies have shown that combining current steering and current focusing reduces spread of excitation and improves virtual channel discrimination in a single-channel context. It is unclear whether the single-channel benefits from current focusing extend to a multi-channel context, in which the physical and perceptual interference of multiple stimulated channels might overwhelm the benefits of improved spectral resolution. In this study, signal discrimination was measured with and without current focusing, in the presence of competing stimuli on nearby electrodes. Results showed that signal discrimination was consistently better with current focusing than without, regardless of the amplitude of the competing stimuli. Therefore, combining current steering and current focusing may provide more effective spectral cues than are currently available.

Recovery from forward masking in elderly cochlear implant users

OBJECTIVE

To compare temporal aspects of peripheral neural responses and central auditory perception between groups of younger adult and elderly cochlear implant users.

STUDY DESIGN

Cohort study.

SETTING

Academic hospital and cochlear implant center.

PATIENTS

Adult cochlear implant users aged 28 to 57 years in the younger group (n = 5) and 61 to 89 years (n = 9) in the elderly group. All subjects used Advanced Bionics devices.

INTERVENTION

Diagnostic.

MAIN OUTCOME MEASURES

Time constants of neural (i.e., electrically evoked compound action potentials [ECAPs]) and perceptual recovery from forward masking. Interstimulus intervals (ISIs) were varied in both experiments.

RESULTS

ECAP recovery rates were equivalent between groups, and no correlation was found between ECAP recovery and age. No correlations were found between ECAP recovery and speech perception. Psychophysical recovery was significantly slower in the elderly compared with the younger subjects (p < 0.0005), with a significant effect of age (R2 = 0.70, p < 0.0005). At the longest ISI (240 ms), elderly subjects experienced a mean maximum threshold shift of 35.2% (relative to 1 ms ISI) versus 14.8% for younger subjects. There was a significant positive relationship between psychophysical recovery and consonant-nucleus-consonant word scores (R2 = 0.62, p < 0.001), although no relationship was found with Hearing in Noise Test sentences.

CONCLUSION

These findings suggest that difficulties observed in speech perception by elderly CI users may be due to age-related changes in the central rather than peripheral auditory system. With further study, these results may provide information to allow clinicians to assess patients' temporal processing abilities and facilitate setting program parameters that will maximize their auditory perceptual experience with a cochlear implant.

Potential benefits from deeply inserted cochlear implant electrodes

OBJECTIVES

This review examines evidence for potential benefits of using cochlear implant electrodes that extend into the apical regions of the cochlea. Most cochlear implant systems use electrode arrays that extend 1 to 1.5 turns from the basal cochleostomy, but one manufacturer (MED-EL GmbH) uses an electrode array that is considerably longer. The fundamental rationale for using electrodes extending toward the apex of the cochlea is to provide additional low-pitched auditory percepts and thereby increase the spectral information available to the user. Several experimental long arrays have also been produced by other manufacturers to assess potential benefits of this approach.

DESIGN

In addition to assessing the effects of deeply inserted electrodes on performance, this review examines several underlying and associated issues, including cochlear anatomy, electrode design, surgical considerations (including insertion trauma), and pitch scaling trials. Where possible, the aim is to draw conclusions regarding the potential from apical electrodes in general, rather than relating to the performance of specific and current devices.

RESULTS

Imaging studies indicate that currently available electrode arrays rarely extend more than two turns into the cochlea, the mean insertion angle for full insertions of the MED-EL electrodes being about 630°. This is considerably shorter than the total length of the cochlea and more closely approximates the length of the spiral ganglion. Anatomical considerations, and some modelling studies, suggest that fabrication of even longer electrodes is unlikely to provide additional spectral information. The issue of potential benefit from the most apical electrodes, therefore, is whether they are able to selectively stimulate discrete and tonotopically ordered neural populations near the apex of the spiral ganglion, where the ganglion cells are closely grouped. Pitch scaling studies, using the MED-EL and experimental long arrays, suggest that this is achieved in many cases, but that a significant number of individuals show evidence of pitch confusions or reversals among the most apical electrodes, presumably reducing potential performance benefit and presenting challenges for processor programming.

CONCLUSIONS

Benefits in terms of speech recognition and other performance measures are less clear. Several studies have indicated that deactivation of apical electrodes results in poorer speech recognition performance, but these have been mostly acute studies where the subjects have been accustomed to the full complement of electrodes, thus making interpretation difficult. Some chronic studies have suggested that apical electrodes do provide additional performance benefit, but others have shown performance improvement after deactivating some of the apical electrodes. Whether or not deeply inserted electrodes can offer performance benefits, there is evidence that currently available designs tend to produce more intracochlear trauma than shorter arrays, in terms of loss of residual acoustic hearing and reduction of the neural substrate. This may have important long-term consequences for the user. Furthermore, as it is possible that subjects with better low-frequency residual hearing are more likely to benefit from the inclusion of apical electrodes, there may be a potential clinical dilemma as the same subjects are those most likely to benefit from bimodal electroacoustic stimulation, requiring a relatively shallow insertion.

Psychoacoustic abilities associated with music perception in cochlear implant users

OBJECTIVES

This study was designed to determine what acoustic elements are associated with musical perception ability in cochlear implant (CI) users and to understand how acoustic elements, which are important to good speech perception, contribute to music perception in CI users. It was hypothesized that the variability in the performance of music and speech perception may be related to differences in the sensitivity to specific acoustic features such as spectral changes or temporal modulations, or both.

DESIGN

A battery of hearing tasks was administered to 42 CI listeners. The Clinical Assessment of Music Perception was used, which evaluates complex-tone pitch-direction discrimination, melody recognition, and timbre recognition. To investigate spectral and temporal processing, spectral-ripple discrimination and Schroeder-phase discrimination abilities were evaluated. Speech perception ability in quiet and noise was also evaluated. Relationships between Clinical Assessment of Music Perception subtest scores, spectral-ripple discrimination thresholds, Schroeder-phase discrimination scores, and speech recognition scores were assessed.

RESULTS

Spectral-ripple discrimination was shown to correlate with all three aspects of music perception studied. Schroeder-phase discrimination was generally not predictive of music perception outcomes. Music perception ability was significantly correlated with speech perception ability. Nearly half of the variance in melody and timbre recognition was predicted jointly by spectral-ripple and pitch-direction discrimination thresholds. Similar results were observed on speech recognition as well.

CONCLUSIONS

This study suggests that spectral-ripple discrimination is significantly associated with music perception in CI users. A previous report showed that spectral-ripple discrimination is significantly correlated with speech recognition in quiet and in noise. This study also showed that speech recognition and music perception are also related to one another. Spectral-ripple discrimination ability seems to reflect a wide range of hearing abilities in CI users. The results suggest that materially improving spectral resolution could provide significant benefits in music and speech perception outcomes in CI users.

Relationship between behavioral and physiological spectral-ripple discrimination

Previous studies have found a significant correlation between spectral-ripple discrimination and speech and music perception in cochlear implant (CI) users. This relationship could be of use to clinicians and scientists who are interested in using spectral-ripple stimuli in the assessment and habilitation of CI users. However, previous psychoacoustic tasks used to assess spectral discrimination are not suitable for all populations, and it would be beneficial to develop methods that could be used to test all age ranges, including pediatric implant users. Additionally, it is important to understand how ripple stimuli are processed in the central auditory system and how their neural representation contributes to behavioral performance. For this reason, we developed a single-interval, yes/no paradigm that could potentially be used both behaviorally and electrophysiologically to estimate spectral-ripple threshold. In experiment 1, behavioral thresholds obtained using the single-interval method were compared to thresholds obtained using a previously established three-alternative forced-choice method. A significant correlation was found (r = 0.84, p = 0.0002) in 14 adult CI users. The spectral-ripple threshold obtained using the new method also correlated with speech perception in quiet and noise. In experiment 2, the effect of the number of vocoder-processing channels on the behavioral and physiological threshold in normal-hearing listeners was determined. Behavioral thresholds, using the new single-interval method, as well as cortical P1-N1-P2 responses changed as a function of the number of channels. Better behavioral and physiological performance (i.e., better discrimination ability at higher ripple densities) was observed as more channels added. In experiment 3, the relationship between behavioral and physiological data was examined. Amplitudes of the P1-N1-P2 "change" responses were significantly correlated with d' values from the single-interval behavioral procedure. Results suggest that the single-interval procedure with spectral-ripple phase inversion in ongoing stimuli is a valid approach for measuring behavioral or physiological spectral resolution.

Probing the electrode-neuron interface with focused cochlear implant stimulation

Cochlear implants are highly successful neural prostheses for persons with severe or profound hearing loss who gain little benefit from hearing aid amplification. Although implants are capable of providing important spectral and temporal cues for speech perception, performance on speech tests is variable across listeners. Psychophysical measures obtained from individual implant subjects can also be highly variable across implant channels. This review discusses evidence that such variability reflects deviations in the electrode-neuron interface, which refers to an implant channel's ability to effectively stimulate the auditory nerve. It is proposed that focused electrical stimulation is ideally suited to assess channel-to-channel irregularities in the electrode-neuron interface. In implant listeners, it is demonstrated that channels with relatively high thresholds, as measured with the tripolar configuration, exhibit broader psychophysical tuning curves and smaller dynamic ranges than channels with relatively low thresholds. Broader tuning implies that frequency-specific information intended for one population of neurons in the cochlea may activate more distant neurons, and a compressed dynamic range could make it more difficult to resolve intensity-based information, particularly in the presence of competing noise. Degradation of both types of cues would negatively affect speech perception.