Psychophysical studies for two multiple-channel cochlear implant patients

A Hundred Ways to Encode Sound Signals for Cochlear Implants

Cochlear implants are the most successful neural prostheses used to restore hearing in severe-to-profound hearing-impaired individuals. The field of cochlear implant coding investigates interdisciplinary approaches to translate acoustic signals into electrical pulses transmitted at the electrode-neuron interface, ranging from signal preprocessing algorithms, enhancement, and feature extraction methodologies to electric signal generation. In the last five decades, numerous coding strategies have been proposed clinically and experimentally. Initially developed to restore speech perception, increasing computational possibilities now allow coding of more complex signals, and new techniques to optimize the transmission of electrical signals are constantly gaining attention. This review provides insights into the history of multichannel coding and presents an extensive list of implemented strategies. The article briefly addresses each method and considers promising future directions of neural prostheses and possible signal processing, with the ultimate goal of providing a current big picture of the large field of cochlear implant coding.

Limitations on Temporal Processing by Cochlear Implant Users: A Compilation of Viewpoints

Cochlear implant (CI) users are usually poor at using timing information to detect changes in either pitch or sound location. This deficit occurs even for listeners with good speech perception and even when the speech processor is bypassed to present simple, idealized stimuli to one or more electrodes. The present article presents seven expert opinion pieces on the likely neural bases for these limitations, the extent to which they are modifiable by sensory experience and training, and the most promising ways to overcome them in future. The article combines insights from physiology and psychophysics in cochlear-implanted humans and animals, highlights areas of agreement and controversy, and proposes new experiments that could resolve areas of disagreement.

Comparison of Tonotopic and Default Frequency Fitting for Speech Understanding in Noise in New Cochlear Implantees: A Prospective, Randomized, Double-Blind, Cross-Over Study

OBJECTIVES

While cochlear implants (CIs) have provided benefits for speech recognition in quiet for subjects with severe-to-profound hearing loss, speech recognition in noise remains challenging. A body of evidence suggests that reducing frequency-to-place mismatch may positively affect speech perception. Thus, a fitting method based on a tonotopic map may improve speech perception results in quiet and noise. The aim of our study was to assess the impact of a tonotopic map on speech perception in noise and quiet in new CI users.

DESIGN

A prospective, randomized, double-blind, two-period cross-over study in 26 new CI users was performed over a 6-month period. New CI users older than 18 years with bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on the Greenwood function. Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Each setting was maintained for 6 weeks, at the end of which participants performed speech perception tasks. The primary outcome measure was speech recognition in noise. Participants were allocated to sequences by block randomization of size two with a ratio 1:1 (CONSORT Guidelines). Participants and those assessing the outcomes were blinded to the intervention.

RESULTS

Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (one in each sequence) had to be excluded due to the COVID-19 pandemic. Twenty-four participants were analyzed. Speech recognition in noise was significantly better with the tonotopic fitting at all signal-to-noise ratio (SNR) levels tested [SNR = +9 dB, p = 0.002, mean effect (ME) = 12.1%, 95% confidence interval (95% CI) = 4.9 to 19.2, standardized effect size (SES) = 0.71; SNR = +6 dB, p < 0.001, ME = 16.3%, 95% CI = 9.8 to 22.7, SES = 1.07; SNR = +3 dB, p < 0.001 ME = 13.8%, 95% CI = 6.9 to 20.6, SES = 0.84; SNR = 0 dB, p = 0.003, ME = 10.8%, 95% CI = 4.1 to 17.6, SES = 0.68]. Neither period nor interaction effects were observed for any signal level. Speech recognition in quiet ( p = 0.66) and tonal audiometry ( p = 0.203) did not significantly differ between the two settings. 92% of the participants kept the tonotopy-based map after the study period. No correlation was found between speech-in-noise perception and age, duration of hearing deprivation, angular insertion depth, or position or width of the frequency filters allocated to the electrodes.

CONCLUSION

For new CI users, tonotopic fitting appears to be more efficient than the default frequency fitting because it allows for better speech recognition in noise without compromising understanding in quiet.

Combining Place and Rate of Stimulation Improves Frequency Discrimination in Cochlear Implant Users

In the auditory system, frequency is represented as tonotopic and temporal response properties of the auditory nerve. While these response properties are inextricably linked in normal hearing, cochlear implants can separately excite tonotopic location and temporal synchrony using different electrodes and stimulation rates, respectively. This separation allows for the investigation of the contributions of tonotopic and temporal cues for frequency discrimination. The present study examines frequency discrimination in adult cochlear implant users as conveyed by electrode position and stimulation rate, separately and combined. The working hypothesis is that frequency discrimination is better provided by place and rate cues combined compared to either cue alone. This hypothesis was tested in two experiments. In the first experiment, frequency discrimination needed for melodic contour identification was measured for frequencies near 100, 200, and 400 Hz using frequency allocation modeled after clinical processors. In the second experiment, frequency discrimination for pitch ranking was measured for frequencies between 100 and 1600 Hz using an experimental frequency allocation designed to provide better access to place cues. The results of both experiments indicate that frequency discrimination is better with place and rate cues combined than with either cue alone. These results clarify how signal processing for cochlear implants could better encode frequency into place and rate of electrical stimulation. Further, the results provide insight into the contributions of place and rate cues for pitch.

Computational Modeling of Synchrony in the Auditory Nerve in Response to Acoustic and Electric Stimulation

Cochlear implants are medical devices that provide hearing to nearly one million people around the world. Outcomes are impressive with most recipients learning to understand speech through this new way of hearing. Music perception and speech reception in noise, however, are notably poor. These aspects of hearing critically depend on sensitivity to pitch, whether the musical pitch of an instrument or the vocal pitch of speech. The present article examines cues for pitch perception in the auditory nerve based on computational models. Modeled neural synchrony for pure and complex tones is examined for three different electric stimulation strategies including Continuous Interleaved Sampling (CIS), High-Fidelity CIS (HDCIS), and Peak-Derived Timing (PDT). Computational modeling of current spread and neuronal response are used to predict neural activity to electric and acoustic stimulation. It is shown that CIS does not provide neural synchrony to the frequency of pure tones nor to the fundamental component of complex tones. The newer HDCIS and PDT strategies restore synchrony to both the frequency of pure tones and to the fundamental component of complex tones. Current spread reduces spatial specificity of excitation as well as the temporal fidelity of neural synchrony, but modeled neural excitation restores precision of these cues. Overall, modeled neural excitation to electric stimulation that incorporates temporal fine structure (e.g., HDCIS and PDT) indicates neural synchrony comparable to that provided by acoustic stimulation. Discussion considers the importance of stimulation rate and long-term rehabilitation to provide temporal cues for pitch perception.

Anatomy-Based Frequency Allocation in Cochlear Implantation: The Importance of Cochlear Coverage

OBJECTIVES/HYPOTHESIS

This study aimed to compare the predicted anatomy-based frequency allocation of cochlear implant electrodes with the default standard frequencies.

STUDY DESIGN

Retrospective study.

METHODS

A retrospective analysis was performed using computed tomography (CT) images of patients who received cochlear implants at a tertiary referral center. Patients were excluded if they had any congenital or acquired cochlear anatomical anomalies. The CT images of the patients were uploaded to the surgical planning software. Two independent reviewers allocated the anatomical parameters of the cochlea. The software then used these parameters to calculate the frequency allocation for each electrode according to the type of electrode and the length of the organ of Corti (OC) in each patient. These anatomy-based frequency allocations were compared with the default frequency settings.

MAIN OUTCOME MEASURE

Frequency-to-place mismatch in semitones.

RESULTS

A total of 169 implanted ears in 102 patients were included in this study. The readings of the two reviewers were homogenous, with a Cronbach's alpha of 0.98. The mean anatomy-based frequency allocation was 487.3 ± 202.9 Hz in electrode 1; 9,298.6 ± 490.6 Hz in electrode 12. The anatomy-based frequency allocations were found to be significantly higher than the frequencies of the default frequencies for each corresponding electrode (one-sample t-test, P < .001). The frequency-to-place mismatch was negatively correlated with cochlear coverage and positively correlated with the cochlear duct length (Pearson correlation > 0.65, P < .003).

CONCLUSIONS

The anatomy-based frequency allocation of each electrode is significantly different from the default frequency setting. This frequency-to-place mismatch was affected mainly by the cochlear coverage.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Perceptual learning of pitch provided by cochlear implant stimulation rate

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

Auditory Stream Segregation and Selective Attention for Cochlear Implant Listeners: Evidence From Behavioral Measures and Event-Related Potentials

The role of the spatial separation between the stimulating electrodes (electrode separation) in sequential stream segregation was explored in cochlear implant (CI) listeners using a deviant detection task. Twelve CI listeners were instructed to attend to a series of target sounds in the presence of interleaved distractor sounds. A deviant was randomly introduced in the target stream either at the beginning, middle or end of each trial. The listeners were asked to detect sequences that contained a deviant and to report its location within the trial. The perceptual segregation of the streams should, therefore, improve deviant detection performance. The electrode range for the distractor sounds was varied, resulting in different amounts of overlap between the target and the distractor streams. For the largest electrode separation condition, event-related potentials (ERPs) were recorded under active and passive listening conditions. The listeners were asked to perform the behavioral task for the active listening condition and encouraged to watch a muted movie for the passive listening condition. Deviant detection performance improved with increasing electrode separation between the streams, suggesting that larger electrode differences facilitate the segregation of the streams. Deviant detection performance was best for deviants happening late in the sequence, indicating that a segregated percept builds up over time. The analysis of the ERP waveforms revealed that auditory selective attention modulates the ERP responses in CI listeners. Specifically, the responses to the target stream were, overall, larger in the active relative to the passive listening condition. Conversely, the ERP responses to the distractor stream were not affected by selective attention. However, no significant correlation was observed between the behavioral performance and the amount of attentional modulation. Overall, the findings from the present study suggest that CI listeners can use electrode separation to perceptually group sequential sounds. Moreover, selective attention can be deployed on the resulting auditory objects, as reflected by the attentional modulation of the ERPs at the group level.

Evaluation of a Two-Formant Speech-Processing Strategy for a Multichannel Cochlear Prosthesis

Initial results with the two-formant speech-processing strategy (F0F1F2) confirm the advantage of a multichannel cochlear prosthesis capable of stimulating at different sites within the cochlea. The successful presentation of two spectra] components by varying the place of stimulation leads to the possibility of presenting further spectral information in this manner. Because virtually all multichannel implant patients demonstrate good “place” (electrode site) discrimination, these more refined coding strategies should lead to benefits for the majority of implantees. Already, with the F0F1F2 strategy, we have a system that appears to provide some effective auditory-alone communication ability for the average patient.

Responses of Cat Auditory Nerve Fibers to Biphasic Electrical Current Pulses

Discharge patterns of single auditory nerve fibers were recorded from normal-hearing cats implanted with a 12-band intracochlear electrode array. Stimuli were biphasic current pulses of specifiable width, amplitude, and rate. Acoustic tuning curves were obtained to determine the cochlear positions of the fibers. Response latencies to electrical stimuli formed two groups. Short latency (0.3 to 0.7 ms) responses were attributed to direct activation of spiral ganglion neurons. At high stimulus intensities, these often exhibited abrupt shifts toward even shorter latencies. Long latency (> 1.5 ms) responses were probably caused by electrophonic activation of functional hair cells. Response thresholds to electrical stimuli depended on a fiber's proximity to the stimulating electrodes, and they did not depend on a fiber's acoustic response threshold or spontaneous discharge rate. High intensity (> 1.5 mA) stimuli could excite fibers over a wide range of characteristic frequencies, even for the narrowest (0.45 mm) electrode separations. Response threshold was an exponentially decreasing function of pulse width for widths up to 300 μs/phase. Fiber discharges were highly phase-locked at all suprathreshold intensities, and saturation discharge rates usually equaled stimulus pulse rates for rates up to at least 800 pulses/s. Dynamic ranges were small (1 to 6 dB), increased with pulse rate, and were uncorrelated with electrical response threshold. Within the dynamic range, shapes of poststimulus time and interspike interval histograms resembled those obtained in response to acoustic stimuli. Depolarization block caused fiber activity to cease in 2 to 5 seconds for sustained stimuli presented at high (> 600 pulses/s) pulse rates and intensities.

Comparison of Two Cochlear Implant Speech-Processing Strategies

Speech processors extracting either the fundamental frequency (F0) alone, or the fundamental frequency combined with second formant information (F0-F2), have been evaluated on a totally deaf patient using a multiple-channel cochlear implant. A closed set test using 16 spondees and a modified rhyme test showed that for electrical stimulation alone the F0-F2 speech processor was significantly better than the F0 processor. The open set tests using phonetically balanced words and Central Institute for the Deaf everyday sentences showed that for electrical stimulation alone and electrical stimulation combined with lipreading, the results with the F0-F2 speech processor were all significantly better than with the F0 processor. Information transmission for consonant speech features was also better when using the F0-F2 processor.

Deficits in the Sensitivity to Pitch Sweeps by School-Aged Children Wearing Cochlear Implants

Sensitivity to static changes in pitch has been shown to be poorer in school-aged children wearing cochlear implants (CIs) than children with normal hearing (NH), but it is unclear whether this is also the case for dynamic changes in pitch. Yet, dynamically changing pitch has considerable ecological relevance in terms of natural speech, particularly aspects such as intonation, emotion, or lexical tone information. Twenty one children with NH and 23 children wearing a CI participated in this study, along with 18 NH adults and 6 CI adults for comparison. Listeners with CIs used their clinically assigned settings with envelope-based coding strategies. Percent correct was measured in one- or three-interval two-alternative forced choice tasks, for the direction or discrimination of harmonic complexes based on a linearly rising or falling fundamental frequency. Sweep rates were adjusted per subject, in a logarithmic scale, so as to cover the full extent of the psychometric function. Data for up- and down-sweeps were fitted separately, using a maximum-likelihood technique. Fits were similar for up- and down-sweeps in the discrimination task, but diverged in the direction task because psychometric functions for down-sweeps were very shallow. Hits and false alarms were then converted into d′ and beta values, from which a threshold was extracted at a d′ of 0.77. Thresholds were very consistent between the two tasks and considerably higher (worse) for CI listeners than for their NH peers. Thresholds were also higher for children than adults. Factors such as age at implantation, age at profound hearing loss, and duration of CI experience did not play any major role in this sensitivity. Thresholds of dynamic pitch sensitivity (in either task) also correlated with thresholds for static pitch sensitivity and with performance in tasks related to speech prosody.

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.

Limitations on Monaural and Binaural Temporal Processing in Bilateral Cochlear Implant Listeners

Monaural rate discrimination and binaural interaural time difference (ITD) discrimination were studied as functions of pulse rate in a group of bilaterally implanted cochlear implant users. Stimuli for the rate discrimination task were pulse trains presented to one electrode, which could be in the apical, middle, or basal part of the array, and in either the left or the right ear. In each two-interval trial, the standard stimulus had a rate of 100, 200, 300, or 500 pulses per second and the signal stimulus had a rate 35 % higher. ITD discrimination between pitch-matched electrode pairs was measured for the same standard rates as in the rate discrimination task and with an ITD of +/− 500 μs. Sensitivity (d′) on both tasks decreased with increasing rate, as has been reported previously. This study tested the hypothesis that deterioration in performance at high rates occurs for the two tasks due to a common neural basis, specific to the stimulation of each electrode. Results show that ITD scores for different pairs of electrodes correlated with the lower rate discrimination scores for those two electrodes. Statistical analysis, which partialed out overall differences between listeners, electrodes, and rates, supports the hypothesis that monaural and binaural temporal processing limitations are at least partly due to a common mechanism.

Toward more versatile and intuitive cortical brain-machine interfaces

Brain-machine interfaces have great potential for the development of neuroprosthetic applications to assist patients suffering from brain injury or neurodegenerative disease. One type of brain-machine interface is a cortical motor prosthetic, which is used to assist paralyzed subjects. Motor prosthetics to date have typically used the motor cortex as a source of neural signals for controlling external devices. The review will focus on several new topics in the arena of cortical prosthetics. These include using: recordings from cortical areas outside motor cortex; local field potentials as a source of recorded signals; somatosensory feedback for more dexterous control of robotics; and new decoding methods that work in concert to form an ecology of decode algorithms. These new advances promise to greatly accelerate the applicability and ease of operation of motor prosthetics.

The multi-channel cochlear implant: multi-disciplinary development of electrical stimulation of the cochlea and the resulting clinical benefit

This multi-disciplinary research showed sound could be coded by electrical stimulation of the cochlea and peripheral auditory nervous system. But the temporal coding of frequency as seen in the experimental animal, was inadequate for the important speech frequencies. The data indicated the limitation was due in particular to deterministic firing of neurons and failure to reproduce the normal fine temporo-spatial pattern of neural responses seen with sound. However, the data also showed the need for the place coding of frequency, and this meant multi-electrodes inserted into the cochlea. Nevertheless, before this was evaluated on people we undertook biological safety studies to determine the effects of surgical trauma and electrical stimuli, and how to prevent infection. Then our research demonstrated place of stimulation had timbre and was perceived as vowels. This led to our discovery in 1978 of the formant-extraction speech code that first enabled severely-profoundly deaf people to understand running speech. This result in people who had hearing before becoming severely deaf was an outcome not previously considered possible. In 1985 it was the first multi-channel implant to be approved by the US Food and Drug Administration (FDA). It was also the fore runner of our advanced formant and fixed filter strategies When these codes were used from 1985 for those born deaf or deafened early in life we discovered there was a critical period when brain plasticity would allow speech perception and language to be developed near- normally, and this required in particular the acquisition of place coding. In 1990 this led to the first cochlear implant to be approved by the FDA for use in children. Finally, we achieved binaural hearing in 1989 with bilateral cochlear implants, followed by bimodal speech processing in 1990 with a hearing aid in one ear and implant in the other. The above research has been developed industrially, with for example 250,000 people worldwide receiving the Cochlear device in 2013, and as of December 2012 the NIH estimated that approximately 324,200 people worldwide had received this and other implants (NIH Publication No. 11-4798). This article is part of a Special Issue entitled <Lasker Award>.

Is there a fundamental 300 Hz limit to pulse rate discrimination in cochlear implants?

Literature often refers to a 300 pps limit for cochlear implant (CI) electrical stimulation, above which pulse rate discrimination deteriorates or above which rate pitch is not perceived to increase. The present study investigated the effect on pulse rate difference limens (PRDLs) when using compound stimuli in which identical pulse trains were applied to multiple electrodes across the length of the electrode array and compared the results to those of single-electrode stimuli. PRDLs of seven CI users were determined in two stimulus pulse phase conditions, one in which the phase delays between pulses on different electrodes were minimised (burst mode) and a second in which they were maximised (spread mode). PRDLs were measured at base rates of 100 to 600 pps in 100 pps intervals, using compound stimuli on one, two, five, nine and 18 electrodes. As smaller PRDLs were expected to reflect improved rate pitch perception, 18-electrode spread mode stimuli were also included in a pitch ranking task. PRDLs improved markedly when multi-electrode compound stimuli were used, with average spread mode PRDLs across listeners between 6 and 8 % of the base rate in the whole range tested (i.e. up to 600 pps). PRDLs continued to improve as more electrodes were included, up to at least nine electrodes in the compound stimulus. Stimulus pulse phase had a significant influence on the results, with PRDLs being smaller in spread mode. Results indicate that pulse rate discrimination may be manipulated with stimulus parameter choice so that previously observed deterioration of PRDLs at 300 pps probably does not reflect a fundamental limitation to rate discrimination. However, rate pitch perception did not improve in the conditions that resulted in smaller PRDLs. This may indicate that listeners used cues other than pitch to perform the rate discrimination task or may reflect limitations in the electrically evoked neural excitation patterns presented to a rate pitch extraction mechanism.

Biomedical studies on temporal bones of the first multi-channel cochlear implant patient at the University of Melbourne

OBJECTIVE

To analyse the temporal bones and implant of the first University of Melbourne's (UOM) patient (MC-1) to receive the multi-channel cochlear prosthesis.

METHODS

The left cochlea was implanted with the prototype multi-channel cochlear prosthesis on 1 August 1978, and the Cochlear versions CI-22 and CI-24 on 22 June 1983 and 10 November 1998, respectively. MC-1 died in 2007.

RESULTS

Plain X-rays of the temporal bones showed that after the CI-22 had been explanted seven electrode bands remained in situ. Micro-CT scans also revealed a partially united fracture transecting the left implanted and right control cochleae. Histology indicated a total loss of the organ of Corti on both sides, and a tear of the left basilar membrane. In addition, there was a dense fibrous capsule with heterotopic bone surrounding one proximal band of the CI-22 array that restricted its removal. This pathology was associated with dark particulate material within macrophages, probably due to the release of platinum from the electrode bands. Scanning electron microscopy (SEM) showed possible corrosion of platinum and surface roughening. Three-dimensional reconstruction of the cochlear histology demonstrated the position of the electrode tracts (C1-22 and CI-24) in relation to the spiral ganglion, which showed 85-90% loss of ganglion cells.

DISCUSSION AND CONCLUSIONS

This study confirms our first histopathological findings that our first free-fitting banded electrode array produced moderate trauma to the cochlea when inserted around the scala tympani of the basal turn. The difficulty in extraction was most likely due to one band being surrounded by an unusually large amount of fibrous tissue and bone, with an electrode band caught due to surface irregularities. Some surface corrosion and a small degree of platinum deposition in the tissue may also help explain the outcome for this long-term cochlear implantation.

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.

Training improves cochlear implant rate discrimination on a psychophysical task

The purpose of this study was to determine the extent to which cochlear implant (CI) rate discrimination can be improved through training. Six adult CI users took part in a study that included 32 h of training and assessment on rate discrimination measures. Rate difference limens (DLs) were measured from 110 to 3520 Hz in octave steps using 500 ms biphasic pulse trains; the target and standard stimuli were loudness-balanced with the target always at an adaptively lower rate. DLs were measured at four electrode positions corresponding to basal, mid-basal, mid-apical, and apical locations. Procedural variations were implemented to determine if rate discrimination was impacted by random variations in stimulus amplitude or by amplitude modulation. DLs improved by more than a factor of 2 across subjects, electrodes, and standard rates. Factor analysis indicated that the effect of training was comparable for all electrodes and standard rates tested. Neither level roving nor amplitude modulation had a significant effect on rate DLs. In conclusion, the results demonstrate that training can significantly improve CI rate discrimination on a psychophysical task.

The effect of visual cues on difficulty ratings for segregation of musical streams in listeners with impaired hearing

Background

Enjoyment of music is an important part of life that may be degraded for people with hearing impairments, especially those using cochlear implants. The ability to follow separate lines of melody is an important factor in music appreciation. This ability relies on effective auditory streaming, which is much reduced in people with hearing impairment, contributing to difficulties in music appreciation. The aim of this study was to assess whether visual cues could reduce the subjective difficulty of segregating a melody from interleaved background notes in normally hearing listeners, those using hearing aids, and those using cochlear implants.

Methodology/Principal Findings

Normally hearing listeners (N = 20), hearing aid users (N = 10), and cochlear implant users (N = 11) were asked to rate the difficulty of segregating a repeating four-note melody from random interleaved distracter notes. The pitch of the background notes was gradually increased or decreased throughout blocks, providing a range of difficulty from easy (with a large pitch separation between melody and distracter) to impossible (with the melody and distracter completely overlapping). Visual cues were provided on half the blocks, and difficulty ratings for blocks with and without visual cues were compared between groups. Visual cues reduced the subjective difficulty of extracting the melody from the distracter notes for normally hearing listeners and cochlear implant users, but not hearing aid users.

Conclusion/Significance

Simple visual cues may improve the ability of cochlear implant users to segregate lines of music, thus potentially increasing their enjoyment of music. More research is needed to determine what type of acoustic cues to encode visually in order to optimise the benefits they may provide.

Effects of extreme tonotopic mismatches between bilateral cochlear implants on electric pitch perception: a case study

OBJECTIVES

Recent studies suggest that pitch perceived through cochlear implants (CIs) changes with experience to minimize spectral mismatches between electric and acoustic hearing. This study aimed to test whether perceived spectral mismatches are similarly minimized between two electric inputs.

DESIGN

Pitch perception was studied in a subject with a 10-mm CI in one ear and a 24-mm CI in the other ear. Both processors were programmed to allocate information from the same frequency range of 188-7938 Hz, despite the large differences in putative insertion depth and stimulated cochlear locations between the CIs.

RESULTS

After 2 and 3 years of experience, pitch-matched electrode pairs between CIs were aligned closer to the processor-provided frequencies than to cochlear position.

CONCLUSIONS

Pitch perception may have adapted to reduce perceived spectral discrepancies between bilateral CI inputs, despite 2-3 octave differences in tonotopic mapping.

Effects of stimulation rate on modulation detection and speech recognition by cochlear implant users

OBJECTIVE

This study investigated the effect of low to moderate electrical stimulation rates (275, 350, 500 and 900 pps/ch) on modulation detection ability of cochlear implant subjects, and the relationship between modulation detection and speech perception as a function of rate.

DESIGN

A repeated ABCD experimental design for the four rate conditions was employed. A sinusoidally amplitude modulated acoustic signal was presented to the audio input of a research processor. Stimuli were presented at an acoustic level that produced electrical levels close to the subjects' most comfortable level (MCL) of stimulation and at an acoustic level 20 dB below this.

STUDY SAMPLE

Ten postlingually deaf adult users of the Nucleus CI24 cochlear implant participated.

RESULTS

Acoustic modulation detection thresholds (MDTs), averaged across the subject group, were significantly better for rates of 500 pps/ch compared to the other rates examined for stimuli presented at MCL. In addition, there was a significant relation between speech perception in noise and acoustic MDTs at MCL.

CONCLUSIONS

The benefits obtained in speech perception and modulation detection as a function of rate were attributed to an increased electrical dynamic range as a function of stimulation rate, at least for rates up to 500 pps/ch.

Effects of stimulus duration on amplitude modulation processing with cochlear implants

This study investigated temporal integration processes underlying cochlear implant (CI) users' amplitude modulation processing. Thresholds for modulation detection (AMDTs) and modulation frequency discrimination (AMFDTs) were measured for 50-, 100-, and 200-Hz modulation frequencies with stimulus durations from 50 to 400 ms in eight adult CI users. The results showed significant interactions between modulation frequency and stimulus duration for AMDTs and AMFDTs. The data suggest that temporal integration limits CI users' sensitivity to low temporal pitch over short durations, and that temporal integration over longer durations may not enhance CI users' sensitivity to high temporal pitch.

Investigating the effects of stimulus duration and context on pitch perception by cochlear implant users

Cochlear implant sound processing strategies that use time-varying pulse rates to transmit fine structure information are one proposed method for improving the spectral representation of a sound with the eventual goal of improving speech recognition in noisy conditions, speech recognition in tonal languages, and music identification and appreciation. However, many of the perceptual phenomena associated with time-varying rates are not well understood. In this study, the effects of stimulus duration on both the place and rate-pitch percepts were investigated via psychophysical experiments. Four Nucleus CI24 cochlear implant users participated in these experiments, which included a short-duration pitch ranking task and three adaptive pulse rate discrimination tasks. When duration was fixed from trial-to-trial and rate was varied adaptively, results suggested that both the place-pitch and rate-pitch percepts may be independent of duration for durations above 10 and 20 ms, respectively. When duration was varied and pulse rates were fixed, performance was highly variable within and across subjects. Implications for multi-rate sound processing strategies are discussed.

Frequency modulation detection with simultaneous amplitude modulation by cochlear implant users

To better represent fine structure cues in cochlear implants (CIs), recent research has proposed varying the stimulation rate based on slowly varying frequency modulation (FM) information. The present study investigated the abilities of CI users to detect FM with simultaneous amplitude modulation (AM). FM detection thresholds (FMDTs) for 10-Hz sinusoidal FM and upward frequency sweeps were measured as a function of standard frequency (75-1000 Hz). Three AM conditions were tested, including (1) No AM, (2) 20-Hz Sinusoidal AM (SAM) with modulation depths of 10%, 20%, or 30%, and (3) Noise AM (NAM), in which the amplitude was randomly and uniformly varied over a range of 1, 2, or 3 dB, relative to the reference amplitude. Results showed that FMDTs worsened with increasing standard frequencies, and were lower for sinusoidal FM than for upward frequency sweeps. Simultaneous AM significantly interfered with FM detection; FMDTs were significantly poorer with simultaneous NAM than with SAM. Besides, sinusoidal FMDTs significantly worsened when the starting phase of simultaneous SAM was randomized. These results suggest that FM and AM in CI partly share a common loudness-based coding mechanism and the feasibility of "FM+AM" strategies for CI speech processing may be limited.

Melodic contour identification by cochlear implant listeners

OBJECTIVE

While the cochlear implant provides many deaf patients with good speech understanding in quiet, music perception and appreciation with the cochlear implant remains a major challenge for most cochlear implant users. The present study investigated whether a closed-set melodic contour identification (MCI) task could be used to quantify cochlear implant users' ability to recognize musical melodies and whether MCI performance could be improved with moderate auditory training. The present study also compared MCI performance with familiar melody identification (FMI) performance, with and without MCI training.

METHODS

For the MCI task, test stimuli were melodic contours composed of 5 notes of equal duration whose frequencies corresponded to musical intervals. The interval between successive notes in each contour was varied between 1 and 5 semitones; the "root note" of the contours was also varied (A3, A4, and A5). Nine distinct musical patterns were generated for each interval and root note condition, resulting in a total of 135 musical contours. The identification of these melodic contours was measured in 11 cochlear implant users. FMI was also evaluated in the same subjects; recognition of 12 familiar melodies was tested with and without rhythm cues. MCI was also trained in 6 subjects, using custom software and melodic contours presented in a different frequency range from that used for testing.

RESULTS

Results showed that MCI recognition performance was highly variable among cochlear implant users, ranging from 14% to 91% correct. For most subjects, MCI performance improved as the number of semitones between successive notes was increased; performance was slightly lower for the A3 root note condition. Mean FMI performance was 58% correct when rhythm cues were preserved and 29% correct when rhythm cues were removed. Statistical analyses revealed no significant correlation between MCI performance and FMI performance (with or without rhythmic cues). However, MCI performance was significantly correlated with vowel recognition performance; FMI performance was not correlated with cochlear implant subjects' phoneme recognition performance. Preliminary results also showed that the MCI training improved all subjects' MCI performance; the improved MCI performance also generalized to improved FMI performance.

CONCLUSIONS

Preliminary data indicate that the closed-set MCI task is a viable approach toward quantifying an important component of cochlear implant users' music perception. The improvement in MCI performance and generalization to FMI performance with training suggests that MCI training may be useful for improving cochlear implant users' music perception and appreciation; such training may be necessary to properly evaluate patient performance, as acute measures may underestimate the amount of musical information transmitted by the cochlear implant device and received by cochlear implant listeners.

Changes in pitch with a cochlear implant over time

In the normal auditory system, the perceived pitch of a tone is closely linked to the cochlear place of vibration. It has generally been assumed that high-rate electrical stimulation by a cochlear implant electrode also evokes a pitch sensation corresponding to the electrode's cochlear place ("place" code) and stimulation rate ("temporal" code). However, other factors may affect electric pitch sensation, such as a substantial loss of nearby nerve fibers or even higher-level perceptual changes due to experience. The goals of this study were to measure electric pitch sensations in hybrid (short-electrode) cochlear implant patients and to examine which factors might contribute to the perceived pitch. To look at effects of experience, electric pitch sensations were compared with acoustic tone references presented to the non-implanted ear at various stages of implant use, ranging from hookup to 5 years. Here, we show that electric pitch perception often shifts in frequency, sometimes by as much as two octaves, during the first few years of implant use. Additional pitch measurements in more recently implanted patients at shorter time intervals up to 1 year of implant use suggest two likely contributions to these observed pitch shifts: intersession variability (up to one octave) and slow, systematic changes over time. We also found that the early pitch sensations for a constant electrode location can vary greatly across subjects and that these variations are strongly correlated with speech reception performance. Specifically, patients with an early low-pitch sensation tend to perform poorly with the implant compared to those with an early high-pitch sensation, which may be linked to less nerve survival in the basal end of the cochlea in the low-pitch patients. In contrast, late pitch sensations show no correlation with speech perception. These results together suggest that early pitch sensations may more closely reflect peripheral innervation patterns, while later pitch sensations may reflect higher-level, experience-dependent changes. These pitch shifts over time not only raise questions for strict place-based theories of pitch perception, but also imply that experience may have a greater influence on cochlear implant perception than previously thought.

The multiple-channel cochlear implant: the interface between sound and the central nervous system for hearing, speech, and language in deaf people-a personal perspective

The multiple-channel cochlear implant is the first sensori-neural prosthesis to effectively and safely bring electronic technology into a direct physiological relation with the central nervous system and human consciousness, and to give speech perception to severely-profoundly deaf people and spoken language to children. Research showed that the place and temporal coding of sound frequencies could be partly replicated by multiple-channel stimulation of the auditory nerve. This required safety studies on how to prevent the effects to the cochlea of trauma, electrical stimuli, biomaterials and middle ear infection. The mechanical properties of an array and mode of stimulation for the place coding of speech frequencies were determined. A fully implantable receiver-stimulator was developed, as well as the procedures for the clinical assessment of deaf people, and the surgical placement of the device. The perception of electrically coded sounds was determined, and a speech processing strategy discovered that enabled late-deafened adults to comprehend running speech. The brain processing systems for patterns of electrical stimuli reproducing speech were elucidated. The research was developed industrially, and improvements in speech processing made through presenting additional speech frequencies by place coding. Finally, the importance of the multiple-channel cochlear implant for early deafened children was established.

Electromotile hearing: acoustic tones mask psychophysical response to high-frequency electrical stimulation of intact guinea pig cochleae

When sinusoidal electric stimulation is applied to the intact cochlea, a frequency-specific acoustic emission can be recorded in the ear canal. Acoustic emissions are produced by basilar membrane motion, and have been used to suggest a corresponding acoustic sensation termed "electromotile hearing." Electromotile hearing has been specifically attributed to electric stimulation of outer hair cells in the intact organ of Corti. To determine the nature of the auditory perception produced by electric stimulation of a cochlea with intact outer hair cells, guinea pigs were tested in a psychophysical task. First, subjects were trained to report detection of sinusoidal acoustic stimuli and dynamic range was assessed using response latency. Subjects were then implanted with a ball electrode placed into scala tympani. Following the surgical implant procedure, subjects were transferred to a task in which acoustic signals were replaced by sinusoidal electric stimulation, and dynamic range was assessed again. Finally, the ability of acoustic pure-tone stimuli to mask the detection of the electric signals was assessed. Based on the masking effects, it is concluded that sinusoidal electric stimulation of the intact cochlea results in perception of a tonal (rather than a broadband or noisy) sound at a frequency of 8 kHz or above.

Sensitivity to isolated and concurrent intensity and fundamental frequency increments by cochlear implant users under natural listening conditions

Sensitivity to acoustic cues in cochlear implant (CI) listening under natural conditions is a potentially complex interaction between a number of simultaneous factors, and may be difficult to predict. In the present study, sensitivity was measured under conditions that approximate those of natural listening. Synthesized words having increases in intensity or fundamental frequency (F0) in a middle stressed syllable were presented in soundfield to normal-hearing listeners and to CI listeners using their everyday speech processors and programming. In contrast to the extremely fine sensitivity to electrical current observed when direct stimulation of single electrodes is employed, difference limens (DLs) for intensity were larger for the CI listeners by a factor of 2.4. In accord with previous work, F0 DLs were larger by almost one order of magnitude. In a second experiment, it was found that the presence of concurrent intensity and F0 increments reduced the mean DL to half that of either cue alone for both groups of subjects, indicating that both groups combine concurrent cues with equal success. Although sensitivity to either cue in isolation was not related to word recognition in CI users, the listeners having lower combined-cue thresholds produced better word recognition scores.

Effects of Stimulation Rate on Speech Recognition with Cochlear Implants

Phoneme and speech recognition were measured as a function of stimulation pulse rate in 12 listeners with three types of cochlear implants. Identification of consonants and vowels and recognition of words and sentences were measured in 5 Clarion C1 subjects fit with continuous interleaved sampling (CIS) processors having 4 or 8 electrodes, 4 Nucleus 24 subjects fit with CIS processors having 4, 8, 12 or 16 electrodes and 3 Clarion C2 subjects fit with CIS processors with 4, 8, 12 and 16 electrodes. Stimulation rates ranged from 200 to more than 5000 Hz per electrode, depending on the device, number of electrodes used and stimulation strategy. Listeners were also tested on the same materials with their original processor prior to receiving the experimental processors. All testing was done in quiet listening conditions with essentially no practice with the experimental processor prior to data collection. Listeners scored the highest with their original processor. Little difference in speech understanding was observed for listener scores with processors using different stimulation rates. Speech recognition was significantly poorer only at the lowest stimulation rate and at high rates that used noninterleaved pulses. Speech recognition was similar for processors using 8, 12 or 16 electrodes. Only 4-electrode processors produced a significantly poorer performance. These results suggest that patients with present commercial implants are not able to make full use of the number of channels of spectral information delivered by the present speech processors. In addition, the results show no significant change in performance as a function of stimulation rate, suggesting that high stimulation rates do not result in improved access to temporal cues in speech, at least under quiet listening conditions.

Relative contributions of temporal and place pitch cues to fundamental frequency discrimination in cochlear implantees

The effect of the filter bank on fundamental frequency (F0) discrimination was examined in four Nucleus CI24 cochlear implant subjects for synthetic stylized vowel-like stimuli. The four tested filter banks differed in cutoff frequencies, amount of overlap between filters, and shape of the filters. To assess the effects of temporal pitch cues on F0 discrimination, temporal fluctuations were removed above 10 Hz in one condition and above 200 Hz in another. Results indicate that F0 discrimination based upon place pitch cues is possible, but just-noticeable differences exceed 1 octave or more depending on the filter bank used. Increasing the frequency resolution in the F0 range improves the F0 discrimination based upon place pitch cues. The results of F0 discrimination based upon place pitch agree with a model that compares the centroids of the electrical excitation pattern. The addition of temporal fluctuations up to 200 Hz significantly improves F0 discrimination. Just-noticeable differences using both place and temporal pitch cues range from 6% to 60%. Filter banks that do not resolve the higher harmonics provided the best temporal pitch cues, because temporal pitch cues are clearest when the fluctuation on all channels is at F0 and preferably in phase.

Frequency modulation detection in cochlear implant subjects

Frequency modulation (FM) detection was investigated in acoustic and electric hearing to characterize cochlear-implant subjects' ability to detect dynamic frequency changes and to assess the relative contributions of temporal and spectral cues to frequency processing. Difference limens were measured for frequency upward sweeps, downward sweeps, and sinusoidal FM as a function of standard frequency and modulation rate. In electric hearing, factors including electrode position and stimulation level were also studied. Electric hearing data showed that the difference limen increased monotonically as a function of standard frequency regardless of the modulation type, the modulation rate, the electrode position, and the stimulation level. In contrast, acoustic hearing data showed that the difference limen was nearly a constant as a function of standard frequency. This difference was interpreted to mean that temporal cues are used only at low standard frequencies and at low modulation rates. At higher standard frequencies and modulation rates, the reliance on the place cue is increased, accounting for the better performance in acoustic hearing than for electric hearing with single-electrode stimulation. The present data suggest a speech processing strategy that encodes slow frequency changes using lower stimulation rates than those typically employed by contemporary cochlear-implant speech processors.

Topographic spread of inferior colliculus activation in response to acoustic and intracochlear electric stimulation

The design of contemporary multichannel cochlear implants is predicated on the presumption that they activate multiple independent sectors of the auditory nerve array. The independence of these channels, however, is limited by the spread of activation from each intracochlear electrode across the auditory nerve array. In this study, we evaluated factors that influence intracochlear spread of activation using two types of intracochlear electrodes: (1) a clinical-type device consisting of a linear series of ring contacts positioned along a silicon elastomer carrier, and (2) a pair of visually placed (VP) ball electrodes that could be positioned independently relative to particular intracochlear structures, e.g., the spiral ganglion. Activation spread was estimated by recording multineuronal evoked activity along the cochleotopic axis of the central nucleus of the inferior colliculus (ICC). This activity was recorded using silicon-based single-shank, 16-site recording probes, which were fixed within the ICC at a depth defined by responses to acoustic tones. After deafening, electric stimuli consisting of single biphasic electric pulses were presented with each electrode type in various stimulation configurations (monopolar, bipolar, tripolar) and/or various electrode orientations (radial, off-radial, longitudinal). The results indicate that monopolar (MP) stimulation with either electrode type produced widepread excitation across the ICC. Bipolar (BP) stimulation with banded pairs of electrodes oriented longitudinally produced activation that was somewhat less broad than MP stimulation, and tripolar (TP) stimulation produced activation that was more restricted than MP or BP stimulation. Bipolar stimulation with radially oriented pairs of VP ball electrodes produced the most restricted activation. The activity patterns evoked by radial VP balls were comparable to those produced by pure tones in normal-hearing animals. Variations in distance between radially oriented VP balls had little effect on activation spread, although increases in interelectrode spacing tended to reduce thresholds. Bipolar stimulation with longitudinally oriented VP electrodes produced broad activation that tended to broaden as the separation between electrodes increased.

Multichannel place pitch sensitivity in cochlear implant recipients

Cochlear implant recipients perceive a rise in pitch when the site of stimulation is moved from the apex toward the base. The place pitch sensitivity is typically measured using the stimulation of single channels. However, all current cochlear implant devices stimulate multiple channels simultaneously or with pulses temporally interleaved. The primary goal of the present study is to test whether the sensitivity of a cochlear implant recipient to changes in perceived pitch associated with changes of place of excitation improves or deteriorates when the number of active channels is increased, compared with stimulation with only one active channel. Place pitch sensitivity was recorded in four Nucleus CI24 subjects as a function of number of active channels (from 1 to 8). Just noticeable differences were estimated from a constant stimuli 2AFC pitch-ranking experiment with roving loudness. Reference and comparison stimuli contained the same number of active channels but were shifted one or two electrodes toward the base or toward the apex. The place pitch sensitivity was measured using monopolar stimulation at two locations along the electrode array. To minimize cues related to loudness, the multichannel stimuli were loudness balanced relative to the single-channel stimuli presented at C-level. The number of active channels did not affect place pitch sensitivity. This is consistent with a model that compares the edges of the excitation pattern irrespective of the overlap between excitation patterns. There was a significant difference in sensitivity to place pitch among subjects. The average just noticeable differences of place pitch, extrapolated from a fitting procedure, for the subjects ranged from 0.25 mm to 0.46 mm.

Neurophysiology of cochlear implant users II: comparison among speech perception, dynamic range, and physiological measures

OBJECTIVE

The overall objective of this study was to relate electrically evoked potentials recorded from different levels of the auditory pathway with behavioral measures obtained from adult cochlear implant subjects. The hypothesis was that adult recipients of cochlear implants who have open-set speech perception and those recipients with no open-set speech perception would differ in their neurophysiologic responses recorded at one or more levels of the auditory pathway.

DESIGN

The subjects were 11 adults implanted with the Clarion cochlear implant. The electrical auditory brainstem response (EABR, Wave V), electrical auditory middle latency response (EAMLR, Na-Pa complex), and the electrical late auditory response (ELAR, N1-P2 complex), were recorded from three intra-cochlear electrodes. The stimuli used to record the evoked potentials varied in rate and amplitude. Behavioral measures (between threshold and upper limit of comfortable loudness) were used to define the subject's dynamic range at the different stimulus rates. Word and sentence recognition tests evaluated subjects' speech perception in quiet and noise. Evoked potential and behavioral measures were examined for statistical significance using analysis of variance for repeated measures and correlational analyses.

RESULTS

Subjects without open-set speech recognition demonstrated 1) poorly formed or absent evoked potential responses, 2) reduced behavioral dynamic ranges, 3) lack of change in the size of the dynamic range with a change in stimulus rate, and 4) longer periods of auditory deprivation. The variables that differentiated the best performers included 1) presence of responses at all three levels of the auditory pathway, with large normalized amplitudes for the EAMLR, 2) lower evoked potential thresholds for the Na-Pa complex, 3) relatively large dynamic ranges, and 4) changes in the size of the dynamic range with changes in stimulus rate.

CONCLUSIONS

In this study, the inability to follow changes in the temporal characteristics of the stimulus was associated with poor speech perception performance. Results also illustrate that variability in speech perception scores of cochlear implant recipients relates to neurophysiologic responses at higher cortical levels of the auditory pathway. Presumably, limited neural synchrony for elicitation of electrophysiologic responses underlies limited speech perception. Results confirm that neural encoding with electrical stimulation must provide sufficient physiologic responses of the central nervous system to perceive speech through a cochlear implant.

Investigating perceptual features of electrode stimulation via a multidimensional scaling paradigm

To achieve the most effective speech processing for individuals with cochlear implants, it is important to understand the perceptual features associated with the stimulation parameters. In general, when electrodes are stimulated in order from apex to base, the pitch of the perceived sound changes in an orderly fashion from low to high. Some deviations from this assumed order have been documented. Also, pitch is the dominant perceptual attribute of a sound when the stimuli associated with different electrodes have been accurately loudness balanced. In this study, the results of a multidimensional scaling (MDS) paradigm were compared to the results of a pitch-ranking procedure for six subjects implanted with multichannel cochlear prostheses. Results indicate that there may be multiple percepts that change with electrode location. Not surprisingly, the dominant percept is strongly correlated with pitch. The results also indicate that the structure of the second percept is consistent across subjects, although not interpretable using the data measured in this study. Furthermore, results indicate that MDS data can be used to pinpoint indiscriminable electrodes more accurately than pitch data. The results of this study may have importance for the design of the next generation of speech processors.

The relationship between speech perception and electrode discrimination in cochlear implantees

Speech Intelligibility Index (SII) procedures were used to measure the amount of speech information perceived in five frequency bands (170-570, 570-1170, 1170-1768, 1768-2680, and 2680-5744 Hz) by 15 users of the Cochlear Ltd. CI-22M implant and Spectra-22/SPEAK processor. The speech information perceived was compared to that perceived by normal-hearing listeners. The ability of these subjects to discriminate between stimulation on adjacent electrodes corresponding to each frequency band was also investigated, using a 4IFC procedure with random current level variations of between 0% and 60% of the dynamic range. Relative to normal-hearing listeners, speech information was, on average, significantly more reduced in the four frequency regions between 170 and 2680 Hz than in the region 2680-5744 Hz. There was a significant correlation between electrode discrimination ability (when the random level variation encompassed 20% or more of the dynamic range) and the amount of speech information perceived in the four frequency regions between 170 and 2680 Hz. There was no such correlation in the region 2680-5744 Hz, regardless of the extent of random level variation. These results indicate that speech information in the low to medium frequencies is more difficult for implantees to perceive, that this difficulty is correlated with the difficulty in discriminating electrode place in the presence of random loudness variations, and that fine spectral discrimination may be relatively more important in the vowel-formant regions than in higher frequency regions.

Electrode discrimination by early-deafened subjects using the cochlear limited multiple-electrode cochlear implant

OBJECTIVE

The aims of this study were to determine whether electrode discrimination by early-deafened subjects using the Cochlear Limited prosthesis varied at different locations on the electrode array, was influenced by the effects of auditory deprivation and experience with electric stimulation, and was related to speech perception.

DESIGN

Difference limens for electrode discrimination were measured in 16 early-deafened subjects at three positions on the array: electrodes 18 (apical), 14 (mid), and 8 (basal). Electrodes were stimulated using random variations in current level to minimize the influence of loudness cues. Assessed were correlations between the difference limens, subject variables related to auditory deprivation (age at onset of deafness, duration of deafness, and age at implantation) and auditory experience (duration of implant use and the total time period of auditory experience), and speech perception scores from two closed-set and two open-set tests.

RESULTS

The average difference limens across the three positions were less than two electrodes for 75% of subjects, with average limens between 2 and 6.5 electrodes for the remaining 25% of subjects. Significant differences across the three positions were found for 69% of subjects. The average limens and those at the basal position positively correlated with variables related to auditory deprivation, with larger limens for subjects implanted at a later age and with a longer duration of deafness. The average limens and those at the apical position negatively correlated with closed-set speech perception scores, with lower scores for subjects with larger limens, but not with open-set scores. Speech scores also negatively correlated with variables related to auditory deprivation.

CONCLUSIONS

These findings showed that early-deafened subjects were generally successful in electrode discrimination although performance varied across the array for over half the subjects. Discrimination performance was influenced by the effects of auditory deprivation, and both electrode discrimination and variables related to auditory deprivation influenced closed-set speech perception.