Intensity discrimination with cochlear implants

Impact of Aging and the Electrode-to-Neural Interface on Temporal Processing Ability in Cochlear-Implant Users: Gap Detection Thresholds

Accurate processing of temporal information is critical to understanding speech through a cochlear implant (CI). This has potential implications for the growing population of CI users who are ≥65 years of age because of age-related auditory temporal processing deficits. The goal of this study was to measure temporal processing ability in a gap detection task in younger, middle-aged, and older CI users and to determine the relative contributions of chronological age and peripheral neural survival to performance. Single-electrode gap detection thresholds (GDTs) were measured using direct stimulation at five electrode locations and three electrical stimulation rates. The relationship between peripheral status (e.g., electrode-to-neural interface) and GDTs was assessed by the slope of the electrically evoked compound action potential (ECAP) amplitude growth function. Results showed that ECAP slope was the strongest subject-level predictor of GDTs. Steeper ECAP slopes, which are partially indicative of better peripheral function, were associated with better GDTs in younger participants. However, ECAP slope significantly interacted with stimulation rate and age, suggesting that ECAP slopes were not predictive of GDTs in middle-aged and older participants at some stimulation rates. ECAP slope was also related to age, with middle-aged and older participants exhibiting relatively shallow slopes and smaller ranges of slopes compared with younger participants. This pattern of ECAP results limited the evaluation of the independent effects of aging per se and peripheral status on temporal processing ability.

Discrimination of Simultaneous Frequency and Level Changes in Electrical Stimuli

Frequency difference limens for sinusoidal electrical stimuli were measured at operationally defined equal-loudness points in a behaviorally trained monkey that was deafened and implanted in one ear. The equal-loudness points were defined as the levels at which the discrimination of a frequency change was minimal when frequency and level were varied simultaneously. To determine accurately these points, we varied the level in very fine steps (as small as 0.05 dB) above and below the estimated equal-loudness point. With this method we also determined precise equal-loudness contours and level difference limens. Frequency difference limens ranged from 7% at 100 Hz, 17 dB sensation level (SL) to about 30% at 100, 300, and 600 Hz, 7 to 9 dB SL. Level difference limens ranged from 0.4 to 1.9 dB. Slopes of the equal-loudness contours were 0 at 100 Hz, about 6 dB/octave at 300 Hz, and leveled off to about 2 dB/octave above 600 Hz.

Intensity coding in electric hearing: effects of electrode configurations and stimulation waveforms

OBJECTIVES

Current cochlear implants typically stimulate the auditory nerve with biphasic pulses and monopolar electrode configurations. Tripolar stimulation can increase spatial selectivity and potentially improve place pitch related perception but requires higher current levels to elicit the same loudness as monopolar stimulation. The present study combined delayed pseudomonophonasic pulses, which produce lower thresholds, with tripolar stimulation in an attempt to solve the power-performance tradeoff problem.

DESIGN

The present study systematically measured thresholds, dynamic range, loudness growth, and intensity discrimination using either biphasic or delayed pseudomonophonasic pulses under both monopolar and tripolar stimulation. Participants were five Clarion cochlear implant users. For each subject, data from apical, middle, and basal electrode positions were collected when possible.

RESULTS

Compared with biphasic pulses, delayed pseudomonophonasic pulses increased the dynamic range by lowering thresholds while maintaining comparable maximum allowable levels under both electrode configurations. However, delayed pseudomonophonasic pulses did not change the shape of loudness growth function and actually increased intensity discrimination limens, especially at lower current levels.

CONCLUSIONS

The present results indicate that delayed pseudomonophonasic pulses coupled with tripolar stimulation cannot provide significant power savings nor can it increase the functional dynamic range. Whether this combined stimulation could improve functional spectral resolution remains to be seen.

Auditory midbrain implant: a review

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

Electrotactile stimulation on the tongue: Intensity perception, discrimination, and cross-modality estimation

Due to its high sensitivity and conductivity, electrotactile stimulation (ETS) on the tongue has proven to be a useful and technically convenient tool to substitute and/or augment sensory capabilities. However, most of its applications have only provided spatial attributes and little is known about (a) the ability of the tongue's sensory system to process electrical stimuli of varying magnitudes and (b) how modulation of ETS intensity affects subjects' ability to decode stimulus intensity. We addressed these questions by quantifying: (1) the magnitude of the dynamic range (DR; maximal comfortable intensity/perception threshold) and its sensitivity to prolonged exposure; (2) subjects' ability to perceive intensity changes; and (3) subjects' ability to associate intensity with angular excursions of a protractor's handle. We found that the average DR (17 dB) was generally large in comparison with other tactile loci and of a relatively constant magnitude among subjects, even after prolonged exposure, despite a slight but significant upward drift (p < 0.001). Additionally, our results showed that as stimulus intensity increased, subjects' ability to discriminate ETS stimuli of different intensities improved (p < 0.05) while estimation accuracy, in general, slightly decreased (increasing underestimation). These results suggest that higher ETS intensity may increase recruitment of rapidly adapting mechanoreceptor fibers, as these are specialized for coding stimulus differences rather than absolute intensities. Furthermore, our study revealed that the tongue's sensory system can effectively convey electrical stimuli despite minimal practice and when information transfer is limited by memory and DR drift.

Influence of stimulation rate and loudness growth on modulation detection and intensity discrimination in cochlear implant users

In cochlear implants (CIs), increasing the stimulation rate typically increases the electric dynamic range (DR), mostly by reducing audibility thresholds. While CI users' intensity resolution has been shown to be fairly constant across stimulation rates, high rates have been shown to weaken modulation sensitivity, especially at low listening levels. In this study, modulation detection thresholds (MDTs) were measured in five CI users for a range of stimulation rates (250-2000 pulses per second) and modulation frequencies (5-100 Hz) at 8 stimulation levels that spanned the DR (loudness-balanced across stimulation rates). Intensity difference limens (IDLs) were measured for the same stimulation rates and levels used for modulation detection. For all modulation frequencies, modulation sensitivity was generally poorer at low levels and at higher stimulation rates. CI users were sensitive to modulation frequency only at relatively high levels. Similarly, IDLs were poorer at low levels and at high stimulation rates. When compared directly in terms of relative amplitude, IDLs were generally better than MDTs at low levels. Differences in loudness growth between dynamic and steady stimuli might explain level-dependent differences between MDTs and IDLs. The slower loudness growth associated with high stimulation rates might explain the poorer MDTs and IDLs with high rates. In general, high stimulation rates provided no advantage in intensity resolution and a disadvantage in modulation sensitivity.

Current-level discrimination and spectral profile analysis in multi-channel electrical stimulation

In experiment 1, six cochlear-implant (CI) listeners discriminated a stimulation pattern eliciting equal loudness for each electrode from a stimulation pattern in which the stimulation at one or more electrodes was increased (peak) or decreased (notch). Three cochlear locations and three bandwidths were tested, without and with level roving. Listeners could always detect peaks but not always notches. Increasing the bandwidth beyond two electrodes produced no improvement in just-noticeable differences (JNDs). JNDs for the basal location were higher than for the apical and middle locations, although listeners had highly individual tendencies. In experiment 2, listeners discriminated changes in the peak heights and notch depths. JNDs for higher peaks were better while JNDs for deeper notches were worse than for experiment 1. In experiment 3, listeners discriminated the electrode position of peaks or notches. JNDs were approximately one electrode. In experiment 4, the first three experiments were repeated with large amounts of level roving. There was no evidence that CI listeners performed an across-channel comparison in these tasks.

Psychophysical assessment of stimulation sites in auditory prosthesis electrode arrays

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

The auditory midbrain implant: effects of electrode location

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

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

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

Spatially distinct functional output regions within the central nucleus of the inferior colliculus: implications for an auditory midbrain implant

The inferior colliculus central nucleus (ICC) has potential as a new site for an auditory prosthesis [i.e., auditory midbrain implant (AMI)] for deaf patients who cannot benefit from cochlear implants (CIs). We have previously shown that ICC stimulation achieves lower thresholds, greater dynamic ranges, and more localized, frequency-specific primary auditory cortex (A1) activation than CI stimulation. However, we also observed that stimulation location along the caudorostral (isofrequency) dimension of the ICC affects thresholds and frequency specificity in A1, suggesting possible differences in functional (output) organization within the ICC. In this study, we electrically stimulated different regions along the isofrequency laminas of the ICC and recorded the corresponding A1 activity in ketamine-anesthetized guinea pigs using multisite probes to systematically assess ICC stimulation location effects. Our results indicate that stimulation of more rostral and somewhat ventral regions within an ICC lamina achieves lower thresholds, smaller discriminable level steps, and larger evoked potentials in A1. We also observed longer first spike latencies, which correlated with reduced spiking precision, when stimulating in more caudal and dorsal ICC regions. These findings suggest that at least two spatially distinct functional output regions exist along an ICC lamina: a caudal-dorsal region and a rostral-ventral region. The AMI will be implanted along the tonotopic axis of the ICC to achieve frequency-specific activation. However, stimulation location along the ICC laminas affects response properties that have shown to be important for speech perception performance, and needs to be considered when implanting future AMI patients.

Current-level discrimination in the context of interleaved, multichannel stimulation in cochlear implants: effects of number of stimulated electrodes, pulse rate, and electrode separation

The ability of cochlear implantees to detect an increment in current level at one of many stimulated electrodes was investigated. Such changes in the electric profile provide information for cochlear implantees to discriminate numerous sounds, especially vowels. In Experiment 1, sensitivity to increases in current level at one stimulation site in the electric profile decreased as the number of stimulated electrodes increased. This outcome was most likely a result of decreased stimulus levels at individual electrodes that were required to retain a comfortable loudness when the number of active electrodes was increased. Experiment 2 investigated the effects of pulse rate and separation between stimulation sites when the levels in percent of dynamic range and number of stimulated electrodes were held constant. The effect of pulse rate and electrode separation varied among listeners. The sensitivity of 6 of 9 listeners was best at the pulse rate that they used clinically. This might have been the result of adaptation to the clinical pulse rate, or listeners might have chosen their inherently best pulse rate during the clinical fitting.

Auditory cortical responses to electrical stimulation of the inferior colliculus: implications for an auditory midbrain implant

The success and limitations of cochlear implants (CIs) along with recent advances in deep brain stimulation and neural engineering have motivated the development of a central auditory prosthesis. In this study, we investigated the effects of electrical stimulation of the inferior colliculus central nucleus (ICC) on primary auditory cortex (A1) activity to determine the potential benefits of an auditory midbrain implant (AMI). We recorded multiunit activity in A1 of ketamine-anesthetized guinea pigs in response to single-pulse (200 micros/phase) monopolar stimulation of the ICC using multisite silicon-substrate probes. We then compared measures of threshold, dynamic range, and tonotopic spread of activation for ICC stimulation with that of published data for CI stimulation. Our results showed that compared with cochlear stimulation, ICC stimulation achieved: 1) thresholds about 8 dB lower; 2) dynamic ranges > or = 4 dB greater; and 3) more localized, frequency-specific activation, even though frequency specificity was partially lost at higher stimulus levels for low-frequency ICC regions. Our results also showed that stimulation of rostral ICC regions elicited lower thresholds but with greater activation spread along the tonotopic gradient of A1 than did stimulation of more caudal regions. These results suggest that an AMI may improve frequency and level coding with lower energy requirements compared with CIs. However, a trade-off between lower perceptual thresholds and better frequency discrimination may exist that depends on location of stimulation along the caudorostral dimension of the ICC. Overall, this study provides the foundation for future AMI research and development.

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.

Current-level discrimination using bipolar and monopolar electrode configurations in cochlear implants

This study examined current-level discrimination ability in listeners with cochlear implants using bipolar and monopolar electrode configurations. Current-level discrimination ability was measured as a function of electrode configuration (monopolar and bipolar), stimulation site (8 and 16) and level (5%, 15%, 25%, 50% and 80% of the dynamic range). Weber fractions usually decreased with increasing level. Differences in Weber fractions between monopolar and bipolar configurations were observed for listeners with short durations of deafness (<5 years). For these listeners, in the bipolar condition at the more-apical site 16, Weber fractions remained constant with increasing level, and the Weber fractions at low levels were smaller than in other conditions. We suggest that nerve density was better and the nerve-to-site-of-action-potential distance was smaller in these cases such that more fibers could be recruited with a unit increase in current level, leading to better current-level sensitivity.

Predicting Dynamic Range and Intensity Discrimination for Electrical Pulse-Train Stimuli Using a Stochastic Auditory Nerve Model: The Effects of Stimulus Noise

This work investigates dynamic range and intensity discrimination for electrical pulse-train stimuli that are modulated by noise using a stochastic auditory nerve model. Based on a hypothesized monotonic relationship between loudness and the number of spikes elicited by a stimulus, theoretical prediction of the uncomfortable level has previously been determined by comparing spike counts to a fixed threshold, Nucl. However, no specific rule for determining Nucl has been suggested. Our work determines the uncomfortable level based on the excitation pattern of the neural response in a normal ear. The number of fibers corresponding to the portion of the basilar membrane driven by a stimulus at an uncomfortable level in a normal ear is related to Nucl at an uncomfortable level of the electrical stimulus. Intensity discrimination limens are predicted using signal detection theory via the probability mass function of the neural response and via experimental simulations. The results show that the uncomfortable level for pulse-train stimuli increases slightly as noise level increases. Combining this with our previous threshold predictions, we hypothesize that the dynamic range for noise-modulated pulse-train stimuli should increase with additive noise. However, since our predictions indicate that intensity discrimination under noise degrades, overall intensity coding performance may not improve significantly.

Intensity discrimination and increment detection in cochlear-implant users

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

Psychophysics of a prototype peri-modiolar cochlear implant electrode array

Psychophysical measurements were performed in three hearing-impaired adult subjects implanted with a CI22 cochlear prosthesis (Cochlear Ltd.) fitted with a developmental peri-modiolar electrode array. The array was manufactured with a curvature approximating that of the inner wall of the scala tympani but, after straightening and insertion, lay on average about half way between the inner and outer walls of the scala. All subjects were tested with bipolar stimulation; two were also tested with monopolar, employing the most basal electrode as the return. Maximum comfortable level and threshold reduced with decreasing distance of electrode from the modiolus, whereas dynamic range increased. The linearity of the loudness growth function did not vary significantly with electrode position but the function was more non-linear for lower maximum comfortable levels. Current level discrimination, normalized with respect to dynamic range, improved with decreasing distance of electrode from the modiolus in two subjects. Pitch varied regularly with insertion depth of the stimulated electrode for bipolar stimulation in two subjects and also for monopolar stimulation in one subject. Electrode discrimination was enhanced by closeness to the modiolus. Whereas the forward masking patterns for bipolar stimulation of electrodes close to the modiolus had a sharp double-peaked structure, those for monopolar stimulation were flatter and had a single peak.

Effects of chronic stimulation on auditory nerve survival in ototoxically deafened animals

For almost 10 years, chronic stimulation has been known to affect spiral ganglion cell (SGC) survival in the deaf ear. However, the reported effects of chronic stimulation vary across preparations and studies. In this review, the effects of chronic stimulation on the deafened auditory periphery are examined, and variables that may impact on the efficacy of chronic stimulation are identified. The effects of deafening on the unstimulated peripheral and central auditory system are also described, as the deafened, unstimulated system is the canvas upon which stimulation-mediated effects are imposed. Discrepancies in the effects of chronic stimulation across studies may be attributable in large part to the combined effects of the deafening method and the post-deafening delay prior to chronic stimulation, which vary across studies. Emphasis is placed on the need to consider the natural progression of SGC loss following deafening in the absence of chronic stimulation, as the rate of SGC loss almost certainly affects both the efficacy of stimulation, and the impact of any delay between deafening and initiation of stimulation. The differences across preparations complicate direct comparison of protective efficacy of stimulation. At the same time, these differences can be used to our advantage, aiding characterization of the effects of different factors on the efficacy of chronic stimulation as a neuroprotective intervention.

Speech recognition by normal-hearing and cochlear implant listeners as a function of intensity resolution

The importance of intensity resolution in terms of the number of intensity steps needed for speech recognition was assessed for normal-hearing and cochlear implant listeners. In experiment 1, the channel amplitudes extracted from a six-channel continuous interleaved sampling (CIS) processor were quantized into 2, 4, 8, 16, or 32 steps. Consonant recognition was assessed for five cochlear implant listeners, using the Med-El/CIS-link device, as a function of the number of steps in the electrical dynamic range. Results showed that eight steps within the dynamic range are sufficient for reaching asymptotic performance in consonant recognition. These results suggest that amplitude resolution is not a major factor in determining consonant identification. In experiment 2, the relationship between spectral resolution (number of channels) and intensity resolution (number of steps) in normal-hearing listeners was investigated. Speech was filtered through 4-20 frequency bands, synthesized as a linear combination of sine waves with amplitudes extracted from the envelopes of the bandpassed waveforms, and then quantized into 2-32 levels to produce stimuli with varying degrees of intensity resolution. Results showed that the number of steps needed to achieve asymptotic performance was a function of the number of channels and the speech material used. For vowels, asymptotic performance was obtained with four steps, while for consonants, eight steps were needed for most channel conditions, consistent with our findings in experiment 1. For sentences processed though 4 channels, 16 steps were needed to reach asymptotic performance, while for sentences processed through 16 channels, 4 steps were needed. The results with normal-hearing listeners on sentence recognition point to an inverse relationship between spectral resolution and intensity resolution. When spectral resolution is poor (i.e., a small number of channels is available) a relatively fine intensity resolution is needed to achieve high levels of understanding. Conversely, when the intensity resolution is poor, a high degree of spectral resolution is needed to achieve asymptotic performance. The results of this study, taken together with previous findings on the effect of reduced dynamic range, suggest that the performance of cochlear implant subjects is primarily limited by the small number (four to six) of channels received, and not by the small number of intensity steps or reduced dynamic range.

Electrical cochlear stimulation in the deaf cat: comparisons between psychophysical and central auditory neuronal thresholds

Cochlear prostheses for electrical stimulation of the auditory nerve ("electrical hearing") can provide auditory capacity for profoundly deaf adults and children, including in many cases a restored ability to perceive speech without visual cues. A fundamental challenge in auditory neuroscience is to understand the neural and perceptual mechanisms that make rehabilitation of hearing possible in these deaf humans. We have developed a feline behavioral model that allows us to study behavioral and physiological variables in the same deaf animals. Cats deafened by injection of ototoxic antibiotics were implanted with either a monopolar round window electrode or a multichannel scala tympani electrode array. To evaluate the effects of perceptually significant electrical stimulation of the auditory nerve on the central auditory system, an animal was trained to avoid a mild electrocutaneous shock when biphasic current pulses (0.2 ms/phase) were delivered to its implanted cochlea. Psychophysical detection thresholds and electrical auditory brain stem response (EABR) thresholds were estimated in each cat. At the conclusion of behavioral testing, acute physiological experiments were conducted, and threshold responses were recorded for single neurons and multineuronal clusters in the central nucleus of the inferior colliculus (ICC) and the primary auditory cortex (A1). Behavioral and neurophysiological thresholds were evaluated with reference to cochlear histopathology in the same deaf cats. The results of the present study include: 1) in the cats implanted with a scala tympani electrode array, the lowest ICC and A1 neural thresholds were virtually identical to the behavioral thresholds for intracochlear bipolar stimulation; 2) behavioral thresholds were lower than ICC and A1 neural thresholds in each of the cats implanted with a monopolar round window electrode; 3) EABR thresholds were higher than behavioral thresholds in all of the cats (mean difference = 6.5 dB); and 4) the cumulative number of action potentials for a sample of ICC neurons increased monotonically as a function of the amplitude and the number of stimulating biphasic pulses. This physiological result suggests that the output from the ICC may be integrated spatially across neurons and temporally integrated across pulses when the auditory nerve array is stimulated with a train of biphasic current pulses. Because behavioral thresholds were lower and reaction times were faster at a pulse rate of 30 pps compared with a pulse rate of 2 pps, spatial-temporal integration in the central auditory system was presumably reflected in psychophysical performance.

Fos-like immunoreactivity in the auditory brainstem evoked by bipolar intracochlear electrical stimulation: effects of current level and pulse duration

Fos-like immunoreactivity was used to compare the auditory brain stem excitation elicited by bipolar electrical stimulation of the cochlea at various current levels relative to the electrically evoked auditory brain stem response threshold for a 50-micros/phase monophasic pulse. Fos-like immunoreactive cells were labeled in primary auditory brain stem regions. The distribution of labeled cells was restricted to regions known to be cochleotopically related to the stimulated region of the scala tympani. Some labeled cells were observed at 2x electrically evoked auditory brain stem response threshold. The number, density and spatial distribution of labeled cells were quantified in the dorsal cochlear nucleus and inferior colliculus, and found to increase with increasing level of stimulation. For 50-micros pulses, the location of labeled neurons remained reasonably restricted to narrow bands within each region until the 1Ox level of stimulation (20 dB above electrically evoked auditory brain stem response threshold) was reached. While a monotonic increase in Fos-like immunoreactivity with increasing stimulus level was observed in most nuclei, for cells of the superficial layer of the dorsal cochlear nucleus, a non-monotonic change with increasing stimulus level was seen. This dorsal cochlear nucleus non-monotonicity may indicate that, at higher levels of stimulation, a secondary indirect inhibitory input, probably associated with activation of deep layer dorsal cochlear nucleus cells, reduces excitatory responses at the superficial layer of the dorsal cochlear nucleus. Electrically evoked auditory brain stem response and Fos expression showed parallel changes as a function of stimulus level and pulse duration. The data indicate that discrete activation of cell populations within the central auditory pathways can occur with bipolar electrical stimulation to the highest levels of stimulation typically useful in humans. The data also indicate a close, but not identical, quantitative relationship between Fos-like immunoreactivity and electrophysiological response amplitude. These findings support the view that a study of Fos-like immunoreactivity can provide a powerful and quantitative tool for study of the dynamic response characteristics of cells of the central auditory system to electrical stimulation at suprathreshold levels. The data suggest that there is a monotonic increase in the number of neurons responsive to intracochlear electrical stimulation as a function of stimulus level, at least through the upper half of the dynamic range, but that this increase does not result in a complete loss of spatial selectivity. Coupled with previous psychophysical studies, these results suggest that the increase in the number of activated neurons is functionally beneficial, resulting in improved discrimination of changes in the electrical signals.

Studies of prosody perception by cochlear implant patients

Prosodic information is conveyed to normally-hearing listeners by variations in acoustic fundamental frequency, amplitude envelope, and duration of speech segments. This study measured cochlear implant patients' sensitivity to these parameters in electrically coded speech. The psychophysical discrimination of electric parameters used to code prosodic information, were examined, together with prosody perception using speech processing strategies which modified the contributions of these parameters. Patients were implanted with the Cochlear Limited prosthesis and used the MPEAK speech processing strategy. In the psychophysical studies, difference limens were measured for steady-state and time-varying stimuli, of different pulse rates and pulse durations, over a series of different stimulus durations. These limens were obtained using an adaptive procedure which converged on the 50 per cent correct point. In the prosody perception studies, performance was measured for the MPEAK strategy and for strategies which modified the contributions of pulse rate and pulse duration. Data were collected for five tests of prosodic contrasts. Difference limens for steady-state pulse rates were larger at higher rates (17 per cent at 400 pulses/s) than at lower rates (6 per cent at 100 pulses/s). For some patients, limens for the time-varying pulse rates were larger than those for the steady-state pulse rates while for the other patients, the limens were similar. Difference limens for pulse duration were 0.3 dB, corresponding to 4 per cent of the dynamic range, for steady-state stimuli and doubled in size for the time-varying stimuli. Prosody perception performance was generally poorer for the modified strategies than for the MPEAK strategy, suggesting that the removal of information coded by pulse rate and pulse duration reduced the perception of prosodic contrasts.

Electrical stimulation of the auditory nerve: effects of pulse width on frequency discrimination

Effects of pulse width on discrimination of simultaneous changes in frequency and level of electrical pulse trains were studied in a monkey subject with a cochlear implant. At test-stimulus levels where performance was minimum, frequency difference limens were larger for longer-duration pulses than that for shorter-duration pulses. Several factors may have contributed to these differences.

Changes over time in thresholds for electrical stimulation of the cochlea

The purpose of this paper is to better characterize changes over time that occurred in psychophysical detection thresholds for electrical stimulation of the cochlea. Threshold changes observed in nonhuman primates implanted with cochlear electrode arrays can be divided into at least three types based on the patterns of change over time. Short-term increases and subsequent decreases in threshold were commonly observed during the first months after implantation and were often followed by periods of long-term threshold stability. Long-term slow increases in thresholds and more rapid increases after a period of threshold stability have also been observed. The threshold changes may be divided into at least two classes based on their dependence on the waveforms used for the threshold measurements. Some changes occurred primarily in thresholds for long phase-duration signals while other changes were equal in magnitude (in decibels) for all tested stimuli. This suggests that at least two mechanisms underlay these threshold changes. The observed changes in thresholds have implications for experimental studies of electrical stimulation and for clinical application of auditory prostheses.

Effects of level on nonspectral frequency difference limens for electrical and acoustic stimuli

The purpose of this experiment was to study the effects of stimulus level on discrimination of frequency as represented in the temporal waveforms of acoustic and electrical signals. The subjects were four nonhuman primates in which one ear had been deafened and implanted with an electrode array and the other ear was untreated. Frequency difference limens for 100 Hz electrical sinusoidal stimulation via a cochlear implant in the deafened ear were compared to those for 100 Hz sinusoidally amplitude-modulated white noise (SAM noise) acoustic stimuli to the normal-hearing contralateral ear. To correct for loudness cues, levels of the test stimuli were varied relative to the reference-stimulus level. The test-stimulus levels at which the percent responses were minimum were determined. These levels were used to measure the frequency difference limens. Frequency difference limens for the electrical stimuli decreased as a function of reference-stimulus level through most of the dynamic range, while those for the acoustic stimuli reached a minimum at 20 dB to 40 dB above threshold. For the electrical stimuli the slopes and relative positions of the frequency difference limen vs. level functions varied from subject to subject, and with changes in electrode configuration within a subject. These differences were related to threshold level and dynamic range. At higher levels of stimulation, frequency difference limens for acoustic and electrical stimuli fell in the same range. The slopes and relative positions of the frequency difference limen vs. level functions for electrical stimuli did not parallel those of level difference limen vs. level functions collected simultaneously from the same ears. The data suggest that nonspectral frequency discrimination may depend on the number of nerve fibers stimulated. With prostheses in cochleas with less than a full complement of auditory nerve fibers, the data suggest that stimulation level is an important variable influencing discriminability.

Comparisons of psychophysical and neurophysiological studies of cochlear implants

This paper compares psychophysical and neural studies of electrical stimulation of the auditory nerve with the goal of evaluating the relevance of single-unit animal models for the development of cochlear prostheses for profoundly deaf humans. Comparative psychophysical studies with implanted deaf subjects indicate that animal models, at least nonhuman primates, provide a close match to humans, though this is not always true for acoustic stimulation of normal-hearing subjects. However, the human-animal comparisons, especially those involving electrical stimuli, need further study using more carefully matched conditions. Comparisons of psychophysical and neurophysiological thresholds for electrical stimulation in animals reveal consistently higher thresholds in the neural studies. A number of factors which may account for these differences are discussed. A partial resolution of the problem could result from conducting neurophysiological and behavioral studies in the same animal. Finally, comparison of psychophysical and neurophysiological studies of temporal encoding suggest that there may be more information encoded in the auditory nerve than is used by the system, at least for nonspectral frequency discrimination. This points to a need for further analysis of the processing of this information at higher levels in the auditory pathway.