Pitch perception for different modes of stimulation using the cochlear multiple-electrode prosthesis

Tripolar configuration and pulse shape in cochlear implants reduce channel interactions in the temporal domain

The present study investigates effects of current focusing and pulse shape on threshold, dynamic range, spread of excitation and channel interaction in the time domain using cochlear implant stimulation. The study was performed on 20 adult guinea pigs using a 6-channel animal cochlear implant, recording was performed in the auditory midbrain using a multielectrode array. After determining the best frequencies for individual recording contacts with acoustic stimulation, the ear was deafened and a cochlear implant was inserted into the cochlea. The position of the implant was controlled by x-ray. Stimulation with biphasic, pseudomonophasic and monophasic stimuli was performed with monopolar, monopolar with common ground, bipolar and tripolar configuration in two sets of experiments, allowing comparison of the effects of the different stimulation strategies on threshold, dynamic range, spread of excitation and channel interaction. Channel interaction was studied in the temporal domain, where two electrodes were activated with pulse trains and phase locking to these pulse trains in the midbrain was quantified. The results documented multifactorial influences on the response properties, with significant interaction between factors. Thresholds increased with increasing current focusing, but decreased with pseudomonophasic and monophasic pulse shapes. The results documented that current focusing, particularly tripolar configuration, effectively reduces channel interaction, but that also pseudomonophasic and monophasic stimulation and phase duration intensity coding reduce channel interactions.

Targeted Optical Neural Stimulation: A New Era for Personalized Medicine

Targeted optical neural stimulation comprises infrared neural stimulation and optogenetics, which affect the nervous system through induced thermal transients and activation of light-sensitive proteins, respectively. The main advantage of this pair of optical tools is high functional selectivity, which conventional electrical stimulation lacks. Over the past 15 years, the mechanism, safety, and feasibility of optical stimulation techniques have undergone continuous investigation and development. When combined with other methods like optical imaging and high-field functional magnetic resonance imaging, the translation of optical stimulation to clinical practice adds high value. We review the theoretical foundations and current state of optical stimulation, with a particular focus on infrared neural stimulation as a potential bridge linking optical stimulation to personalized medicine.

Current distribution of distributed all-polar cochlear implant stimulation mode measured in-situ

Oticon Medical cochlear implants use a stimulation mode called Distributed All-Polar (DAP) that connects all non-stimulating available intracochlear electrodes and an extracochlear reference electrode. It results in a complex distribution of current that is yet undescribed. The present study aims at providing a first characterization of this current distribution. A Neuro Zti was modified to allow the measurement of current returning to each electrode during a DAP stimulation and was implanted in an ex-vivo human head. Maps of distributed current were then created for different stimulation conditions with different charge levels. Results show that, on average, about 20% of current returns to the extracochlear reference electrode, while the remaining 80% is distributed between intracochlear electrodes. The position of the stimulating electrode changed this ratio, and about 10% more current to the extracochlear return in case of the first 3 basal electrodes than for apical and mid position electrodes was observed. Increasing the charge level led to small but significant change in the ratio, and about 4% more current to the extracochlear return was measured when increasing the charge level from 11.7 to 70 nC. Further research is needed to show if DAP yields better speech understanding than other stimulation modes.

Coherent Coding of Enhanced Interaural Cues Improves Sound Localization in Noise With Bilateral Cochlear Implants

Bilateral cochlear implant (BCI) users only have very limited spatial hearing abilities. Speech coding strategies transmit interaural level differences (ILDs) but in a distorted manner. Interaural time difference (ITD) information transmission is even more limited. With these cues, most BCI users can coarsely localize a single source in quiet, but performance quickly declines in the presence of other sound. This proof-of-concept study presents a novel signal processing algorithm specific for BCIs, with the aim to improve sound localization in noise. The core part of the BCI algorithm duplicates a monophonic electrode pulse pattern and applies quasistationary natural or artificial ITDs or ILDs based on the estimated direction of the dominant source. Three experiments were conducted to evaluate different algorithm variants: Experiment 1 tested if ITD transmission alone enables BCI subjects to lateralize speech. Results showed that six out of nine BCI subjects were able to lateralize intelligible speech in quiet solely based on ITDs. Experiments 2 and 3 assessed azimuthal angle discrimination in noise with natural or modified ILDs and ITDs. Angle discrimination for frontal locations was possible with all variants, including the pure ITD case, but for lateral reference angles, it was only possible with a linearized ILD mapping. Speech intelligibility in noise, limitations, and challenges of this interaural cue transmission approach are discussed alongside suggestions for modifying and further improving the BCI algorithm.

Use of Research Interfaces for Psychophysical Studies With Cochlear-Implant Users

A growing number of laboratories are using research interfaces to conduct experiments with cochlear-implant (CI) users. Because these interfaces bypass a subject’s clinical sound processor, several concerns exist regarding safety and stimulation levels. Here we suggest best-practice approaches for how to safely and ethically perform this type of research and highlight areas of limited knowledge where further research is needed to help clarify safety limits. The article is designed to provide an introductory level of technical detail about the devices and the effects of electrical stimulation on perception and neurophysiology. From this, we summarize what should be the best practices in the field, based on the literature and our experience. Findings from the review of the literature suggest that there are three main safety concerns: (a) to prevent biological or neural damage, (b) to avoid presentation of uncomfortably loud sounds, and (c) to ensure that subjects have control over stimulus presentation. Researchers must pay close attention to the software–hardware interface to ensure that the three main safety concerns are closely monitored. An important area for future research will be the determination of the amount of biological damage that can occur from electrical stimulation from a CI placed in the cochlea, not in direct contact with neural tissue. As technology used in research with CIs evolve, some of these approaches may change. However, the three main safety principles outlined here are not anticipated to undergo change with technological advances.

Evaluation of focused multipolar stimulation for cochlear implants in acutely deafened cats

OBJECTIVE

The conductive nature of the fluids and tissues of the cochlea can lead to broad activation of spiral ganglion neurons using contemporary cochlear implant stimulation configurations such as monopolar (MP) stimulation. The relatively poor spatial selectivity is thought to limit implant performance, particularly in noisy environments. Several current focusing techniques have been proposed to reduce the spread of activation with the aim towards achieving improved clinical performance.

APPROACH

The present research evaluated the efficacy of focused multipolar (FMP) stimulation, a relatively new focusing technique in the cochlea, and compared its efficacy to both MP stimulation and tripolar (TP) stimulation. The spread of neural activity across the inferior colliculus (IC), measured by recording the spatial tuning curve, was used as a measure of spatial selectivity. Adult cats (n = 6) were acutely deafened and implanted with an intracochlear electrode array before multi-unit responses were recorded across the cochleotopic gradient of the contralateral IC. Recordings were made in response to acoustic and electrical stimulation using the MP, TP and FMP configurations.

MAIN RESULTS

FMP and TP stimulation resulted in greater spatial selectivity than MP stimulation. However, thresholds were significantly higher (p < 0.001) for FMP and TP stimulation compared to MP stimulation. There were no differences found in spatial selectivity and threshold between FMP and TP stimulation.

SIGNIFICANCE

The greater spatial selectivity of FMP and TP stimulation would be expected to result in improved clinical performance. However, further research will be required to demonstrate the efficacy of these modes of stimulation after longer durations of deafness.

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>.

Infrared neural stimulation in the cochlea

The application of photonics to manipulate and stimulate neurons and to study neural networks has gained momentum over the last decade. Two general methods have been used: the genetic expression of light or temperature sensitive ion channels in the plasma membrane of neurons (Optogenetics and Thermogenetics) and the direct stimulation of neurons using infrared radiation (Infrared Neural Stimulation, INS). Both approaches have their strengths and challenges, which are well understood with a profound understanding of the light tissue interaction(s). This paper compares the opportunities of the methods for the use in cochlear prostheses. Ample data are already available on the stimulation of the cochlea with INS. The data show that the stimulation is selective, feasible at rates that would be sufficient to encode acoustic information and may be beneficial over conventional pulsed electrical stimulation. A third approach, using lasers in stress confinement to generate pressure waves and to stimulate the functional cochlea mechanically will also be discussed.

MUSIC APPRECIATION AND TRAINING FOR COCHLEAR IMPLANT RECIPIENTS: A REVIEW

In recent years, there has been increasing interest in music perception of cochlear implant (CI) recipients, and a growing body of research conducted in this area. The majority of these studies have examined perceptual accuracy for pitch, rhythm, and timbre. Another important, but less commonly studied aspect of music listening is appreciation, or appraisal. Despite the ongoing research into potential technological improvements that may improve music perception for recipients, both perceptual accuracy and appreciation generally remain poor for most recipients. Whilst perceptual accuracy for music is important, appreciation and enjoyment also warrants research as it also contributes to clinical outcomes and perceived benefits. Music training is being shown to offer excellent potential for improving music perception and appreciation for recipients.Therefore, the primary topics of this review are music appreciation and training. However, a brief overview of the psychoacoustic, technical, and physiological factors associated with a recipient's perception of music is provided, as these are important factors in understanding the listening experience for CI recipients. The purpose of this review is to summarize key papers that have investigated these issues, in order to demonstrate that i) music enjoyment and appraisal is an important and valid consideration in evaluating music outcomes for recipients, and ii) that music training can improve music listening for many recipients, and is something that can be offered to persons using current technology.

Visual cortex responses to suprachoroidal electrical stimulation of the retina: effects of electrode return configuration

A clinically effective retinal prosthesis must evoke localized phosphenes in a retinotopic manner in response to stimulation of each of the retinal electrodes, evoke brightness cues over a wide dynamic range and function within safe stimulus limits. The effects of varying return configuration for retinal stimulation are currently unknown. To investigate this, we implanted a flexible, 7 × 12 electrode array into the suprachoroidal space of normally-sighted, anesthetized cats. Multi-unit activity in the primary visual cortex was recorded in response to electrical stimulation using various return configurations: monopolar vitreous (MPV), common ground (CG), hexagonal (HX), monopolar remote (MPR) and bipolar (BP_N). MPV stimulation was found to be the most charge efficient and was most likely to induce cortical activity within safe charge limits. HX and CG stimulation were found to exhibit greater retinal selectivity compared to the MPV return at the expense of lower cortical yield and higher P50 charge levels, while cortical selectivity was unaffected by choice of return. Responses using MPR and widely spaced BP_N configurations were similar to those using the MPV return. These results suggest that choice of return configuration for a retinal prosthesis will be balanced between resolution and stimulation within safe charge limits.

Emotional and analytic music perception in cochlear implant users after optimizing the speech processor

CONCLUSION

Cochlear implant (CI) users are able to detect harmonic differences and the emotionally exciting effect of music (arousal) even when using a speech adapted program. Raising the power of lower frequencies of speech processors in CIs for a music program further improved this ability and enhanced subjectively perceived pleasure during listening to music.

OBJECTIVE

This pilot study compares aspects of analytical and emotional music perception before and after optimizing the speech processor compared to results of normal-hearing subjects.

METHODS

Six adult post-lingually deafened CI users and six subjects with normal hearing abilities were tested on different aspects of analytical and emotional music perception. After optimizing speech processors for a music program, the CI users were tested again after a period of 1 week.

RESULTS

The CI users were able to detect different levels of emotional arousal conveyed by music. Switching to the music program resulted in an even better distinction between different levels of musical arousal. With both the speech and music programs, CI users gave overall higher ratings for arousal and valence of the heard music when asked to estimate how listeners with normal hearing perceived the music than when asked about their own perception.

Neural excitation patterns induced by phased-array stimulation in the implanted human cochlea

CONCLUSIONS

Phased-array stimulation is a promising technique, which uses electrical interaction to focus the stimulation in cochlear implants, at the expense of limited threshold shifts. It has potential advantages over, for example, tripolar stimulation.

OBJECTIVES

Current spread imposes limitations in cochlear implants. Van Compernolle (1985) suggested using all electrode contacts simultaneously to reduce these effects. Van den Honert et al. (2007) validated this so-called phased array algorithm in patients with respect to the electrode potentials but the effect on neural excitation remained unclear. The present study used computational modeling to relate the effect of phased-array stimulation to the neural elements.

METHODS

A computational model of the implanted human cochlea was used to compare the neural excitation patterns induced by conventional monopolar stimulation and by phased-array stimulation. Neural thresholds and electrical dynamic ranges were visualized with excitation profiles, showing the auditory nerve's response to a range of stimulus levels.

RESULTS

Phased-array stimulation of a single region reduces the spread of excitation and increases the dynamic range. The phased array paradigm can be extended to stimulate multiple sites simultaneously, thereby eliminating the need for sequential stimulation, but with a more limited range of usable stimulus levels, especially with perimodiolar electrodes.

Probing the electrode-neuron interface with focused cochlear implant stimulation

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

Pitch estimation of a deeply inserted cochlear implant electrode

In this short communication, we evaluate the place-pitch relation of a newly designed, deeply inserted, cochlear implant electrode. The insertion depths ranged from 471 degrees to 662 degrees. Pitch perception was measured in eight subjects with monopolar stimulation on each electrode contact at intensities of 50% and 80% of the dynamic range. We observed a monotonic reduction of pitch estimate with insertion depth. For about half of the subjects, a flattening of the pitch estimate at the basal end of the electrode was seen, while for the other half, pitch continued to decrease monotonically up to the most apical part of the array. We conclude that deeper insertion could increase pitch range for at least some cochlear implant recipients, and could hence potentially increase group performance.

Cochlear-implant high pulse rate and narrow electrode configuration impair transmission of temporal information to the auditory cortex

In the most commonly used cochlear prosthesis systems, temporal features of sound are signaled by amplitude modulation of constant-rate pulse trains. Several convincing arguments predict that speech reception should be optimized by use of pulse rates > or approximately 2,000 pulses per second (pps) and by use of intracochlear electrode configurations that produce restricted current spread (e.g., bipolar rather than monopolar configurations). Neither of those predictions has been borne out in consistent improvements in speech reception. Neurons in the auditory cortex of anesthetized guinea pigs phase lock to the envelope of sine-modulated electric pulse trains presented through a cochlear implant. The present study used that animal model to quantify the effects of carrier pulse rate, electrode configuration, current level, and modulator wave shape on transmission of temporal information from a cochlear implant to the auditory cortex. Modulation sensitivity was computed using a signal-detection analysis of cortical phase-locking vector strengths. Increasing carrier pulse rate in 1-octave steps from 254 to 4,069 pps resulted in systematic decreases in sensitivity. Comparison of sine- versus square-wave modulator waveforms demonstrated that some, but not all, of the loss of modulation sensitivity at high pulse rates was a result of the decreasing size of pulse-to-pulse current steps at the higher rates. Use of a narrow bipolar electrode configuration, compared with the monopolar configuration, produced a marked decrease in modulation sensitivity. Results from this animal model suggest explanations for the failure of high pulse rates and/or bipolar electrode configurations to produce hoped-for improvements in speech reception.

Laser stimulation of auditory neurons: effect of shorter pulse duration and penetration depth

We have pioneered what we believe is a novel method of stimulating cochlear neurons, using pulsed infrared radiation, based on the hypothesis that optical radiation can provide more spatially selective stimulation of the cochlea than electric current. Very little of the available optical parameter space has been used for optical stimulation of neurons. Here, we use a pulsed diode laser (1.94 microm) to stimulate auditory neurons of the gerbil. Radiant exposures measured at CAP threshold are similar for pulse durations of 5, 10, 30, and 100 micros, but greater for 300-micros-long pulses. There is evidence that water absorption of optical radiation is a significant factor in optical stimulation. Heat-transfer-based analysis of the data indicates that potential structures involved in optical stimulation of cochlear neurons have a dimension on the order of approximately 10 microm. The implications of these data could direct further research and design of an optical cochlear implant.

Reimplantation of hybrid cochlear implant users with a full-length electrode after loss of residual hearing

OBJECTIVE

To assess word recognition and pitch-scaling abilities of cochlear implant users first implanted with a Nucleus 10-mm Hybrid electrode array and then reimplanted with a full length Nucleus Freedom array after loss of residual hearing.

BACKGROUND

Although electroacoustic stimulation is a promising treatment for patients with residual low-frequency hearing,a small subset of them lose that residual hearing. It is not clear whether these patients would be better served by leaving in the 10-mm array and providing electric stimulation through it, or by replacing it with a standard full-length array.

METHODS

Word recognition and pitch-scaling abilities were measured in 2 users of hybrid cochlear implants who lost their residual hearing in the implanted ear after a few months. Tests were repeated over several months, first with a 10-mm array, and after, these patients were reimplanted with a full array. The word recognition task consisted of 2 50-word consonant nucleus consonant (CNC) lists. In the pitch-scaling task, 6 electrodes were stimulated in pseudorandom order, and patients assigned a pitch value to the sensation elicited by each electrode.

RESULTS

Shortly after reimplantation with the full electrode array, speech understanding was much better than with the 10-mm array. Patients improved their ability to perform the pitch-scaling task over time with the full array, although their performance on that task was variable, and the improvements were often small.

CONCLUSION

1) Short electrode arrays may help preserve residual hearing but may also provide less benefit than traditional cochlear implants for some patients. 2) Pitch percepts in response to electric stimulation may be modified by experience.

Optical stimulation of auditory neurons: effects of acute and chronic deafening

In developing neural prostheses, particular success has been realized with cochlear implants. These devices bypass damaged hair cells in the auditory system and electrically stimulate the auditory nerve directly. In contemporary cochlear implants, however, the injected electric current spreads widely along the scala tympani and across turns. Consequently, stimulation of spatially discrete spiral ganglion cell populations is difficult. In contrast to electrical stimulation, it has been shown that extremely spatially selective stimulation is possible using infrared radiation (e.g. [Izzo, A.D., Su, H.S., Pathria, J., Walsh Jr., J.T., Whitlon, D.S., Richter, C.-P., 2007a. Selectivity of neural stimulation in the auditory system: a comparison of optic and electric stimuli. J. Biomed. Opt. 12, 1-7]). Here, we explore the correlation between surviving spiral ganglion cells, following acute and chronic deafness induced by neomycin application into the middle ear, and neural stimulation using optical radiation and electrical current. In vivo experiments were conducted in gerbils. Before the animals were deafened, acoustic thresholds were obtained and neurons were stimulated with optical radiation at various pulse durations, radiation exposures, and pulse repetition rates. In one group of animals, measurements were made immediately after deafening, while the other group was tested at least four weeks after deafening. Deafness was confirmed by measuring acoustically evoked compound action potentials. Optically and electrically evoked compound action potentials and auditory brainstem responses were determined for different radiation exposures and for different electrical current amplitudes, respectively. After completion of the experiments, the animals were euthanized and the cochleae were harvested for histology. Acoustically evoked compound action potential thresholds were elevated by more than 40 dB after neomycin application in acutely deaf and more than 60 dB in chronically deaf animals. Compound action potential thresholds, which were determined with optical radiation pulses, were not significantly elevated in acutely deaf animals. However, in chronically deaf animals optically evoked CAP thresholds were elevated. Changes correlated with the number of surviving spiral ganglion cells and the optical parameters that were used for stimulation.

Pitch ranking of complex tones by normally hearing subjects and cochlear implant users

The ability of 10 normally hearing (NH) adults and eight cochlear implant (CI) users to pitch-rank pairs of complex tones was assessed. The acoustically presented stimuli differed in fundamental frequency (F0) by either one or six semitones (F0 range: 98 to 740 Hz). The NH group obtained significantly higher mean scores for both experiments: (NH: one semitone - 81.2%, six semitones - 89.0%; CI: one semitone - 49.0%, six semitones - 60.2%; p<0.001). Prior musical experience was found to be associated with higher pitch-ranking scores for the NH subjects. Those with musical experience ratings <3 obtained significantly lower scores for both interval sizes (p<0.001) than those with higher ratings. Nevertheless, the scores obtained by the musically inexperienced, NH adults were significantly higher than those obtained by the CI group for both the one-semitone (p=0.022) and six-semitone (p=0.018) intervals. These results suggest that the pitch information CI users obtain from their implant systems is less accurate than that obtained by NH listeners when listening to the same complex sounds. Furthermore, the relatively poor pitch-ranking ability of at least some CI users may be associated with a more-limited experience of music in general.

Optical parameter variability in laser nerve stimulation: a study of pulse duration, repetition rate, and wavelength

Pulsed lasers can evoke neural activity from motor as well as sensory neurons in vivo. Lasers allow more selective spatial resolution of stimulation than the conventional electrical stimulation. To date, few studies have examined pulsed, mid-infrared laser stimulation of nerves and very little of the available optical parameter space has been studied. In this study, a pulsed diode laser, with wavelength between 1.844-1.873 microm, was used to elicit compound action potentials (CAPs) from the auditory system of the gerbil. We found that pulse durations as short as 35 micros elicit a CAP from the cochlea. In addition, repetition rates up to 13 Hz can continually stimulate cochlear spiral ganglion cells for extended periods of time. Varying the wavelength and, therefore, the optical penetration depth, allowed different populations of neurons to be stimulated. The technology of optical stimulation could significantly improve cochlear implants, which are hampered by a lack of spatial selectivity.

Focused intracochlear electric stimulation with phased array channels

A method is described for producing focused intracochlear electric stimulation using an array of N electrodes. For each electrode site, N weights are computed that define the ratios of positive and negative electrode currents required to produce cancellation of the voltage within scala tympani at all of the N-1 other sites. Multiple sites can be stimulated simultaneously by superposition of their respective current vectors. The method allows N independent stimulus waveforms to be delivered to each of the N electrode sites without spatial overlap. Channel interaction from current spread associated with monopolar stimulation is substantially eliminated. The method operates by inverting the spread functions of individual monopoles as measured with the other electrodes. The method was implemented and validated with data from three human subjects implanted with 22-electrode perimodiolar arrays. Results indicate that (1) focusing is realizable with realistic precision; (2) focusing comes at the cost of increased total stimulation current; (3) uncanceled voltages that arise beyond the ends of the array are weak except when stimulating the two end channels; and (4) close perimodiolar positioning of the electrodes may be important for minimizing stimulation current and sensitivity to measurement errors.

Differences between electrode-assigned frequencies and cochlear implant recipient pitch perception

CONCLUSION

This study demonstrated an evident mismatch between frequencies assigned to electrodes and frequencies evoked by stimulation of those same electrodes in implanted patients. We propose that the mapping procedures should include, whenever possible, a comparison with homolateral residual hearing in order to obtain an appropriate frequency range assignation for each electrode.

OBJECTIVES

The study aimed to investigate the correspondence between the frequencies assigned to each electrode and those actually perceived by the cochlear implant patient.

PATIENTS AND METHODS

We studied five post-lingually deaf adults with detectable residual hearing in the implanted and in the contralateral ear, who had each received a Cochlear implant. An ACE standard setting was used for mapping. The patients were asked to match the electric pitch with the acoustic one following presentation of pure tones to both the implanted and the contralateral ear.

RESULTS

In almost all patients the two most apical electrodes evoked higher frequencies than those assigned by the mapping software (E22 = 188-313, E21 = 313-438 Hz). Therefore, electric stimulation seems not to determine pitch sensations for frequencies <500 Hz. For most electrodes there is no correspondence between the acoustic pitch and the assigned frequency ranges. Moreover, these results were almost always different when stimulating the implanted and the contralateral ear.

Selectivity of neural stimulation in the auditory system: a comparison of optic and electric stimuli

Pulsed, mid-infrared lasers were recently investigated as a method to stimulate neural activity. There are significant benefits of optically stimulating nerves over electrically stimulating, in particular the application of more spatially confined neural stimulation. We report results from experiments in which the gerbil auditory system was stimulated by optical radiation, acoustic tones, or electric current. Immunohistochemical staining for the protein c-FOS revealed the spread of excitation. We demonstrate a spatially selective activation of neurons using a laser; only neurons in the direct optical path are stimulated. This pattern of c-FOS labeling is in contrast to that after electrical stimulation. Electrical stimulation leads to a large, more spatially extended population of labeled, activated neurons. In the auditory system, optical stimulation of nerves could have a significant impact on the performance of cochlear implants, which can be limited by the electric current spread.

Threshold and channel interaction in cochlear implant users: evaluation of the tripolar electrode configuration

The efficacy of cochlear implants is limited by spatial and temporal interactions among channels. This study explores the spatially restricted tripolar electrode configuration and compares it to bipolar and monopolar stimulation. Measures of threshold and channel interaction were obtained from nine subjects implanted with the Clarion HiFocus-I electrode array. Stimuli were biphasic pulses delivered at 1020 pulses/s. Threshold increased from monopolar to bipolar to tripolar stimulation and was most variable across channels with the tripolar configuration. Channel interaction, quantified by the shift in threshold between single- and two-channel stimulation, occurred for all three configurations but was largest for the monopolar and simultaneous conditions. The threshold shifts with simultaneous tripolar stimulation were slightly smaller than with bipolar and were not as strongly affected by the timing of the two channel stimulation as was monopolar. The subjects' performances on clinical speech tests were correlated with channel-to-channel variability in tripolar threshold, such that greater variability was related to poorer performance. The data suggest that tripolar channels with high thresholds may reveal cochlear regions of low neuron survival or poor electrode placement.

Implications of deep electrode insertion on cochlear implant fitting

Using long Med-El Combi40+ electrode arrays, it is now possible to cover the whole range of the cochlea, up to about two turns. Such insertion depths have received little attention. To evaluate the contribution of deeply inserted electrodes, five Med-El cochlear implant users were tested on vowel and consonant identification tests with fittings with first one, two, and up to five apical electrodes being deactivated. In addition, subjects performed pitch-ranking experiments, using loudness-balanced stimuli, to identify electrodes creating pitch confusions. Radiographs were taken to measure each electrode insertion depth. All subjects used each modified fitting for two periods of about 3 weeks. During the experiment, the same stimulation rate and frequency range were maintained across all the fittings used for each individual subject. After each trial period the subject had to perform three consonant and three vowel identification tests. All subjects showed deep electrode insertions ranging from 605 degrees to 720 degrees. The two subjects with the deepest electrode insertions showed significantly increased vowel- and consonant-identification performances with fittings with the two or three most apical electrodes deactivated compared to their standard fitting with all available electrodes activated. The other three subjects did not show significant improvements in performance when one or two of their most apical electrodes were deactivated. Four out of five subjects preferred to continue use of a fitting with one or more apical electrodes deactivated. The two subjects with the deepest insertions also showed pitch confusions between their most apical electrodes. Two possible reasons for these results are discussed. One is to reduce neural interactions related to electrodes producing pitch confusions. Another is to improve the alignment of the frequency components of sounds coded by the electrical signals delivered to each electrode to the overall pitch of the auditory perception produced by the electrical stimulation of auditory nerve fibers.

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.

Effects of interaural time differences in fine structure and envelope on lateral discrimination in electric hearing

Bilateral cochlear implant (CI) listeners currently use stimulation strategies which encode interaural time differences (ITD) in the temporal envelope but which do not transmit ITD in the fine structure, due to the constant phase in the electric pulse train. To determine the utility of encoding ITD in the fine structure, ITD-based lateralization was investigated with four CI listeners and four normal hearing (NH) subjects listening to a simulation of electric stimulation. Lateralization discrimination was tested at different pulse rates for various combinations of independently controlled fine structure ITD and envelope ITD. Results for electric hearing show that the fine structure ITD had the strongest impact on lateralization at lower pulse rates, with significant effects for pulse rates up to 800 pulses per second. At higher pulse rates, lateralization discrimination depended solely on the envelope ITD. The data suggest that bilateral CI listeners benefit from transmitting fine structure ITD at lower pulse rates. However, there were strong interindividual differences: the better performing CI listeners performed comparably to the NH listeners.

Speech perception with mono- and quadrupolar electrode configurations: a crossover study

OBJECTIVE

To study the effect of two multipolar electrode configurations on speech perception, pitch perception, and the intracochlear electrical field.

STUDY DESIGN

Crossover design; within subject.

SETTING

Tertiary referral center.

PATIENTS

Eight experienced adult cochlear implant users.

INTERVENTION

Each subject used each of three experimental processors for 3 weeks. The following processors were compared that differed only in electrode configuration: 1) monopolar; 2) hybrid quadrupolar, in which half of the current returned to the extracochlear reference electrode and half to two electrodes immediately to the left and right of the active electrode; and 3) flat tripolar +2, which directed all the current to four reference electrodes (two on each side), separated from the active electrode by two inactive electrodes. All the processors used the standard Advanced Bionics HiRes speech-processing strategy, 12 channels, 1,220 pulses per second per channel, and with a pulse width of 33 (micros/phase).

RESULTS

The monopolar processors had the largest stimulation efficiency and the smallest dynamic range in linear current units. The reverse was true of flat tripolar +2 processor, whereas the hybrid quadrupolar processor fell in between. Insufficient loudness growth prevented the use of the flat tripolar +2 processor in three subjects. Word recognition did not differ between the clinically used 16-channel monopolar processor and the experimental monopolar processor, regardless of the differences in the number of channels, pulse rate, and duration of experience. Word recognition with the flat tripolar +2 processor was significantly poorer than with the monopolar and hybrid quadrupolar processors; monopolar and quadrupolar processors did not differ. There was no significant interaction between processor type and competing noise type (stationary or fluctuating), but performance at the higher level of fluctuating noise was best with the hybrid quadrupolar processor in almost all the subjects. Pitch scaling showed ceiling performance in five subjects and differed between processors in the two other subjects with imperfect tonotopy. Intracochlear current spread was considerable with the monopolar configuration; it was reduced with the hybrid quadrupolar configuration and virtually absent beyond the active electrodes with the tripolar configuration.

CONCLUSION

More confined configurations reduced the longitudinal width of the electrical field, which was expected to enhance channel separation, but no improvement in word recognition was found. More research is needed to test confined configurations that have enhanced efficiency and to evaluate the fundamental effects of configuration on channel discriminability.

Acoustic to electric pitch comparisons in cochlear implant subjects with residual hearing

The aim of this study was to assess the frequency-position function resulting from electric stimulation of electrodes in cochlear implant subjects with significant residual hearing in their nonimplanted ear. Six cochlear implant users compared the pitch of the auditory sensation produced by stimulation of an intracochlear electrode to the pitch of acoustic pure tones presented to their contralateral nonimplanted ear. Subjects were implanted with different Clarion electrode arrays, designed to lie close to the inner wall of the cochlea. High-resolution radiographs were used to determine the electrode positions in the cochlea. Four out of six subjects presented electrode insertions deeper than 450 degrees . We used a two-interval (one acoustic, one electric), two-alternative forced choice protocol (2I-2AFC), asking the subject to indicate which stimulus sounded the highest in pitch. Pure tones were used as acoustic stimuli. Electric stimuli consisted of trains of biphasic pulses presented at relatively high rates [higher than 700 pulses per second (pps)]. First, all electric stimuli were balanced in loudness across electrodes. Second, acoustic pure tones, chosen to approximate roughly the pitch sensation produced by each electrode, were balanced in loudness to electric stimuli. When electrode insertion lengths were used to describe electrode positions, the pitch sensations produced by electric stimulation were found to be more than two octaves lower than predicted by Greenwood's frequency-position function. When insertion angles were used to describe electrode positions, the pitch sensations were found about one octave lower than the frequency-position function of a normal ear. The difference found between both descriptions is because of the fact that these electrode arrays were designed to lie close to the modiolus. As a consequence, the site of excitation produced at the level of the organ of Corti corresponds to a longer length than the electrode insertion length, which is used in Greenwood's function. Although exact measurements of the round window position as well as the length of the cochlea could explain the remaining one octave difference found when insertion angles were used, physiological phenomena (e.g., stimulation of the spiral ganglion cells) could also create this difference. From these data, analysis filters could be determined in sound coding strategies to match the pitch percepts elicited by electrode stimulation. This step might be of main importance for music perception and for the fitting of bilateral cochlear implants.

Dual electrode stimulation using the nucleus CI24RE cochlear implant: electrode impedance and pitch ranking studies

OBJECTIVE

The first aim of the study was to determine the reduction in electrode impedances using dual electrode stimulation compared with single electrode stimulation in the new Nucleus CI24RE receiver-stimulator. The CI24RE is connected to the Nucleus 22-electrode intracochlear array. Dual electrode stimulation is produced by electrically coupling two adjacent single electrodes. The second aim was to determine whether dual electrode stimulation produced pitch percepts that were intermediate to the pitch of the two adjacent single electrodes.

DESIGN

Eight postlingually hearing-impaired adults with severe to profound loss, implanted with the CI24RE, participated in the study. Electrode impedances were measured by using the standard telemetry function of the system. A pitch ranking task was used to measure pitch for dual and single electrodes. Seven sets of three electrodes along the electrode array were tested. Each set of electrodes consisted of a dual electrode and the two adjacent single electrodes. Pitch ranking was measured using a two-alternative forced choice procedure, with the three electrodes in each set paired with each other as AB and BA pairs. The subject indicated which of the two stimuli had the higher pitch. Random variation in current level was used to remove any loudness cues.

RESULTS

The average electrode impedance was 38.6% lower for dual electrodes compared with single electrodes. Three subjects were able to successfully rank the three electrodes in each set in the expected tonotopic order for all seven sets of electrodes along the array. Three other subjects were able to rank sets of electrodes in the tonotopic order for most of the tested positions on the array. The remaining two subjects gave more variable pitch ranking across positions along the array, although successful tonotopic ranking was demonstrated for several sets of electrodes.

CONCLUSIONS

Dual electrode stimulation with the CI24RE receiver-stimulator produced systematically lower electrode impedances and was capable of producing pitch percepts that were intermediate to those produced by the corresponding adjacent single electrodes. This makes available up to 43 channels of stimulation from 22 single electrodes.

Psychophysical measures in patients fitted with Contour™ and straight Nucleus electrode arrays

The objective of this study was to compare the psychophysical performance of patients using the Nucleus Contour electrode array with that of patients using the straight banded-electrode array. In particular, we wished to consider how psychophysical parameters would differ for an electrode array positioned closer to the modiolus, and how this might influence both patient benefits and the design of speech processing strategies. Nine subjects participated in the study: four used the Nucleus straight array and five used the Nucleus Contour electrode array. Radiographic analyses found that the Contour array lay closer to the modiolus, was more deeply inserted and spanned a larger fractional length of the basilar membrane than the straight banded-electrode array. The results were analysed in terms of array type and of the position of the individual electrode band, both distance from the modiolus and longitudinal placement. Mean threshold was lower for the Contour array but maximum comfortable level was similar. Whereas threshold varied significantly with distance of electrode band from the modiolus, maximum comfortable level did not. Pitch varied fairly regularly with longitudinal position of the stimulated electrode, with the exception of one Contour subject. The forward masking profiles, using moderately loud maskers, were narrower for the Contour array, indicative of more localized neural excitation.

Music perception with cochlear implants: a review

The acceptance of cochlear implantation as an effective and safe treatment for deafness has increased steadily over the past quarter century. The earliest devices were the first implanted prostheses found to be successful in compensating partially for lost sensory function by direct electrical stimulation of nerves. Initially, the main intention was to provide limited auditory sensations to people with profound or total sensorineural hearing impairment in both ears. Although the first cochlear implants aimed to provide patients with little more than awareness of environmental sounds and some cues to assist visual speech-reading, the technology has advanced rapidly. Currently, most people with modern cochlear implant systems can understand speech using the device alone, at least in favorable listening conditions. In recent years, an increasing research effort has been directed towards implant users' perception of nonspeech sounds, especially music. This paper reviews that research, discusses the published experimental results in terms of both psychophysical observations and device function, and concludes with some practical suggestions about how perception of music might be enhanced for implant recipients in the future. The most significant findings of past research are: (1) On average, implant users perceive rhythm about as well as listeners with normal hearing; (2) Even with technically sophisticated multiple-channel sound processors, recognition of melodies, especially without rhythmic or verbal cues, is poor, with performance at little better than chance levels for many implant users; (3) Perception of timbre, which is usually evaluated by experimental procedures that require subjects to identify musical instrument sounds, is generally unsatisfactory; (4) Implant users tend to rate the quality of musical sounds as less pleasant than listeners with normal hearing; (5) Auditory training programs that have been devised specifically to provide implant users with structured musical listening experience may improve the subjective acceptability of music that is heard through a prosthesis; (6) Pitch perception might be improved by designing innovative sound processors that use both temporal and spatial patterns of electric stimulation more effectively and precisely to overcome the inherent limitations of signal coding in existing implant systems; (7) For the growing population of implant recipients who have usable acoustic hearing, at least for low-frequency sounds, perception of music is likely to be much better with combined acoustic and electric stimulation than is typical for deaf people who rely solely on the hearing provided by their prostheses.

Pitch ranking ability of cochlear implant recipients: a comparison of sound-processing strategies

Pitch ranking of sung vowel stimuli, separated in fundamental frequency (F0) by half an octave, was measured with a group of eleven Nucleus 24 cochlear implant recipients using different sound coding strategies. In three consecutive studies, either two or three different sound coding strategies were compared to the Advanced Combinational Encoder (ACE) strategy. These strategies included Continuous Interleaved Sampling (CIS), Peak Derived Timing (PDT), Modulation Depth Enhancement (MDE), F0 Synchronized ACE (FOSync), and Multi-channel Envelope Modulation (MEM), the last four being experimental strategies. While pitch ranking results on average were poor compared to those expected for most normal hearing listeners, significantly higher scores were obtained using the MEM, MDE, and FOSync strategies compared to ACE. These strategies enhanced coding of temporal F0 cues by providing deeper modulation cues to F0 coincidentally in time across all activated electrodes. In the final study, speech recognition tests were also conducted using ACE, CIS, MDE, and MEM. Similar results among all strategies were obtained for word tests in quiet and between ACE and MEM for sentence tests in noise. These findings demonstrate that strategies such as MEM may aid perception of pitch and still adequately code segmental speech features as per existing coding strategies.

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.

Effects of cochlear-implant pulse rate and inter-channel timing on channel interactions and thresholds

Interactions among the multiple channels of a cochlear prosthesis limit the number of channels of information that can be transmitted to the brain. This study explored the influence on channel interactions of electrical pulse rates and temporal offsets between channels. Anesthetized guinea pigs were implanted with 2-channel scala-tympani electrode arrays, and spike activity was recorded from the auditory cortex. Channel interactions were quantified as the reduction of the threshold for pulse-train stimulation of the apical channel by sub-threshold stimulation of the basal channel. Pulse rates were 254 or 4069 pulses per second (pps) per channel. Maximum threshold reductions averaged 9.6 dB when channels were stimulated simultaneously. Among nonsimultaneous conditions, threshold reductions at the 254-pps rate were entirely eliminated by a 1966-micros inter-channel offset. When offsets were only 41 to 123 micros, however, maximum threshold shifts averaged 3.1 dB, which was comparable to the dynamic ranges of cortical neurons in this experimental preparation. Threshold reductions at 4069 pps averaged up to 1.3 dB greater than at 254 pps, which raises some concern in regard to high-pulse-rate speech processors. Thresholds for various paired-pulse stimuli, pulse rates, and pulse-train durations were measured to test possible mechanisms of temporal integration.

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.

Across-site variation in detection thresholds and maximum comfortable loudness levels for cochlear implants

In cochlear implants, variation across stimulation sites in psychophysical detection thresholds (T levels) and maximum comfortable loudness levels (C levels) can be large when narrow-bipolar (BP) stimulation is used. This across-site variation is typically smaller when monopolar (MP) stimulation is used. At least two models can account for across-site variation and the effects of electrode configuration on the magnitude of the variation. According to one model, across-site variation reflects site-to-site differences in the distances between the stimulating electrodes and the sites of action-potential initiation. Under this model, the lower across-site variation with MP stimulation is due to shallower current versus distance gradients. An alternative model assumes that T and C levels depend on integration of activity across the whole population of neurons and that MP stimulation activates neurons over a larger spatial extent than does BP stimulation. If T and C levels are determined by integration of activity across large overlapping populations of neurons, then their values at adjacent sites should be more similar than if these levels result from integration across smaller, more independent populations. We tested the models by examining the effects on across-site variation of three variables believed to affect the spatial extent of activation: electrode configuration, stimulus level within the dynamic range, and electrode-array design. T levels and C levels were measured in 13 subjects with Nucleus CI24M (straight array) and 9 subjects with Nucleus CI24R(CS) (Contour) cochlear implants using bipolar (BP) and monopolar (MP) electrode configurations. Site-to-site variation in T and C levels for BP stimulation was 2.1-3.3 times larger than that for MP stimulation. Contrary to the across-neuron integration hypothesis, no significant differences were found between across-site variation for T levels and that for C levels for the BP configuration. There was considerable overlap in site-to-site variation values for the two types of implants but mean site-to-site variation in C levels for CI24M implants was significantly lower than that for CI24R(CS) implants. Control studies suggested that these results were not an artifact of the scale, and not due to differences in inherent variability of the psychophysical measures, or to the method of quantifying across-site variation.

Electrical field interactions in different cochlear implant systems

The goal of this study was to evaluate electrical field interactions produced by the stimulation of different types of intracochlear electrodes in 12 adult subjects (three Ineraid, four Clarion S-Series, three S-Series with the electrode positioning system-EPS and two Clarion HiFocus-I with the EPS). Psychophysical measurements were conducted with biphasic stimuli (813 pulse per second, 153.8 micros/phase). "Perturbation" signals (300 ms) were applied to one electrode chosen at the middle of the array and their effects on detection thresholds of "probe" signals (30 ms) were measured on the neighbor basal electrode. Perturbation levels were set below the detection threshold of the perturbation electrode (-2 dB re threshold). Measurements were first conducted for simultaneous stimulation of the probe and of the perturbation electrodes, for monopolar for all subjects and for bipolar stimulus configurations for both Clarion HiFocus-I subjects. The tested Clarion electrodes did not present lower monopolar interactions than the Ineraid electrodes. Nevertheless, considering the shorter distance between electrodes for the Clarion than for the Ineraid, the tested Clarion electrodes might be more selective than the Ineraid. We did not find any significant monopolar electrical field-interaction differences between subjects who received the S-Series array with and without the EPS. We did not find lower interactions for both subjects who received the HiFocus-I array than for subjects who received the S-Series. Electrical field interactions were lower for bipolar than for monopolar configurations for both HiFocus-I subjects. A second set of measurements was conducted for nonsimultaneous stimulation similar to the one used in continuous interleaved sampling sound strategy. These measurements showed that interactions evaluated for simultaneous biphasic stimuli were larger than for nonsimultaneous stimulation.

The effect of channel interactions on speech recognition in cochlear implant subjects: predictions from an acoustic model

Acoustic models that produce speech signals with information content similar to that provided to cochlear implant users provide a mechanism by which to investigate the effect of various implant-specific processing or hardware parameters independent of other complicating factors. This study compares speech recognition of normal-hearing subjects listening through normal and impaired acoustic models of cochlear implant speech processors. The channel interactions that were simulated to impair the model were based on psychophysical data measured from cochlear implant subjects and include pitch reversals, indiscriminable electrodes, and forward masking effects. In general, spectral interactions degraded speech recognition more than temporal interactions. These effects were frequency dependent with spectral interactions that affect lower-frequency information causing the greatest decrease in speech recognition, and interactions that affect higher-frequency information having the least impact. The results of this study indicate that channel interactions, quantified psychophysically, affect speech recognition to different degrees. Investigation of the effects that channel interactions have on speech recognition may guide future research whose goal is compensating for psychophysically measured channel interactions in cochlear implant subjects.

The perception of Cantonese lexical tones by early-deafened cochlear implantees

This study investigated whether cochlear implant users can identify Cantonese lexical tones, which differ primarily in their F0 pattern. Seventeen early-deafened deaf children (age= 4 years, 6 months to 8 years, 11 months; postoperative period= 11-41 months) took part in the study. Sixteen children were fitted with the Nucleus 24 cochlear implant system; one child was fitted with a Nucleus 22 implant. Participants completed a 2AFC picture identification task in which they identified one of the six contrastive Cantonese tones produced on the monosyllabic target word /ji/. Each target stimulus represented a concrete object and was presented within a carrier phrase in sentence-medial position. Group performance was significantly above chance for three contrasts. However, the cochlear implant listeners performed much worse than a 6 1/2-year-old, moderately hearing impaired control listener who was tested on the same task. These findings suggest that this group of cochlear implant users had great difficulty in extracting the pitch information needed to accurately identify Cantonese lexical tones.

The results in patients implanted with the nucleus double array cochlear implant: pitch discrimination and auditory performance

OBJECTIVE

In patients with total or surgically inaccessible cochlear obliteration, only a reduced number of active electrodes can be inserted with standard cochlear implants, resulting in below average auditory performance. Therefore, a special implant with two electrode arrays was developed on the basis of the Nucleus 22 cochlear implant, the socalled Double Array. One electrode array with 11 active electrodes is inserted into the basal turn of the cochlea, while the second array with 10 active electrodes is inserted into the second turn. The Double Array is now available on the basis of the more advanced Nucleus 24 with 11 active electrodes on each array and two reference electrodes, one at the case and the second one an additional ball electrode, which is placed under the temporalis muscle. For device description and surgical technique see Lenarz et al. (2001). This paper presents psychophysical data on pitch discrimination and auditory performance of patients implanted with a Double Array on the basis of the Nucleus 22.

STUDY DESIGN

A prospective intra-individual study using a Latin square paradigm was performed in six adult patients with obliterated cochlea who received the Nucleus 22 Double Array. After appropriate fitting and loudness balancing, patients were tested either with the basal, the apical or both electrode arrays. Apart from auditory performance tests including numbers and monosyllable word tests, pitch discrimination was determined with a defined procedure.

RESULTS

When activating each array alone, auditory performance was better with the basal array than with the apical array. Both arrays together showed marked improvement compared with the basal array, indicating an additional effect of the second array. Pitch discrimination was significantly better for the electrodes in the basal turn than in the second turn, indicating differences in electrical excitation of the auditory nerve fibers. Pitch discrimination was positively correlated with auditory performance data.

CONCLUSION

The additional apical array leads to significant improvement in auditory performance in patients with obliterated cochleae by increasing the number of intracochlear electrodes. Despite reduced pitch discrimination, the apical array provides important information for speech recognition. For this reason the Double Array provides a profound advantage for patients with obliterated or surgically inaccessible cochleae.

Auditory cortical images of cochlear-implant stimuli: dependence on electrode configuration

This study examines patterns of auditory cortical activity elicited by single-pulse cochlear implant stimuli that vary in electrode configuration, cochlear place of stimulation, and stimulus level. Recordings were made from the primary auditory cortex (area A1) of ketamine-anesthetized guinea pigs. The spatiotemporal pattern of neural spike activity was measured simultaneously across 16 cortical locations spanning approximately 2-3 octaves of the tonotopic axis. Such a pattern, averaged over 40 presentations of any particular stimulus, was defined as the "cortical image" of that stimulus. Acutely deafened guinea pigs were implanted with a 6-electrode animal version of the 22-electrode Nucleus banded electrode array (Cochlear). Cochlear electrode configurations consisted of monopolar (MP), bipolar (BP + N) with N inactive electrodes between the active and return electrodes (0 < or = N < or = 4), tripolar (TP) with one active electrode and two flanking return electrodes, and common ground (CG) with one active electrode and as many as five return electrodes. Cortical images typically showed a focus of maximum spike probability and minimum latency. Spike probabilities tended to decrease, and latencies tended to increase, with increasing cortical distance from that focus. Cortical images of TP stimuli were the most spatially compact, followed by BP + N images, and then MP images, which were the broadest. Images of CG stimuli were rather variable across animals and stimulus channels. The locations of cortical images shifted systematically from caudal to rostral as the cochlear place of stimulation changed from basal to apical. At the most sensitive cortical site for each condition, the dynamic ranges over which spike rates increased with increased current level were restricted to about 1-2 dB, regardless of configuration. Dynamic ranges tended to increase with increasing cortical distance from the most sensitive site. Electrode configurations that produced compact cortical images (e.g., TP and BP + 0) showed the greatest range of thresholds within each cortical image and the largest dynamic range at cortical sites removed from the most sensitive site.

Auditory cortical images of cochlear-implant stimuli: coding of stimulus channel and current level

This study quantified the accuracy with which populations of neurons in the auditory cortex can represent aspects of electrical cochlear stimuli presented through a cochlear implant. We tested the accuracy of coding of the place of stimulation (i.e., identification of the active stimulation channel) and of the stimulus current level. Physiological data came from the companion study, which recorded spike activity of neurons simultaneously from 16 sites along the tonotopic axis of the guinea pig's auditory cortex. In that study, cochlear electrical stimuli were presented to acutely deafened animals through a 6-electrode animal version of the 22-electrode Nucleus banded electrode array (Cochlear). Cochlear electrode configurations consisted of monopolar (MP), bipolar (BP + N) with N inactive electrodes between the active and return electrodes (0 < or = N < or = 3), tripolar (TP) with one active electrode and two flanking return electrodes, and common ground (CG) with one active electrode and as many as five return electrodes. In the present analysis, an artificial neural network was trained to recognize spatiotemporal patterns of cortical activity in response to single presentations of particular stimuli and, thereby, to identify those stimuli. The accuracy of pair-wise discrimination of stimulation channels or of current levels was represented by the discrimination index, d', where d' = 1 was taken as threshold. In many cases, the threshold for discrimination of place of cochlear stimulation was < 0.75 mm, and the threshold for discrimination of current levels was < 1 dB. Cochlear electrode configurations varied in the accuracy with which they signaled to the auditory cortex the place of cochlear stimulation. The BP + N and TP configurations provided considerably greater sensitivity to place of stimulation than did the MP configuration. The TP configuration maintained accurate signaling of place of stimulation up to the highest current levels, whereas sensitivity was degraded at high current levels in BP + N configurations. Electrode configurations also varied in the dynamic range over which they signaled stimulus current level. Dynamic ranges were widest for the BP + 0 configuration and narrowest for the TP configuration. That is, the configuration that showed the most accurate signaling of cochlear place of stimulation (TP) showed the most restricted dynamic range for signaling of current level. These results suggest that the choice of the optimal electrode configuration for use by human cochlear-prosthesis users would depend on the particular demands of the speech-processing strategy that is to be employed.

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.

Relative importance of rate and place: experiments using pitch scaling techniques with cochlear implants recipients

Pitch scaling was used to determine the dependence of perceived pitch on rate and place of stimulation in postlingually deafened adult subjects using cochlear implants. For stimulation rates below about 500 pulses per second (pps), perceived pitch is a strong function of both rate and place. In this range, perceived pitch increases logarithmically with stimulation rate, but decreases with distance from the round window. A 2-mm displacement into the cochlea has an effect similar to that of halving the stimulation rate. Place resolution in this context is comparable with the interelectrode spacing (0.75 mm). At rates approaching 1,000 pps, rate has little effect on perceived pitch. An average of bipolar quality judgments showed that periodic pulsatile stimulation is least pleasant when low frequencies are applied to the region closest to the window.