Investigation of the effects of temporal and spatial interactions on speech-recognition skills in cochlear-implant subjects

Speech performance in adults with cochlear implants using combined channel deactivation and dynamic current focusing

OBJECTIVES AND METHODS

Cochlear implant listeners show difficulties in understanding speech in noise. Channel interactions from activating overlapping neural populations reduce the signal accuracy necessary to interpret complex signals. Optimizing programming strategies based on focused detection thresholds to reduce channel interactions has led to improved performance. In the current study, two previously suggested methods, channel deactivation and focused dynamic tripolar stimulation, were combined. Utilizing an automatic channel selection algorithm from focused detection threshold profiles, three cochlear implant programs were created with the same deactivated channels but varying proportions of channels employing focused stimulation, monopolar, dynamic focused and a mixed program. Thirteen ears in eleven adult cochlear implant listeners with Advanced Bionics HiRes90k devices were tested. Vowel identification and sentence perception in quiet and noise served as outcome measures, and the influences of listening experience, age, clinical consonant-nucleus-consonant performance, and perceptual thresholds on speech performance were assessed.

RESULTS

Across subjects, different degrees of focusing showed individual performance improvements for vowels and sentences over the monopolar program. Focused listening benefits were shown for individuals with less cochlear implant experience, and clinically poor performers seem to benefit more from focusing than good performers. However, only slight trends and no significant group improvements were observed.

CONCLUSION

The current findings suggest that deactivating and focusing subsets of channels might improve speech performance for some individuals, especially poor performers, a possible effect of reduced channel interactions. The findings also show that performance is largely variable among individuals.

Spread of activation and interaction between channels with multi-channel optogenetic stimulation in the mouse cochlea

For individuals with severe to profound hearing loss resulting from irreversibly damaged hair cells, cochlear implants can be used to restore hearing by delivering electrical stimulation directly to the spiral ganglion neurons. However, current spread lowers the spatial resolution of neural activation. Since light can be easily confined, optogenetics is a technique that has the potential to improve the precision of neural activation, whereby visible light is used to stimulate neurons that are modified with light-sensitive opsins. This study compares the spread of neural activity across the inferior colliculus of the auditory midbrain during electrical and optical stimulation in the cochlea of acutely deafened mice with opsin-modified spiral ganglion neurons (H134R variant of the channelrhodopsin-2). Monopolar electrical stimulation was delivered via each of four 0.2 mm wide platinum electrode rings at 0.6 mm centre-to-centre spacing, whereas 453 nm wavelength light was delivered via each of five 0.22 × 0.27 mm micro-light emitting diodes (LEDs) at 0.52 mm centre-to-centre spacing. Channel interactions were also quantified by threshold changes during simultaneous stimulation by pairs of electrodes or micro-LEDs at different distances between the electrodes (0.6, 1.2 and 1.8 mm) or micro-LEDs (0.52, 1.04, 1.56 and 2.08 mm). The spread of activation resulting from single channel optical stimulation was approximately half that of monopolar electrical stimulation as measured at two levels of discrimination above threshold (p<0.001), whereas there was no significant difference between optical stimulation in opsin-modified deafened mice and pure tone acoustic stimulation in normal-hearing mice. During simultaneous micro-LED stimulation, there were minimal channel interactions for all micro-LED spacings tested. For neighbouring micro-LEDs/electrodes, the relative influence on threshold was 13-fold less for optical stimulation compared electrical stimulation (p<0.05). The outcomes of this study show that the higher spatial precision of optogenetic stimulation results in reduced channel interaction compared to electrical stimulation, which could increase the number of independent channels in a cochlear implant. Increased spatial resolution and the ability to activate more than one channel simultaneously could lead to better speech perception in cochlear implant recipients.

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

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

Listening to speech with a guinea pig-to-human brain-to-brain interface

Nicolelis wrote in his 2003 review on brain-machine interfaces (BMIs) that the design of a successful BMI relies on general physiological principles describing how neuronal signals are encoded. Our study explored whether neural information exchanged between brains of different species is possible, similar to the information exchange between computers. We show for the first time that single words processed by the guinea pig auditory system are intelligible to humans who receive the processed information via a cochlear implant. We recorded the neural response patterns to single-spoken words with multi-channel electrodes from the guinea inferior colliculus. The recordings served as a blueprint for trains of biphasic, charge-balanced electrical pulses, which a cochlear implant delivered to the cochlear implant user’s ear. Study participants completed a four-word forced-choice test and identified the correct word in 34.8% of trials. The participants' recognition, defined by the ability to choose the same word twice, whether right or wrong, was 53.6%. For all sessions, the participants received no training and no feedback. The results show that lexical information can be transmitted from an animal to a human auditory system. In the discussion, we will contemplate how learning from the animals might help developing novel coding strategies.

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

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

Channel Interaction During Infrared Light Stimulation in the Cochlea

BACKGROUND AND OBJECTIVES

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

STUDY DESIGN/MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

A computational study to model the effect of electrode-to-auditory nerve fiber distance on spectral resolution in cochlear implant

Spectral ripple discrimination (SRD) has been widely used to evaluate the spectral resolution in cochlear implant (CI) recipients based on its strong correlation with speech perception performance. However, despite its usefulness for predicting speech perception outcomes, SRD performance exhibits large across-subject variabilities even among subjects implanted with the same CIs and sound processors. The potential factors of this observation include current spread, nerve survival, and CI mapping. Previous studies have found that the spectral resolution reduces with increasing distance of the stimulation electrode from the auditory nerve fibers (ANFs), attributable to increasing current spread. However, it remains unclear whether the spread of excitation is the only cause of the observation, or whether other factors such as temporal interaction also contribute to it. In this study, we used a computational model to investigate channel interaction upon non-simultaneous stimulation with respect to the electrode-ANF distance, and evaluated the SRD performance for five electrode-ANF distances. The SRD performance was determined based on the similarity between two neurograms in response to standard and inverted stimuli and used to evaluate the spectral resolution in the computational model. The spread of excitation was observed to increase with increasing electrode-ANF distance, consistent with previous findings. Additionally, the preceding pulses delivered from neighboring channels induced a channel interaction that either inhibited or facilitated the neural responses to subsequent pulses depending on the electrode-ANF distance. The SRD performance was also found to decrease with increasing electrode-ANF distance. The findings of this study suggest that variation of the neural responses (inhibition or facilitation) with the electrode-ANF distance in CI users may cause spectral smearing, and hence poor spectral resolution. A computational model such as that used in this study is a useful tool for understanding the neural factors related to CI outcomes, such as cannot be accomplished by behavioral studies alone.

Consonant and Vowel Identification in Cochlear Implant Users Measured by Nonsense Words: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this systematic review and meta-analysis was to establish a baseline of the vowel and consonant identification scores in prelingually and postlingually deaf users of multichannel cochlear implants (CIs) tested with consonant-vowel-consonant and vowel-consonant-vowel nonsense syllables.

METHOD

Six electronic databases were searched for peer-reviewed articles reporting consonant and vowel identification scores in CI users measured by nonsense words. Relevant studies were independently assessed and screened by 2 reviewers. Consonant and vowel identification scores were presented in forest plots and compared between studies in a meta-analysis.

RESULTS

Forty-seven articles with 50 studies, including 647 participants, thereof 581 postlingually deaf and 66 prelingually deaf, met the inclusion criteria of this study. The mean performance on vowel identification tasks for the postlingually deaf CI users was 76.8% (N = 5), which was higher than the mean performance for the prelingually deaf CI users (67.7%; N = 1). The mean performance on consonant identification tasks for the postlingually deaf CI users was higher (58.4%; N = 44) than for the prelingually deaf CI users (46.7%; N = 6). The most common consonant confusions were found between those with same manner of articulation (/k/ as /t/, /m/ as /n/, and /p/ as /t/).

CONCLUSIONS

The mean performance on consonant identification tasks for the prelingually and postlingually deaf CI users was found. There were no statistically significant differences between the scores for prelingually and postlingually deaf CI users. The consonants that were incorrectly identified were typically confused with other consonants with the same acoustic properties, namely, voicing, duration, nasality, and silent gaps. A univariate metaregression model, although not statistically significant, indicated that duration of implant use in postlingually deaf adults predict a substantial portion of their consonant identification ability. As there is no ceiling effect, a nonsense syllable identification test may be a useful addition to the standard test battery in audiology clinics when assessing the speech perception of CI users.

Current Focusing to Reduce Channel Interaction for Distant Electrodes in Cochlear Implant Programs

Speech understanding abilities are highly variable among cochlear implant (CI) listeners. Poor electrode-neuron interfaces (ENIs) caused by sparse neural survival or distant electrode placement may lead to increased channel interaction and reduced speech perception. Currently, it is not possible to directly measure neural survival in CI listeners; therefore, obtaining information about electrode position is an alternative approach to assessing ENIs. This information can be estimated with computerized tomography (CT) imaging; however, postoperative CT imaging is not often available. A reliable method to assess channel interaction, such as the psychophysical tuning curve (PTC), offers an alternative way to identify poor ENIs. This study aimed to determine (a) the within-subject relationship between CT-estimated electrode distance and PTC bandwidths, and (b) whether using focused stimulation on channels with suspected poor ENI improves vowel identification and sentence recognition. In 13 CI listeners, CT estimates of electrode-to-modiolus distance and PTCs bandwidths were measured for all available electrodes. Two test programs were created, wherein a subset of electrodes used focused stimulation based on (a) broad PTC bandwidth (Tuning) and (b) far electrode-to-modiolus distance (Distance). Two control programs were also created: (a) Those channels not focused in the Distance program (Inverse-Control), and (b) an all-channel monopolar program (Monopolar-Control). Across subjects, scores on the Distance and Tuning programs were significantly higher than the Inverse-Control program, and similar to the Monopolar-Control program. Subjective ratings were similar for all programs. These findings suggest that focusing channels suspected to have a high degree of channel interaction result in quite different outcomes, acutely.

The Electrically Evoked Compound Action Potential: From Laboratory to Clinic

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

Spectro-temporal cues enhance modulation sensitivity in cochlear implant users

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

Effects of stimulus level and rate on psychophysical thresholds for interleaved pulse trains in cochlear implants

This study examined channel interactions using interleaved pulse trains to assess masking and potential facilitative effects in cochlear-implant recipients using clinically relevant stimuli. Psychophysical thresholds were measured for two adjacent mid-array electrodes; one served as the masker and the other as the probe. Two rates representative of those found in present-day strategies were tested: 1700 and 3400 pulses per second per channel. Four masker levels ranging from sub-threshold to loud-but-comfortable were tested. It was hypothesized that low-level maskers would produce facilitative effects, shifting to masking effects at high levels, and that faster rates would yield smaller masking effects due to greater stochastic neural firing patterns. Twenty-nine ears with Cochlear or Advanced Bionics devices were tested. High-level maskers produced more masking than low-level maskers, as expected. Facilitation was not observed for sub-threshold or threshold-level maskers in most cases. High masker levels yielded reduced probe thresholds for two Advanced Bionics subjects. This was partly eliminated with a longer temporal offset between each masker-probe pulse pair, as was used with Cochlear subjects. These findings support the use of temporal gaps between stimulation of subsequent electrodes to reduce channel interactions.

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

BACKGROUND

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

NEW METHOD

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

RESULTS

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

COMPARISON WITH EXISTING METHODS

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

CONCLUSIONS

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

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Exploring the Source of Neural Responses of Different Latencies Obtained from Different Recording Electrodes in Cochlear Implant Users

In this study we measured the electrically evoked compound action potential (ECAP) from different recording electrodes in the cochlea. Under the assumption that different response latencies may be the result of differences in the neural population contributing to the response, we assessed the relationship between neural response latency and spread of excitation. First, we evaluated changes in N1 latency when the recording electrode site was varied. Second, we recorded channel interaction functions using a forward masking technique but with recording electrodes at different intracochlear locations. For most individuals, N1 latency was similar across recording electrodes. However, reduced N1 latencies were observed in 21% of cochlear implant users when ECAPs were recorded using a remote recording electrode. We hypothesized that if recordings from different electrodes represented contributions from different populations of neurons, then one might expect that channel interaction functions would be different. However, we did not observe consistent differences in channel interaction functions (neither peak location nor breadth of the functions), and further, any variation in channel interaction functions was not correlated with ECAP latency. These results suggest that ECAPs from different recording electrodes with different latencies originate from similar neural populations.

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.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Using temporal modulation sensitivity to select stimulation sites for processor MAPs in cochlear implant listeners

Previous studies in our laboratory showed that temporal acuity as assessed by modulation detection thresholds (MDTs) varied across activation sites and that this site-to-site variability was subject specific. Using two 10-channel MAPs, the previous experiments showed that processor MAPs that had better across-site mean (ASM) MDTs yielded better speech recognition than MAPs with poorer ASM MDTs tested in the same subject. The current study extends our earlier work on developing more optimal-fitting strategies to test the feasibility of using a site-selection approach in the clinical domain. This study examined the hypothesis that revising the clinical speech processor MAP for cochlear implant (CI) recipients by turning off selected sites that have poorer temporal acuity and reallocating frequencies to the remaining electrodes would lead to improved speech recognition. Twelve CI recipients participated in the experiments. We found that site selection procedure based on MDTs in the presence of a masker resulted in improved performance on consonant recognition and recognition of sentences in noise. In contrast, vowel recognition was poorer with the experimental MAP than with the clinical MAP, possibly due to reduced spectral resolution when sites were removed from the experimental MAP. Overall, these results suggest a promising path for improving recipient outcomes using personalized processor-fitting strategies based on a psychophysical measure of temporal acuity.

Place specificity of monopolar and tripolar stimuli in cochlear implants: the influence of residual masking

This experiment investigated whether place specificity of neural activity evoked by cochlear implant stimulation is improved in tripolar compared to monopolar mode using a forward masking protocol addressing some limitations of previous methods of measurement and analysis. The amount of residual masking (masking remaining at long masker-probe delays) was also measured, and its potential influence on the specificity measures was evaluated. The masker stimulus comprised equally loud interleaved mono- or tripolar stimulation on two electrodes equidistant from a central probe electrode in an apical and basal direction, reducing the influence of off-site listening. The effect of masker-probe distance on the threshold shift of the tripolar probe was analyzed to derive a measure of place specificity. On average, tripolar maskers were more place specific than monopolar maskers, although the mean effect was small. There was no significant effect of masker level on specificity or on the differences observed between modes. The mean influence of residual masking on normalized masking functions was similar for the two modes and, therefore, did not influence the comparison of specificity between the modes. However, variability in amount of residual masking was observed between subjects, and therefore should be considered in forward masking studies that compare place specificity across subjects.

Localization in reverberation with cochlear implants: predicting performance from basic psychophysical measures

Users of bilateral cochlear implants (CIs) experience difficulties localizing sounds in reverberant rooms, even in rooms where normal-hearing listeners would hardly notice the reverberation. We measured the localization ability of seven bilateral CI users listening with their own devices in anechoic space and in a simulated reverberant room. To determine factors affecting performance in reverberant space we measured the sensitivity to interaural time differences (ITDs), interaural level differences (ILDs), and forward masking in the same participants using direct computer control of the electric stimulation in their CIs. Localization performance, quantified by the coefficient of determination r(2) and the root mean squared error, was significantly worse in the reverberant room than in anechoic conditions. Localization performance in the anechoic room, expressed as r(2), was best predicted by subject's sensitivity to ILDs. However, the decrease in localization performance caused by reverberation was better predicted by the sensitivity to envelope ITDs measured on single electrode pairs, with a correlation coefficient of 0.92. The CI users who were highly sensitive to envelope ITDs also better maintained their localization ability in reverberant space. Results in the forward masking task added only marginally to the predictions of localization performance in both environments. The results indicate that envelope ITDs provided by CI processors support localization in reverberant space. Thus, methods that improve perceptual access to envelope ITDs could help improve localization with bilateral CIs in everyday listening situations.

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

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

Improving virtual channel discrimination in a multi-channel context

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

Across-site patterns of modulation detection: relation to speech recognition

The aim of this study was to identify across-site patterns of modulation detection thresholds (MDTs) in subjects with cochlear implants and to determine if removal of sites with the poorest MDTs from speech processor programs would result in improved speech recognition. Five hundred millisecond trains of symmetric-biphasic pulses were modulated sinusoidally at 10 Hz and presented at a rate of 900 pps using monopolar stimulation. Subjects were asked to discriminate a modulated pulse train from an unmodulated pulse train for all electrodes in quiet and in the presence of an interleaved unmodulated masker presented on the adjacent site. Across-site patterns of masked MDTs were then used to construct two 10-channel MAPs such that one MAP consisted of sites with the best masked MDTs and the other MAP consisted of sites with the worst masked MDTs. Subjects' speech recognition skills were compared when they used these two different MAPs. Results showed that MDTs were variable across sites and were elevated in the presence of a masker by various amounts across sites. Better speech recognition was observed when the processor MAP consisted of sites with best masked MDTs, suggesting that temporal modulation sensitivity has important contributions to speech recognition with a cochlear implant.

Forward masking as a method of measuring place specificity of neural excitation in cochlear implants: a review of methods and interpretation

This paper reviews the psychophysical forward masking methods that have been used to investigate place specificity in cochlear implantees. These experiments are relevant for investigating whether the individual variability in outcomes for people using the same device can be explained by individual variations in frequency resolution or whether place specificity is affected by different modes of stimulation (such as bipolar, monopolar or tripolar) in the same person. Unfortunately, there has been no consensus about the methods used to derive electrical forward masking functions, or in the way that they are interpreted in relation to place specificity. Here, the different methods are critically examined to provide insight into the optimal methods that should be used to measure and interpret spatial forward masking functions in electric hearing. It is shown that, in order to separate the temporal effects of masking decay from the place-specificity information, different analyses of the functions are needed depending on whether a fixed-probe or fixed-masker method is employed. The effects of unit of measurement on specificity measures and the effects of subject listening strategy on the forward masked functions are also discussed.

Cochlear-implant spatial selectivity with monopolar, bipolar and tripolar stimulation

Sharp spatial selectivity is critical to auditory performance, particularly in pitch-related tasks. Most contemporary cochlear implants have employed monopolar stimulation that produces broad electric fields, which presumably contribute to poor pitch and pitch-related performance by implant users. Bipolar or tripolar stimulation can generate focused electric fields but requires higher current to reach threshold and, more interestingly, has not produced any apparent improvement in cochlear-implant performance. The present study addressed this dilemma by measuring psychophysical and physiological spatial selectivity with both broad and focused stimulations in the same cohort of subjects. Different current levels were adjusted by systematically measuring loudness growth for each stimulus, each stimulation mode, and in each subject. Both psychophysical and physiological measures showed that, although focused stimulation produced significantly sharper spatial tuning than monopolar stimulation, it could shift the tuning position or even split the tuning tips. The altered tuning with focused stimulation is interpreted as a result of poor electrode-to-neuron interface in the cochlea, and is suggested to be mainly responsible for the lack of consistent improvement in implant performance. A linear model could satisfactorily quantify the psychophysical and physiological data and derive the tuning width. Significant correlation was found between the individual physiological and psychophysical tuning widths, and the correlation was improved by log-linearly transforming the physiological data to predict the psychophysical data. Because the physiological measure took only one-tenth of the time of the psychophysical measure, the present model is of high clinical significance in terms of predicting and improving cochlear-implant performance.

A psychophysical method for measuring spatial resolution in cochlear implants

A novel psychophysical method was developed for assessing spatial resolution in cochlear implants. Spectrally flat and spectrally peaked pulse train stimuli were generated by interleaving pulses on 11 electrodes. Spectrally flat stimuli used loudness-balanced currents and the spectrally peaked stimuli had a single spatial ripple with the current of the middle electrode raised to create a peak while the currents on two electrodes equally spaced at variable distance from the peak electrode were reduced to create valleys. The currents on peak and valley electrodes were adjusted to balance the overall loudness with the spectrally flat stimulus, while keeping the currents on flanking electrodes fixed. The psychometric functions obtained from percent correct discrimination of peaked and flat stimuli versus the distance between peak and valley electrodes were used to quantify spatial resolution for each of the eight subjects. The ability to resolve the spatial ripple correlated strongly with current level difference limens measured on the peak electrode. The results were consistent with a hypothesis that a factor other than spread of excitation (such as neural response variance) might underlie much of the variability in spatial resolution. Resolution ability was not correlated with phoneme recognition in quiet or sentence recognition in quiet and background noise, consistent with a hypothesis that implantees rely on cues other than fine spectral detail to identify speech, perhaps because this detail is poorly accessible or unreliable.

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.

Current focusing sharpens local peaks of excitation in cochlear implant stimulation

Cochlear implant (CI) users' spectral resolution is limited by the number of implanted electrodes, interactions between the electrodes, and the underlying neural population. Current steering has been proposed to increase the number of spectral channels beyond the number of physical electrodes, however, electric field interactions may limit CI users' access to current-steered virtual channels (VCs). Current focusing (e.g tripolar stimulation) has been proposed to reduce current spread and thereby reduce interactions. In this study, current steering and current focusing were combined in a four-electrode stimulation pattern, i.e quadrupolar virtual channels (QPVCs). The spread of excitation was measured and compared between QPVC and Monopolar VC (MPVC) stimuli using a forward masking task. Results showed a sharper peak in the excitation pattern and reduced spread of masking for QPVC stimuli. Results from the forward masking study were compared with a previous study measuring VC discrimination ability and showed a weak relationship between spread of excitation and VC discriminability. The results suggest that CI signal processing strategies that utilize both current steering and current focusing might increase CI users' functional spectral resolution by transmitting more channels and reducing channel interactions.

Speech perception performance for 100 post-lingually deaf adults fitted with Neurelec cochlear implants: Comparison between Digisonic® Convex and Digisonic® SP devices after a 1-year follow-up

CONCLUSION

Patients implanted with the Digisonic® SP device showed better identification scores than those implanted with the Convex device, with skills continuing to improve over a longer time period. Technological improvements were beneficial in terms of speech perception in quiet.

OBJECTIVE

To compare speech perception skills for post-lingually deaf patients implanted with a previous Neurelec device, the Digisonic® Convex, with those implanted with a more recent one, the Digisonic® SP, which provides more electrodes and a faster stimulation rate.

METHODS

This was a retrospective study of 100 implanted patients, 45 with the Digisonic® Convex implant and 55 with the Digisonic® SP. Speech perception (dissyllabic words and sentences, in open set) was evaluated until 1 year after implantation.

RESULTS

Patients fitted with the Digisonic® SP implant showed significantly better scores after 3, 6, and 12 months (mean scores: 53%, 62%, and 68% for words; 58%, 69%, and 75% for sentences) than those fitted with the Convex implant (34%, 42%, and 43% for words; 38%, 59%, and 51% for sentences). The improvement in speech perception after implantation for SP patients continued throughout the 12 months for words and 6 months for sentences, versus 6 months for words and 3 months for sentences for Convex patients.

Frequency and electrode discrimination in children with cochlear implants

The objective of this study was to develop reliable pediatric psychophysical methodologies in order to address the limits of frequency and electrode discrimination in children with cochlear implants. Discrimination was measured with a two-alternative, adaptive, forced choice design using a video game graphical user interface. Implanted children were compared to normal-hearing children in the same age ranges. Twenty-nine implanted children and 68 children with normal-hearing performed frequency discrimination studies at varying frequencies. Electrode discrimination was assessed in thirty-four implanted children at varying electrode locations and stimulation intensities. Older children had better frequency discrimination than younger children, both for implanted and hearing subjects. Implanted children had worse frequency discrimination overall and exhibited learning effects at older ages than hearing children. Frequency discrimination Weber fractions were smallest in low frequencies. Electrode discrimination improved with stimulus intensity level for older but not younger children at all electrode locations. These results support the premise that developmental changes in signal processing contribute to discrimination of simple acoustic stimuli. For implanted children, auditory discrimination improved at lower frequencies and with electrodes at higher intensity. These findings imply that spatial separation may not be the key determinant in creating discriminable electrical stimuli for this population.

A relation between electrode discrimination and amplitude modulation detection by cochlear implant listeners

The objective of this study was to examine the relation between measures of spectral and temporal resolutions in cochlear implant listeners at a particular electrode location. The hypothesis was that a common underlying factor, such as the health of local groups of neurons, might partially determine patients' sensitivity to both spectral and temporal cues at specific tonotopic locations. Participants were adult cochlear implant listeners. A significant correlation was found between electrode discrimination measured at soft levels (20% and 30% of the dynamic range) and modulation sensitivity at those levels, for stimulation in bipolar mode and a 100 Hz modulation rate. Correlations between the two measures were weaker under monopolar stimulation, or when the modulation rate was 10 Hz. At a higher stimulation level (40% of the dynamic range), no significant correlations between these measures were observed. It is hypothesized that the more restricted excitation pattern at lower levels and/or with a narrower stimulation mode allows the measurement of locally driven sensitivity to spectral and temporal cues, particularly under more challenging listening conditions. Thus, psychophysical measures obtained under conditions that evoke a narrower excitation pattern may serve as a useful indicator of the functional health of local neural populations.

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.

Effects of high-rate pulse trains on electrode discrimination in cochlear implant users

Overcoming issues related to abnormally high neural synchrony in response to electrical stimulation is one aspect in improving hearing with a cochlear implant. Desynchronization of electrical stimuli have shown benefits in neural encoding of electrical signals and improvements in psychophysical tasks. In the present study, 10 participants with either CII or HiRes 90k Advanced Bionics devices were tested for the effects of desynchronizing constant-amplitude high-rate (5,000 Hz) pulse trains on electrode discrimination of sinusoidal stimuli (1,000 Hz). When averaged across the sinusoidal dynamic range, overall improvements in electrode discrimination with high-rate pulses were found for 8 of 10 participants. This effect was significant for the group (p = .003). Nonmonotonic patterns of electrode discrimination as a function of sinusoidal stimulation level were observed. By providing additional spectral channels, it is possible that clinical implementation of constant-amplitude high-rate pulse trains in a signal processing strategy may improve performance with the device.

Modeling the effect of channel number and interaction on consonant recognition in a cochlear implant peak-picking strategy

Difficulties in speech recognition experienced by cochlear implant users may be attributed both to information loss caused by signal processing and to information loss associated with the interface between the electrode array and auditory nervous system, including cross-channel interaction. The objective of the work reported here was to attempt to partial out the relative contribution of these different factors to consonant recognition. This was achieved by comparing patterns of consonant feature recognition as a function of channel number and presence/absence of background noise in users of the Nucleus 24 device with normal hearing subjects listening to acoustic models that mimicked processing of that device. Additionally, in the acoustic model experiment, a simulation of cross-channel spread of excitation, or "channel interaction," was varied. Results showed that acoustic model experiments were highly correlated with patterns of performance in better-performing cochlear implant users. Deficits to consonant recognition in this subgroup could be attributed to cochlear implant processing, whereas channel interaction played a much smaller role in determining performance errors. The study also showed that large changes to channel number in the Advanced Combination Encoder signal processing strategy led to no substantial changes in performance.

Psychophysical versus physiological spatial forward masking and the relation to speech perception in cochlear implants

OBJECTIVES

The primary goal of this study was to determine if physiological forward masking patterns in cochlear implants are predictive of psychophysical forward masking (PFM) patterns. It was hypothesized that the normalized amount of physiological masking would be positively correlated with the normalized amount of psychophysical masking for different masker-probe electrode separations. A secondary goal was to examine the relation between the spatial forward masking patterns and speech perception performance. It was hypothesized that subjects with less channel interaction overall (either psychophysically or physiologically) would have better speech perception ability because of better spectral resolution.

DESIGN

Data were collected for 18 adult cochlear implant recipients [N = 9 Clarion CII or HiRes 90K, N = 9 Nucleus 24R(CS)]. Physiological spatial forward masking patterns were obtained with the electrically evoked compound action potential (ECAP) through the implant telemetry system. PFM patterns were obtained using a three-interval, two-alternative forced-choice adaptive procedure. Both measures used a fixed probe electrode with varied masker location. For each subject, spatial forward masking patterns were obtained for three probe electrodes with five masker locations per probe.

RESULTS

On an individual basis, the correlation between ECAP FM and PFM was strong for 10 subjects (r = 0.68-0.85, p 0.14). Results across subjects and electrodes showed a highly significant correlation between ECAP FM and PFM (r = 0.55, p < 0.0001); the correlation was strongest for basal electrodes. There was no significant correlation between speech perception and ECAP FM or PFM. Subjects whose ECAP FM patterns correlated well with PFM patterns generally had the poorest speech perception and subjects with the poorest correlations had the best speech perception.

CONCLUSIONS

ECAP FM and PFM patterns correlated well for two-thirds of the subjects. Although the group correlation was statistically significant, ECAP FM patterns only accounted for 30% of the variance in the PFM measures. This suggests that the ECAP measures alone are not sufficient for accurately predicting PFM patterns for individual subjects.

Cochlear implant electrode configuration effects on activation threshold and tonotopic selectivity

The multichannel design of contemporary cochlear implants (CIs) is predicated on the assumption that each channel activates a relatively restricted and independent sector of the deaf auditory nerve array, just as a sound within a restricted frequency band activates a restricted region of the normal cochlea The independence of CI channels, however, is limited; and the factors that determine their independence, the relative overlap of the activity patterns that they evoke, are poorly understood. In this study, we evaluate the spread of activity evoked by cochlear implant channels by monitoring activity at 16 sites along the tonotopic axis of the guinea pig inferior colliculus (IC). "Spatial tuning curves" (STCs) measured in this way serve as an estimate of activation spread within the cochlea and the ascending auditory pathways. We contrast natural stimulation using acoustic tones with two kinds of electrical stimulation either (1) a loose fitting banded array consisting of a cylindrical silicone elastomer carrier with a linear series of ring contacts; or (2) a space-filling array consisting of a tapered silicone elastomer carrier that is designed to fit snugly into the guinea pig scala tympani with a linear series of ball contacts positioned along it Spatial tuning curves evoked by individual acoustic tones, and by activation of each contact of each array as a monopole, bipole or tripole were recorded. Several channel configurations and a wide range of electrode separations were tested for each array, and their thresholds and selectivity were estimated. The results indicate that the tapered space-filling arrays evoked more restricted activity patterns at lower thresholds than did the banded arrays. Monopolar stimulation (one intracochlear contact activated with an extracochlear return) using either array evoked broad activation patterns that involved the entire recording array at current levels <6dBSL, but at relatively low thresholds. Bi- and tri-polar configurations of both array types evoked more restricted activity patterns, but their thresholds were higher than those of monopolar configurations. Bipolar and tripolar configurations with closely spaced contacts evoked activity patterns that were comparable to those evoked by pure tones. As the spacing of bipolar electrodes was increased (separations >1mm), the activity patterns became broader and evoked patterns with two distinct threshold minima, one associated with each contact.

Spatial selectivity to intracochlear electrical stimulation in the inferior colliculus is degraded after long-term deafness in cats

In an animal model of electrical hearing in prelingually deaf adults, this study examined the effects of deafness duration on response thresholds and spatial selectivity (i.e., cochleotopic organization, spatial tuning and dynamic range) in the central auditory system to intracochlear electrical stimulation. Electrically evoked auditory brain stem response (EABR) thresholds and neural response thresholds in the external (ICX) and central (ICC) nuclei of the inferior colliculus were estimated in cats after varying durations of neonatally induced deafness: in animals deafened <1.5 yr (short-deafened unstimulated, SDU cats) with a mean spiral ganglion cell (SGC) density of approximately 45% of normal and in animals deafened >2.5 yr (long-deafened, LD cats) with severe cochlear pathology (mean SGC density <7% of normal). LD animals were subdivided into unstimulated cats and those that received chronic intracochlear electrical stimulation via a feline cochlear implant. Acutely deafened, implanted adult cats served as controls. Independent of their stimulation history, LD animals had significantly higher EABR and ICC thresholds than SDU and control animals. Moreover, the spread of electrical excitation was significantly broader and the dynamic range significantly reduced in LD animals. Despite the prolonged durations of deafness the fundamental cochleotopic organization was maintained in both the ICX and the ICC of LD animals. There was no difference between SDU and control cats in any of the response properties tested. These findings suggest that long-term auditory deprivation results in a significant and possibly irreversible degradation of response thresholds and spatial selectivity to intracochlear electrical stimulation in the auditory midbrain.

A comparison of adaptive psychometric procedures based on the theory of optimal experiments and bayesian techniques: implications for cochlear implant testing

Numerous previous studies have focused on the development of quick and efficient adaptive psychometric procedures. In psychophysics, there is often a model of the psychometric function supported by previous studies for the task of interest. The theory of optimal experiments provides a framework for utilizing a model of the process to develop quick and efficient sequential-testing strategies for estimating model parameters, making it appropriate for developing adaptive psychophysical-testing methods. In this study, we investigated the application of sequential parameter search strategies based on the theory of optimal experiments and Bayesian adaptive procedures for measuring psychophysical variables. The results presented in this article suggest that more sophisticated psychometric procedures can expedite the measurement of psychophysical variables. Such techniques for quickly collecting psychophysical data may be particularly useful in cochlear implant research, where a large set of psychophysical variables are useful for characterizing the performance of an implanted device. It is to be hoped that further development of these techniques will make psychophysical measurements available to clinicians for tuning and optimizing the speech processors of individual cochlear implant patients.

The effect of perimodiolar placement on speech perception and frequency discrimination by cochlear implant users

CONCLUSION

Neither speech understanding nor frequency discrimination ability was better in Nucleus Contour users than in Nucleus 24 straight electrode users. Furthermore, perimodiolar electrode placement does not result in better frequency discrimination.

OBJECTIVES

We addressed three questions related to perimodiolar electrode placement. First, do patients implanted with the Contour electrode understand speech better than with an otherwise identical device that has a straight electrode? Second, do these groups have different frequency discrimination abilities? Third, is the distance of the electrode from the modiolus related to frequency discrimination ability?

SUBJECTS AND METHODS

Contour and straight electrode users were matched on four important variables. We then tested these listeners on CNC word and HINT sentence identification tasks, and on a formant frequency discrimination task. We also examined X-rays and measured the distance of the electrodes from the modiolus to determine whether there is a relationship between this factor and frequency discrimination ability.

RESULTS

Both speech understanding and frequency discrimination abilities were similar for listeners implanted with the Contour vs a straight electrode. Furthermore, there was no linear relationship between electrode-modiolus distance and frequency discrimination ability. However, we did note a second-order relationship between these variables, suggesting that frequency discrimination is worse when the electrodes are either too close or too far away from the modiolus.

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.

Speech recognition in normal hearing and sensorineural hearing loss as a function of the number of spectral channels

Speech recognition by normal-hearing listeners improves as a function of the number of spectral channels when tested with a noiseband vocoder simulating cochlear implant signal processing. Speech recognition by the best cochlear implant users, however, saturates around eight channels and does not improve when more electrodes are activated, presumably due to reduced frequency selectivity caused by channel interactions. Listeners with sensorineural hearing loss may also have reduced frequency selectivity due to cochlear damage and the resulting reduction in the nonlinear cochlear mechanisms. The present study investigates whether such a limitation in spectral information transmission would be observed with hearing-impaired listeners, similar to implant users. To test the hypothesis, hearing-impaired subjects were selected from a population of patients with moderate hearing loss of cochlear origin, where the frequency selectivity would be expected to be poorer compared to normal hearing. Hearing-impaired subjects were tested for vowel and consonant recognition in steady-state background noise of varying levels using a noiseband vocoder and as a function of the number of spectral channels. For comparison, normal-hearing subjects were tested with the same stimuli at different presentation levels. In quiet and low background noise, performance by normal-hearing and hearing-impaired subjects was similar. In higher background noise, performance by hearing-impaired subjects saturated around eight channels, while performance by normal-hearing subjects continued to increase up to 12-16 channels with vowels, and 10-12 channels with consonants. A similar trend was observed for most of the presentation levels at which the normal-hearing subjects were tested. Therefore, it is unlikely that the effects observed with hearing-impaired subjects were due to insufficient audibility or high presentation levels. Consequently, the results with hearing-impaired subjects were similar to previous results obtained with implant users, but only for background noise conditions.

Acoustic model investigation of a multiple carrier frequency algorithm for encoding fine frequency structure: implications for cochlear implants

Current cochlear implants provide frequency resolution through the number of channels. Improving resolution by increasing channels is limited by factors such as the physiological feasibility of increasing the number of electrodes, the inability to increase the number of channels for those already implanted, and the increased possibility of channel interactions reducing channel efficacy. Recent studies have suggested an alternative method: providing a continuum of pitch percepts for each channel based on the frequency content of that channel. This study seeks to determine the frequency resolution necessary for the highest performance gain, which may give some indication of the feasibility for implementation in implants. A discrete set of carrier frequencies, instead of a continuum, are evaluated using an acoustic model to measure speech recognition. Performance increased as the number of available frequencies increased, and substantive improvement was seen with as few as two frequencies per channel. The effect of variable frequency discrimination was also assessed, and the results suggest that frequency modulation can still provide benefits with poor frequency discrimination on some channels. These results suggest that if two or more discriminable frequencies per channel can be generated for cochlear implant subjects then an improvement in speech recognition may be possible.

Histopathology of human cochlear implants: correlation of psychophysical and anatomical measures

The cadavaric temporal bones of five subjects who underwent cochlear implantation during life (2 Nucleus and 3 Ineraid) were analyzed using two-dimensional (2D) reconstruction of serial sections to determine the number of surviving spiral ganglion cells (SGCs) in the region of each electrode of the implanted arrays. The last psychophysical threshold and maximum-comfortable sensation level measured for each electrode were compared to their respective SGC count to determine the across-electrode psychophysical variance accounted for by the SGC counts. Significant correlations between psychophysical measures and SGC counts were found in only two of the five subjects: one Nucleus implantee (e.g., r=-0.71; p<0.001 for threshold vs. count) and one Ineraid implantee (e.g., r=-0.86; p<0.05 for threshold vs. count). A three-dimensional (3D) model of the implanted cochlea was formulated using the temporal-bone anatomy of the Nucleus subject for whom the 2D analysis did not result in significant correlations between counts and psychophysical measures. Predictions of the threshold vs. electrode profile were closer to the measured profile for the 3D model than for the 2D analysis. These results lead us to hypothesize that 3D techniques will be required to asses the impact of peripheral anatomy on the benefit patients derive from cochlear implantation.

Effects of stimulation mode, level and location on forward-masked excitation patterns in cochlear implant patients

In multi-channel cochlear implants, electrical current is delivered to appropriate electrodes in the cochlea to approximate the spatial representation of speech. Theoretically, electrode configurations that restrict the current spread within the cochlea (e.g., bi- or tri-polar stimulation) may provide better spatial selectivity, and in turn, better speech recognition than configurations that produce a broader current spread (e.g., monopolar stimulation). However, the effects of electrode configuration on supra-threshold excitation patterns have not been systematically studied in cochlear implant patients. In the present study, forward-masked excitation patterns were measured in cochlear implant patients as functions of stimulation mode, level and location within the cochlea. All stimuli were 500 pulses-per-second biphasic pulse trains (200 micros/phase, 20 micros inter-phase gap). Masker stimuli were 200 ms in duration; the bi-polar configuration was varied from narrow (BP+1) to wide (BP+17), depending on the test condition. Probe stimuli were 20 ms in duration and the masker-probe delay was 5 ms; the probe configuration was fixed at BP+1. The results indicated that as the distance between the active and return electrodes in a bi-polar pair was increased, the excitation pattern broadened within the cochlea. When the distance between active and return electrodes was sufficiently wide, two peaks were often observed in the excitation pattern, comparable to non-overlapping electric fields produced by widely separated dipoles. Analyses of the normalized data showed little effect of stimulation level on the shape of the excitation pattern.

The relation between electrophysiologic channel interaction and electrode pitch ranking in cochlear implant recipients

The primary goal of this study was to examine the relation between electrophysiologic measures of channel interaction and the ability to discriminate pitch between electrodes in a psychophysical pitch-ranking task. It was hypothesized that cochlear implant recipients should perform better on an electrode pitch-ranking task when using electrodes with less channel interaction as measured with the electrically evoked compound action potential (ECAP). The width of the ECAP channel interaction function was compared with the slope of the pitch-ranking function for 10 adult Nucleus 24 recipients. Results showed no significant correlation between electrode pitch-ranking ability and width of the ECAP channel interaction function for individual subjects or for group data. Additionally, there was no significant correlation between speech perception performance and either pitch-ranking ability or width of the ECAP channel interaction function. These results suggest that the width of the ECAP interaction function may not be an accurate predictor of the ability to discriminate between electrodes on the basis of pitch.

A psychophysical forward masking comparison of longitudinal spread of neural excitation in the Contour and straight Nucleus electrode arrays

The objective of the study was to compare the widths of forward masking profiles in subjects implanted with the Nucleus 24 Contour or straight electrode array. The Contour array is typically positioned closer to the modiolus than the straight array. Subjects were fourteen postlingually hearing-impaired adults with severe-profound hearing loss, seven used the Contour array and seven used the straight array. Forward masking profiles were measured at three positions along the array (apical, mid, and basal) using maskers at the 15% loudness level. It was hypothesized that masking profile widths would be more sensitive to differences in distance from the neural structures using low-level maskers. Masking width was calculated at the 50% point of the masking peak amplitude. There were no significant differences in masking widths between Contour and straight array subject groups. Current levels for hearing thresholds and maximum comfortable listening levels were significantly lower for the Contour array subjects.