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

The relationship between channel interaction, electrode placement, and speech perception in adult cochlear implant users

This study (1) characterized the effects of channel interaction using spectral blurring, (2) evaluated an image-guided electrode selection (IGES) method aiming to reduce channel interaction, and (3) investigated the impact of electrode placement factors on the change in performance by condition. Twelve adult MED-EL (Innsbruck, Austria) cochlear implant recipients participated. Performance was compared across six conditions: baseline (no blurring), all blurred, apical blurred, middle blurred, basal blurred, and IGES. Electrode placement information was calculated from post-insertion computerized tomography (CT) imaging. Each condition tested measures of speech recognition and subjective ratings. Results showed poorer performance when spectral blurring was applied to all channels compared to baseline, suggesting an increase in channel interaction was achieved. Vowel recognition was more sensitive to apical and middle blurring while consonant recognition was more sensitive to basal blurring, indicating that phoneme identification may be useful for assessing channel interaction clinically. IGES did not significantly improve group performance, and electrode placement factors did not impact results. However, participants who were more affected by spectral blurring tended to benefit more from IGES. These findings indicate that spectral blurring can help identify areas most affected by channel interaction to help optimize electrode selection.

The relationships between cochlear nerve health and AzBio sentence scores in quiet and noise in postlingually deafened adult cochlear implant users

Objectives

This study investigated the relationships between the cochlear nerve (CN) health and sentence-level speech perception outcomes measured in quiet and noise in postlingually deafened adult cochlear implant (CI) users.

Design

Study participants included 24 postlingually deafened adult CI users with a Cochlear® Nucleus™ device. For each participant, only one ear was tested. Neural health of the CN was assessed at three or four electrode locations across the electrode array using two parameters derived from results of the electrically evoked compound action potential (eCAP). One parameter was the phase locking value (PLV) which estimated neural synchrony in the CN. The other parameter was the sensitivity of the eCAP amplitude growth function (AGF) slope to changes in the interphase gap (IPG) of biphasic electrical pulses (i.e., the IPGEslope). Speech perception was tested using AzBio sentences in both quiet and a ten-talker babble background noise with +5 dB and +10 dB signal-to-noise ratios (SNR). IPGEslope and PLV values were averaged across electrodes for each subject, both with and without weighting by the frequency importance function (FIF) of the AzBio sentences. Pearson and Spearman correlations were used to assess the pairwise relationships between the IPGEslope, the PLV, and age. Multiple linear regression models with AzBio score as the outcome and the PLV and the IPGEslope as predictors were used to evaluate the associations between the three variables while controlling for age.

Results

The correlation between the IPGEslope and the PLV was negligible and not statistically significant. The PLV, but not the IPGEslope, differed significantly across electrodes, where the apical electrodes had larger PLVs (better neural synchrony) than the basal electrodes. The IPGEslope, but not the PLV, was significantly correlated with participant's age, where smaller IPGEslope values (poorer CN health) were associated with more advanced age. The PLV, but not the IPGEslope, was significantly associated with AzBio scores in noise, where larger PLVs predicted better speech perception in noise. Neither the PLV nor the IPGEslope was significantly associated with AzBio score in quiet. The result patterns remained the same regardless of whether the mean values of the IPGEslope and the PLV were weighted by the AzBio FIF.

Conclusions

The IPGEslope and the PLV quantify different aspects of CN health. The positive association between the PLV and AzBio scores suggests that neural synchrony is important for speech perception in noise in adult CI users. The lack of association between age and the PLV indicates that reduced neural synchrony in the CN is unlikely the primary factor accounting for the greater deficits in understanding speech in noise observed in elderly, as compared to younger, CI users.

The association of intraoperative electric field and neural excitation patterns of the cochlear implant with patient-related factors of age, gender, cochlear diameter, and postoperative speech measures

PURPOSE

To assess the relationships between the electric field (EF) and neural excitation patterns in cochlear implants (CIs) and explore their associations with the cochlear diameter, patient age and gender, and postoperative speech recognition.

METHOD

The intraoperative transimpedance matrix (TIM) and spread of excitation (SOE) measures were computed to obtain their 50 % widths corresponding to six electrode contacts of a lateral-wall electrode array. The measures were then analyzed for intercorrelations, associations with the cochlear diameter, as well as age and gender-related differences. The relationships between the computed intraoperative measures and postimplant speech recognition were also studied.

RESULTS

The TIM and SOE 50 % widths present moderate correlations and exhibit differences between adults and children. The TIM 50 % widths show additional associations with the cochlear diameter and partly vary with the implantee's gender. Speech recognition was found to have a significant relationship with the exponential spread coefficients (ESCs) obtained for individual electrode contacts.

CONCLUSION

Although interrelated, the EF and neural excitation measures of the CI are associated with different variables. The ESC, derived from computations of the TIM, is the only measure linked to postoperative speech recognition.

The Impact of Daily Processor Use on Adult Cochlear Implant Outcomes: Reexamining the Roles of Duration of Deafness and Age at Implantation

OBJECTIVE

To quantify the roles and relationships between age at implantation, duration of deafness (DoD), and daily processor use via data logging on speech recognition outcomes for postlingually deafened adults with cochlear implants.

STUDY DESIGN

Retrospective case review.

SETTING

Cochlear implant (CI) program at a tertiary medical center.

PATIENTS

Six-hundred fourteen postlingually deafened adult ears with CIs (mean age, 63 yr; 44% female) were included.

MAIN OUTCOME MEASURES

A stepwise multiple regression analysis was completed to investigate the combined effects of age, DoD, and daily processor use on CI-aided speech recognition (Consonant-Nucleus-Consonant monosyllables and AzBio sentences).

RESULTS

Results indicated that only daily processor use was significantly related to Consonant-Nucleus-Consonant word scores ( R2 = 0.194, p < 0.001) and AzBio in quiet scores ( R2 = 0.198, p < 0.001), whereas neither age nor DoD was significantly related. In addition, there was no significant relationship between daily processor use, age at implantation, or DoD and AzBio sentences in noise ( R2 = 0.026, p = 0.005).

CONCLUSIONS

Considering the clinical factors of age at implantation, DoD, and daily processor use, only daily processor use significantly predicted the ~20% of variance in postoperative outcomes (CI-aided speech recognition) accounted for by these clinical factors.

Effects of the Number of Channels and Channel Stimulation Rate on Speech Recognition and Sound Quality Using Precurved Electrode Arrays

PURPOSE

This study investigated the relationship between the number of active electrodes, channel stimulation rate, and their interaction on speech recognition and sound quality measures while controlling for electrode placement. Cochlear implant (CI) recipients with precurved electrode arrays placed entirely within scala tympani and closer to the modiolus were hypothesized to be able to utilize more channels and possibly higher stimulation rates to achieve better speech recognition performance and sound quality ratings than recipients in previous studies.

METHOD

Participants included seven postlingually deafened adult CI recipients with Advanced Bionics Mid-Scala electrode arrays confirmed to be entirely within scala tympani using postoperative computerized tomography. Twelve conditions were tested using four, eight, 12, and 16 electrodes and channel stimulation rates of 600 pulse per second (pps), 1,200 pps, and each participant's maximum allowable rate (1,245-4,800 pps). Measures of speech recognition and sound quality were acutely assessed.

RESULTS

For the effect of channels, results showed no significant improvements beyond eight channels for all measures. For the effect of channel stimulation rate, results showed no significant improvements with higher rates, suggesting that 600 pps was sufficient for maximum speech recognition performance and sound quality ratings. However, across all conditions, there was a significant relationship between mean electrode-to-modiolus distance and all measures, suggesting that a lower mean electrode-to-modiolus distance was correlated with higher speech recognition scores and sound quality ratings.

CONCLUSION

These findings suggest that even well-placed precurved electrode array recipients may not be able to take advantage of more than eight channels or higher channel stimulation rates (> 600 pps), but that closer electrode array placement to the modiolus correlates with better outcomes for these recipients.

Speech recognition as a function of the number of channels for pediatric cochlear implant recipients

This study investigated the number of channels required for asymptotic speech recognition for ten pediatric cochlear implant (CI) recipients with precurved electrode arrays. Programs with 4-22 active electrodes were used to assess word and sentence recognition in noise. Children demonstrated significant performance gains up to 12 electrodes for continuous interleaved sampling (CIS) and up to 22 channels with 16 maxima. These data are consistent with the latest adult CI studies demonstrating that modern CI recipients have access to more than 8 independent channels and that both adults and children exhibit performance gains up to 22 channels.

Speech recognition as a function of the number of channels for Mid-Scala electrode array recipients

This study investigated the number of channels needed for maximum speech understanding and sound quality in 15 adult cochlear implant (CI) recipients with Advanced Bionics (AB) Mid-Scala electrode arrays completely within scala tympani. In experiment I, CI programs used a continuous interleaved sampling (CIS)-based strategy and 4-16 active electrodes. In experiment II, CI programs used an n-of-m strategy featuring 16 active electrodes with either 8- or 12-maxima. Speech understanding and sound quality measures were assessed. For CIS programs, participants demonstrated performance gains using up to 4-10 electrodes on speech measures and sound quality ratings. For n-of-m programs, there was no significant effect of maxima, suggesting 8-maxima is sufficient for this sample's maximum performance and sound quality. These results are largely consistent with previous studies using straight electrode arrays [e.g., Fishman, Shannon, and Slattery (1997). J. Speech Lang. Hear. Res. 40, 1201-1215; Friesen, Shannon, Baskent, and Wang (2001). J. Acoust. Soc. Am. 110, 1150-1163; Shannon, Cruz, and Galvin (2011). Audiol. Neurotol. 16, 113-123; Berg, Noble, Dawant, Dwyer, Labadie, and Gifford (2020). J. Acoust. Soc. Am. 147, 3646-3656] and in contrast with recent studies looking at cochlear precurved electrode arrays [e.g., Croghan, Duran, and Smith (2017). J. Acoust. Soc. Am. 142, EL537-EL543; Berg, Noble, Dawant, Dwuer, Labadie, and Gifford (2019b). J. Acoust. Soc. Am. 145, 1556-1564], which found continuous improvements up to 16 independent channels. These findings suggest that Mid-Scala electrode array recipients demonstrate similar channel independence to straight electrode arrays rather than other manufacturer's precurved electrode arrays.

Distortion of Spectral Ripples Through Cochlear Implants Has Major Implications for Interpreting Performance Scores

The spectral ripple discrimination task is a psychophysical measure that has been found to correlate with speech recognition in listeners with cochlear implants (CIs). However, at ripple densities above a critical value (around 2 RPO, but device-specific), the sparse spectral sampling of CI processors results in stimulus distortions resulting in aliasing and unintended changes in modulation depth. As a result, spectral ripple thresholds above a certain number are not ordered monotonically along the RPO dimension and thus cannot be considered better or worse spectral resolution than each other, thus undermining correlation measurements. These stimulus distortions are not remediated by changing stimulus phase, indicating these issues cannot be solved by spectrotemporally modulated stimuli. Speech generally has very low-density spectral modulations, leading to questions about the mechanism of correlation between high ripple thresholds and speech recognition. Existing data showing correlations between ripple discrimination and speech recognition include many observations above the aliasing limit. These scores should be treated with caution, and experimenters could benefit by prospectively considering the limitations of the spectral ripple test.

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.

Speech recognition as a function of the number of channels for an array with large inter-electrode distances

This study investigated the number of channels available to cochlear implant (CI) recipients for maximum speech understanding and sound quality for lateral wall electrode arrays-which result in large electrode-to-modiolus distances-featuring the greatest inter-electrode distances (2.1-2.4 mm), the longest active lengths (23.1-26.4 mm), and the fewest number of electrodes commercially available. Participants included ten post-lingually deafened adult CI recipients with MED-EL electrode arrays (FLEX28 and STANDARD) entirely within scala tympani. Electrode placement and scalar location were determined using computerized tomography. The number of channels was varied from 4 to 12 with equal spatial distribution across the array. A continuous interleaved sampling-based strategy was used. Speech recognition, sound quality ratings, and a closed-set vowel recognition task were measured acutely for each electrode condition. Participants did not demonstrate statistically significant differences beyond eight channels at the group level for almost all measures. However, several listeners showed considerable improvements from 8 to 12 channels for speech and sound quality measures. These results suggest that channel interaction caused by the greater electrode-to-modiolus distances of straight electrode arrays could be partially compensated for by a large inter-electrode distance or spacing.

The Effect of Side of Implantation on the Cortical Processing of Frequency Changes in Adult Cochlear Implant Users

Cochlear implants (CI) are widely used in children and adults to restore hearing function. However, CI outcomes are vary widely. The affected factors have not been well understood. It is well known that the right and left hemispheres play different roles in auditory perception in adult normal hearing listeners. It is unknown how the implantation side may affect the outcomes of CIs. In this study, the effect of the implantation side on how the brain processes frequency changes within a sound was examined in 12 right-handed adult CI users. The outcomes of CIs were assessed with behaviorally measured frequency change detection threshold (FCDT), which has been reported to significantly affect CI speech performance. The brain activation and regions were also examined using acoustic change complex (ACC, a type of cortical potential evoked by acoustic changes within a stimulus), on which the waveform analysis and the standardized low-resolution brain electromagnetic tomography (sLORETA) were performed. CI users showed activation in the temporal lobe and non-temporal areas, such as the frontal lobe. Right-ear CIs could more efficiently activate the contralateral hemisphere compared to left-ear CIs. For right-ear CIs, the increased activation in the contralateral temporal lobe together with the decreased activation in the contralateral frontal lobe was correlated with good performance of frequency change detection (lower FCDTs). Such a trend was not found in left-ear CIs. These results suggest that the implantation side may significantly affect neuroplasticity patterns in adults.

Estimates of Ripple-Density Resolution Based on the Discrimination From Rippled and Nonrippled Reference Signals

Rippled-spectrum stimuli are used to evaluate the resolution of the spectro-temporal structure of sounds. Measurements of spectrum-pattern resolution imply the discrimination between the test and reference stimuli. Therefore, estimates of rippled-pattern resolution could depend on both the test stimulus and the reference stimulus type. In this study, the ripple-density resolution was measured using combinations of two test stimuli and two reference stimuli. The test stimuli were rippled-spectrum signals with constant phase or rippled-spectrum signals with ripple-phase reversals. The reference stimuli were rippled-spectrum signals with opposite ripple phase to the test or nonrippled signals. The spectra were centered at 2 kHz and had an equivalent rectangular bandwidth of 1 oct and a level of 70 dB sound pressure level. A three-alternative forced-choice procedure was combined with an adaptive procedure. With rippled reference stimuli, the mean ripple-density resolution limits were 8.9 ripples/oct (phase-reversals test stimulus) or 7.7 ripples/oct (constant-phase test stimulus). With nonrippled reference stimuli, the mean resolution limits were 26.1 ripples/oct (phase-reversals test stimulus) or 22.2 ripples/oct (constant-phase test stimulus). Different contributions of excitation-pattern and temporal-processing mechanisms are assumed for measurements with rippled and nonrippled reference stimuli: The excitation-pattern mechanism is more effective for the discrimination of rippled stimuli that differ in their ripple-phase patterns, whereas the temporal-processing mechanism is more effective for the discrimination of rippled and nonrippled stimuli.

Rippled-spectrum resolution dependence on frequency: Estimates obtained by discrimination from rippled and nonrippled reference signals

The resolution of spectral ripples is a useful test for the spectral resolution of hearing. However, the use of different measurement paradigms might yield diverging results because of a paradigm-dependent contribution of excitation-pattern and temporal-processing mechanisms. In the present study, ripple-density resolution was measured in normal-hearing listeners for several frequency bands (centered at 0.5, 1, 2, and 4 kHz), using two paradigms: (i) discrimination of a rippled-spectrum test signal from a rippled reference signal differing by the ripple phase pattern, and (ii) discrimination of a rippled-spectrum test signal from a nonrippled reference signal. For the rippled reference signals, the resolution slightly depended on signal frequency. For the nonrippled reference signals, the resolution depended on the signal frequency; it varied from 8.8 ripples/oct at 0.5 kHz to 34.2 ripples/oct at 4 kHz. Excitation-pattern and temporal-processing models of spectral analysis were considered. Predictions of the excitation-pattern model agreed with the data obtained with the rippled reference signals. In contrast, predictions of the temporal-processing model agreed with the data obtained with the nonrippled reference signals. Thus, depending on the used reference signal type, the ripple-density resolution estimates characterize the discrimination abilities of the corresponding mechanisms.

Cortical Processing of Frequency Changes Reflected by the Acoustic Change Complex in Adult Cochlear Implant Users

The purpose of this study was to examine neural substrates of frequency change detection in cochlear implant (CI) recipients using the acoustic change complex (ACC), a type of cortical auditory evoked potential elicited by acoustic changes in an ongoing stimulus. A psychoacoustic test and electroencephalographic recording were administered in 12 postlingually deafened adult CI users. The stimuli were pure tones containing different magnitudes of upward frequency changes. Results showed that the frequency change detection threshold (FCDT) was 3.79% in the CI users, with a large variability. The ACC N1' latency was significantly correlated with the FCDT and the clinically collected speech perception score. The results suggested that the ACC evoked by frequency changes can serve as a useful objective tool in assessing frequency change detection capability and predicting speech perception performance in CI users.

Evaluation of Mandarin Chinese Speech Recognition in Adults with Cochlear Implants Using the Spectral Ripple Discrimination Test

Background

The aim of this study was to explore the value of the spectral ripple discrimination test in speech recognition evaluation among a deaf (post-lingual) Mandarin-speaking population in China following cochlear implantation.

Material/Methods

The study included 23 Mandarin-speaking adult subjects with normal hearing (normal-hearing group) and 17 deaf adults who were former Mandarin-speakers, with cochlear implants (cochlear implantation group). The normal-hearing subjects were divided into men (n=10) and women (n=13). The spectral ripple discrimination thresholds between the groups were compared. The correlation between spectral ripple discrimination thresholds and Mandarin speech recognition rates in the cochlear implantation group were studied.

Results

Spectral ripple discrimination thresholds did not correlate with age (r=−0.19; p=0.22), and there was no significant difference in spectral ripple discrimination thresholds between the male and female groups (p=0.654). Spectral ripple discrimination thresholds of deaf adults with cochlear implants were significantly correlated with monosyllabic recognition rates (r=0.84; p=0.000).

Conclusions

In a Mandarin Chinese speaking population, spectral ripple discrimination thresholds of normal-hearing individuals were unaffected by both gender and age. Spectral ripple discrimination thresholds were correlated with Mandarin monosyllabic recognition rates of Mandarin-speaking in post-lingual deaf adults with cochlear implants. The spectral ripple discrimination test is a promising method for speech recognition evaluation in adults following cochlear implantation in China.

Intensity Discrimination and Speech Recognition of Cochlear Implant Users

The relation between speech recognition and within-channel or across-channel (i.e., spectral tilt) intensity discrimination was measured in nine CI users (11 ears). Within-channel intensity difference limens (IDLs) were measured at four electrode locations across the electrode array. Spectral tilt difference limens were measured with (XIDL-J) and without (XIDL) level jitter. Only three subjects could perform the XIDL-J task with the amount of jitter required to limit use of within-channel cues. XIDLs (normalized to %DR) were correlated with speech recognition (r = 0.67, P = 0.019) and were highly correlated with IDLs. XIDLs were on average nearly 3 times larger than IDLs and did not vary consistently with the spatial separation of the two component electrodes. The overall pattern of results was consistent with a common underlying subject-dependent limitation in the two difference limen tasks, hypothesized to be perceptual variance (how the perception of a sound differs on different presentations), which may also underlie the correlation of XIDLs with speech recognition. Evidence that spectral tilt discrimination is more important for speech recognition than within-channel intensity discrimination was not unequivocally shown in this study. However, the results tended to support this proposition, with XIDLs more correlated with speech performance than IDLs, and the ratio XIDL/IDL also being correlated with speech recognition. If supported by further research, the importance of perceptual variance as a limiting factor in speech understanding for CI users has important implications for efforts to improve outcomes for those with poor speech recognition.

Auditory sensitivity to spectral modulation phase reversal as a function of modulation depth

The present study evaluated auditory sensitivity to spectral modulation by determining the modulation depth required to detect modulation phase reversal. This approach may be preferable to spectral modulation detection with a spectrally flat standard, since listeners appear unable to perform the task based on the detection of temporal modulation. While phase reversal thresholds are often evaluated by holding modulation depth constant and adjusting modulation rate, holding rate constant and adjusting modulation depth supports rate-specific assessment of modulation processing. Stimuli were pink noise samples, filtered into seven octave-wide bands (0.125–8 kHz) and spectrally modulated in dB. Experiment 1 measured performance as a function of modulation depth to determine appropriate units for adaptive threshold estimation. Experiment 2 compared thresholds in dB for modulation detection with a flat standard and modulation phase reversal; results supported the idea that temporal cues were available at high rates for the former but not the latter. Experiment 3 evaluated spectral modulation phase reversal thresholds for modulation that was restricted to either one or two neighboring bands. Flanking bands of unmodulated noise had a larger detrimental effect on one-band than two-band targets. Thresholds for high-rate modulation improved with increasing carrier frequency up to 2 kHz, whereas low-rate modulation appeared more consistent across frequency, particularly in the two-band condition. Experiment 4 measured spectral weights for spectral modulation phase reversal detection and found higher weights for bands in the spectral center of the stimulus than for the lowest (0.125 kHz) or highest (8 kHz) band. Experiment 5 compared performance for highly practiced and relatively naïve listeners, and found weak evidence of a larger practice effect at high than low spectral modulation rates. These results provide preliminary data for a task that may provide a better estimate of sensitivity to spectral modulation than spectral modulation detection with a flat standard.

Spectral Ripple Discrimination in Normal-Hearing Infants

OBJECTIVES

Spectral resolution is a correlate of open-set speech understanding in postlingually deaf adults and prelingually deaf children who use cochlear implants (CIs). To apply measures of spectral resolution to assess device efficacy in younger CI users, it is necessary to understand how spectral resolution develops in normal-hearing children. In this study, spectral ripple discrimination (SRD) was used to measure listeners' sensitivity to a shift in phase of the spectral envelope of a broadband noise. Both resolution of peak to peak location (frequency resolution) and peak to trough intensity (across-channel intensity resolution) are required for SRD.

DESIGN

SRD was measured as the highest ripple density (in ripples per octave) for which a listener could discriminate a 90° shift in phase of the sinusoidally-modulated amplitude spectrum. A 2 × 3 between-subjects design was used to assess the effects of age (7-month-old infants versus adults) and ripple peak/trough "depth" (10, 13, and 20 dB) on SRD in normal-hearing listeners (experiment 1). In experiment 2, SRD thresholds in the same age groups were compared using a task in which ripple starting phases were randomized across trials to obscure within-channel intensity cues. In experiment 3, the randomized starting phase method was used to measure SRD as a function of age (3-month-old infants, 7-month-old infants, and young adults) and ripple depth (10 and 20 dB in repeated measures design).

RESULTS

In experiment 1, there was a significant interaction between age and ripple depth. The infant SRDs were significantly poorer than the adult SRDs at 10 and 13 dB ripple depths but adult-like at 20 dB depth. This result is consistent with immature across-channel intensity resolution. In contrast, the trajectory of SRD as a function of depth was steeper for infants than adults suggesting that frequency resolution was better in infants than adults. However, in experiment 2 infant performance was significantly poorer than adults at 20 dB depth suggesting that variability of infants' use of within-channel intensity cues, rather than better frequency resolution, explained the results of experiment 1. In experiment 3, age effects were seen with both groups of infants showing poorer SRD than adults but, unlike experiment 1, no significant interaction between age and depth was seen.

CONCLUSIONS

Measurement of SRD thresholds in individual 3 to 7-month-old infants is feasible. Performance of normal-hearing infants on SRD may be limited by across-channel intensity resolution despite mature frequency resolution. These findings have significant implications for design and stimulus choice for applying SRD for testing infants with CIs. The high degree of variability in infant SRD can be somewhat reduced by obscuring within-channel cues.

Nonlinguistic Outcome Measures in Adult Cochlear Implant Users Over the First Year of Implantation

OBJECTIVES

Postlingually deaf cochlear implant users' speech perception improves over several months after implantation due to a learning process which involves integration of the new acoustic information presented by the device. Basic tests of hearing acuity might evaluate sensitivity to the new acoustic information and be less sensitive to learning effects. It was hypothesized that, unlike speech perception, basic spectral and temporal discrimination abilities will not change over the first year of implant use. If there were limited change over time and the test scores were correlated with clinical outcome, the tests might be useful for acute diagnostic assessments of hearing ability and also useful for testing speakers of any language, many of which do not have validated speech tests.

DESIGN

Ten newly implanted cochlear implant users were tested for speech understanding in quiet and in noise at 1 and 12 months postactivation. Spectral-ripple discrimination, temporal-modulation detection, and Schroeder-phase discrimination abilities were evaluated at 1, 3, 6, 9, and 12 months postactivation.

RESULTS

Speech understanding in quiet improved between 1 and 12 months postactivation (mean 8% improvement). Speech in noise performance showed no statistically significant improvement. Mean spectral-ripple discrimination thresholds and temporal-modulation detection thresholds for modulation frequencies of 100 Hz and above also showed no significant improvement. Spectral-ripple discrimination thresholds were significantly correlated with speech understanding. Low FM detection and Schroeder-phase discrimination abilities improved over the period. Individual learning trends varied, but the majority of listeners followed the same stable pattern as group data.

CONCLUSIONS

Spectral-ripple discrimination ability and temporal-modulation detection at 100-Hz modulation and above might serve as a useful diagnostic tool for early acute assessment of cochlear implant outcome for listeners speaking any native language.

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.

Systematic review of compound action potentials as predictors for cochlear implant performance

OBJECTIVES/HYPOTHESIS

The variability in speech perception between cochlear implant users is thought to result from the degeneration of the auditory nerve. Degeneration of the auditory nerve, histologically assessed, correlates with electrophysiologically acquired measures, such as electrically evoked compound action potentials (eCAPs) in experimental animals. To predict degeneration of the auditory nerve in humans, where histology is impossible, this paper reviews the correlation between speech perception and eCAP recordings in cochlear implant patients.

DATA SOURCES

PubMed and Embase.

REVIEW METHODS

We performed a systematic search for articles containing the following major themes: cochlear implants, evoked potentials, and speech perception. Two investigators independently conducted title-abstract screening, full-text screening, and critical appraisal. Data were extracted from the remaining articles.

RESULTS

Twenty-five of 1,429 identified articles described a correlation between speech perception and eCAP attributes. Due to study heterogeneity, a meta-analysis was not feasible, and studies were descriptively analyzed. Several studies investigating presence of the eCAP, recovery time constant, slope of the amplitude growth function, and spatial selectivity showed significant correlations with speech perception. In contrast, neural adaptation, eCAP threshold, and change with varying interphase gap did not significantly correlate with speech perception in any of the identified studies.

CONCLUSIONS

Significant correlations between speech perception and parameters obtained through eCAP recordings have been documented in literature; however, reporting was ambiguous. There is insufficient evidence for eCAPs as a predictive factor for speech perception. More research is needed to further investigate this relation. Laryngoscope, 2016 127:476-487, 2017.

Evaluation of Cochlear Implant Candidates using a Non-linguistic Spectrotemporal Modulation Detection Test

Adults who score 50% correct or less in open-set sentence recognition test under the best aided listening condition may be considered as candidates for cochlear implant (CI). However, the requirement for ‘the best aided listening condition’ needs significant time and clinical resources to ensure such condition. As speech signals are composed of dynamic spectral and temporal modulations, psychoacoustic sensitivity to the combinations of spectral and temporal modulation cues may be a strong predictor for aided speech recognition. In this study, we tested 27 adults with moderately severe to profound hearing loss to explore the possibility that a non-linguistic unaided spectrotemporal modulation (STM) detection test might be a viable option as a surrogate measure to evaluate CI candidacy. Our results showed that STM detection thresholds were significantly correlated with aided sentence recognition scores for the 27 hearing impaired listeners. The receiver operator characteristic (ROC) curve analysis demonstrated that the CI candidacy evaluation by both unaided STM detection test and the traditional best-aided sentence recognition test was fairly consistent. More specifically, our results demonstrated that the STM detection test using a low spectral and temporal modulation rate might provide an efficient process for CI candidacy evaluation.

A Cochlear Implant Performance Prognostic Test Based on Electrical Field Interactions Evaluated by eABR (Electrical Auditory Brainstem Responses)

Background

Cochlear implants (CIs) are neural prostheses that have been used routinely in the clinic over the past 25 years. They allow children who were born profoundly deaf, as well as adults affected by hearing loss for whom conventional hearing aids are insufficient, to attain a functional level of hearing. The “modern” CI (i.e., a multi-electrode implant using sequential coding strategies) has yielded good speech comprehension outcomes (recognition level for monosyllabic words about 50% to 60%, and sentence comprehension close to 90%). These good average results however hide a very important interindividual variability as scores in a given patients’ population often vary from 5 to 95% in comparable testing conditions. Our aim was to develop a prognostic model for patients with unilateral CI. A novel method of objectively measuring electrical and neuronal interactions using electrical auditory brainstem responses (eABRs) is proposed.

Methods and Findings

The method consists of two measurements: 1) eABR measurements with stimulation by a single electrode at 70% of the dynamic range (four electrodes distributed within the cochlea were tested), followed by a summation of these four eABRs; 2) Measurement of a single eABR with stimulation from all four electrodes at 70% of the dynamic range. A comparison of the eABRs obtained by these two measurements, defined as the monaural interaction component (MIC), indicated electrical and neural interactions between the stimulation channels.

Speech recognition performance without lip reading was measured for each patient using a logatome test (64 "vowel-consonant-vowel"; VCV; by forced choice of 1 out of 16). eABRs were measured in 16 CI patients (CIs with 20 electrodes, Digisonic SP; Oticon Medical ®, Vallauris, France).

Significant correlations were found between speech recognition performance and the ratio of the amplitude of the V wave of the eABRs obtained with the two measurements (Pearson's linear regression model, parametric correlation: r2 = 0.26, p<0.05).

Conclusions

This prognostic model allowed a substantial amount of the interindividual variance in speech recognition scores to be explained. The present study used measurements of electrical and neuronal interactions by eABR to assess patients' bio-electric capacity to use multiple information channels supplied by the implant. This type of prognostic information may be valuable in several ways. On the patient level, it allows customizing of individual treatments.

ClinicalTrials.gov Identifier: NCT01805167

Spectrotemporal Modulation Detection and Speech Perception by Cochlear Implant Users

Spectrotemporal modulation (STM) detection performance was examined for cochlear implant (CI) users. The test involved discriminating between an unmodulated steady noise and a modulated stimulus. The modulated stimulus presents frequency modulation patterns that change in frequency over time. In order to examine STM detection performance for different modulation conditions, two different temporal modulation rates (5 and 10 Hz) and three different spectral modulation densities (0.5, 1.0, and 2.0 cycles/octave) were employed, producing a total 6 different STM stimulus conditions. In order to explore how electric hearing constrains STM sensitivity for CI users differently from acoustic hearing, normal-hearing (NH) and hearing-impaired (HI) listeners were also tested on the same tasks. STM detection performance was best in NH subjects, followed by HI subjects. On average, CI subjects showed poorest performance, but some CI subjects showed high levels of STM detection performance that was comparable to acoustic hearing. Significant correlations were found between STM detection performance and speech identification performance in quiet and in noise. In order to understand the relative contribution of spectral and temporal modulation cues to speech perception abilities for CI users, spectral and temporal modulation detection was performed separately and related to STM detection and speech perception performance. The results suggest that that slow spectral modulation rather than slow temporal modulation may be important for determining speech perception capabilities for CI users. Lastly, test–retest reliability for STM detection was good with no learning. The present study demonstrates that STM detection may be a useful tool to evaluate the ability of CI sound processing strategies to deliver clinically pertinent acoustic modulation information.

Comparing auditory filter bandwidths, spectral ripple modulation detection, spectral ripple discrimination, and speech recognition: Normal and impaired hearing

Some listeners with hearing loss show poor speech recognition scores in spite of using amplification that optimizes audibility. Beyond audibility, studies have suggested that suprathreshold abilities such as spectral and temporal processing may explain differences in amplified speech recognition scores. A variety of different methods has been used to measure spectral processing. However, the relationship between spectral processing and speech recognition is still inconclusive. This study evaluated the relationship between spectral processing and speech recognition in listeners with normal hearing and with hearing loss. Narrowband spectral resolution was assessed using auditory filter bandwidths estimated from simultaneous notched-noise masking. Broadband spectral processing was measured using the spectral ripple discrimination (SRD) task and the spectral ripple depth detection (SMD) task. Three different measures were used to assess unamplified and amplified speech recognition in quiet and noise. Stepwise multiple linear regression revealed that SMD at 2.0 cycles per octave (cpo) significantly predicted speech scores for amplified and unamplified speech in quiet and noise. Commonality analyses revealed that SMD at 2.0 cpo combined with SRD and equivalent rectangular bandwidth measures to explain most of the variance captured by the regression model. Results suggest that SMD and SRD may be promising clinical tools for diagnostic evaluation and predicting amplification outcomes.

Spectral and temporal analysis of simulated dead regions in cochlear implants

A cochlear implant (CI) electrode in a "cochlear dead region" will excite neighboring neural populations. In previous research that simulated such dead regions, stimulus information in the simulated dead region was either added to the immediately adjacent frequency regions or dropped entirely. There was little difference in speech perception ability between the two conditions. This may imply that there may be little benefit of ensuring that stimulus information on an electrode in a suspected cochlear dead region is transmitted. Alternatively, performance may be enhanced by a broader frequency redistribution, rather than adding stimuli from the dead region to the edges. In the current experiments, cochlear dead regions were introduced by excluding selected CI electrodes or vocoder noise-bands. Participants were assessed for speech understanding as well as spectral and temporal sensitivities as a function of the size of simulated dead regions. In one set of tests, the normal input frequency range of the sound processor was distributed among the active electrodes in bands with approximately logarithmic spacing ("redistributed" maps); in the remaining tests, information in simulated dead regions was dropped ("dropped" maps). Word recognition and Schroeder-phase discrimination performance, which require both spectral and temporal sensitivities, decreased as the size of simulated dead regions increased, but the redistributed and dropped remappings showed similar performance in these two tasks. Psychoacoustic experiments showed that the near match in word scores may reflect a tradeoff between spectral and temporal sensitivity: spectral-ripple discrimination was substantially degraded in the redistributed condition relative to the dropped condition while performance in a temporal modulation detection task degraded in the dropped condition but remained constant in the redistributed condition.