Benefits of the HiRes 120 coding strategy combined with the Harmony processor in an adult European multicentre study

Cochlear Implant Research and Development in the Twenty-first Century: A Critical Update

Cochlear implants (CIs) are the world's most successful sensory prosthesis and have been the subject of intense research and development in recent decades. We critically review the progress in CI research, and its success in improving patient outcomes, from the turn of the century to the present day. The review focuses on the processing, stimulation, and audiological methods that have been used to try to improve speech perception by human CI listeners, and on fundamental new insights in the response of the auditory system to electrical stimulation. The introduction of directional microphones and of new noise reduction and pre-processing algorithms has produced robust and sometimes substantial improvements. Novel speech-processing algorithms, the use of current-focusing methods, and individualised (patient-by-patient) deactivation of subsets of electrodes have produced more modest improvements. We argue that incremental advances have and will continue to be made, that collectively these may substantially improve patient outcomes, but that the modest size of each individual advance will require greater attention to experimental design and power. We also briefly discuss the potential and limitations of promising technologies that are currently being developed in animal models, and suggest strategies for researchers to collectively maximise the potential of CIs to improve hearing in a wide range of listening situations.

Dynamic current focusing for loudness encoding in cochlear implants: a take-home trial

Objective: This study aimed to evaluate a more energy-efficient dynamic current focussing (DCF) speech-processing strategy after long-term listening experience. In DCF, tripolar stimulation is used near the threshold and loudness is controlled by the compensation coefficient σ. A recent acute pilot study showed improved spectral-temporally modulated ripple test (SMRT) scores at low loudness levels, but battery life was reduced to 1.5-4 hours. Design: Within-subject comparisons were made for the clinical versus. DCF strategy after 5 weeks of at-home usage. Speech intelligibility in noise, spectral ripple discrimination, temporal modulation detection, loudness growth, and subjective ratings were assessed. Study sample: Twenty HiRes90K (Advanced Bionics, Valencia, USA) cochlear implant (CI) users. Results: Average battery life was 9 hours with the newly implemented DCF compared to 13.4 hours with the clinical strategy. Compared with measurements made at the beginning of the study, SMRT-scores and speech intelligibility in noise were significantly improved with DCF. However, both measures suffered from unexpected learning effects over time. The improvement disappeared and speech intelligibility in noise declined significantly relative to the final control measurement with the clinical strategy. Conclusion: Most CI users can adapt to the DCF strategy in a take-home setting. Although DCF has the potential to improve performance on the SMRT test, learning effects complicate the interpretation of the current results.

Dynamic Current Focusing: A Novel Approach to Loudness Coding in Cochlear Implants

OBJECTIVES

In an attempt to improve spectral resolution and speech intelligibility, several current focusing methods have been proposed to increase spatial selectivity by decreasing intracochlear current spread. For example, tripolar stimulation administers current to a central electrode and uses the two flanking electrodes as the return pathway, creating a narrower intracochlear electrical field and hence increases spectral resolution when compared with monopolar (MP) stimulation. However, more current is required, and in some patients, specifically the ones with high electrode impedances, full loudness growth cannot be supported because of compliance limits. The present study describes and analyses a new loudness encoding approach that uses tripolar stimulation near threshold and gradually broadens the excitation (by decreasing compensation coefficient σ) to increase loudness without the need to increase overall current. It is hypothesized that this dynamic current focusing (DCF) strategy increases spatial selectivity, especially at lower loudness levels, while maintaining maximum selectivity at higher loudness levels, without reaching compliance limits.

DESIGN

Eleven adult cochlear implant recipients with postlingual hearing loss, with at least 9 months of experience with their HiRes90K implant, were selected to participate in this study. Baseline performance regarding speech intelligibility in noise (Dutch matrix sentence test), spectral ripple discrimination at 45 and 65 dB, and temporal modulation detection thresholds were assessed using their own clinical program, fitted on a Harmony processor. Subsequently, the DCF strategy was fitted on a research Harmony processor. Threshold levels were determined with σ = 0.8, which means 80% of current is returned to the flanking electrodes and the remaining 20% to the extracochlear ground electrode. Instead of increasing overall pulse magnitude, σ was decreased to determine most comfortable loudness. After 2 to 3 hr of adaptation to the research strategy, the same psychophysical measures were taken.

RESULTS

At 45 dB, average spectral ripple scores improved significantly from 2.4 ripples per octave with their clinical program to 3.74 ripples per octave with the DCF strategy (p = 0.016). Eight out of 11 participants had an improved spectral resolution at 65 dB. Nevertheless, no significant difference between DCF and MP was observed at higher presentation levels. Both speech-in-noise and temporal modulation detection thresholds were equal for MP and DCF strategies. Subjectively, 2 participants preferred the DCF strategy over their own clinical program, 2 preferred their own strategy, while the majority of the participants had no preference. Battery life was decreased and ranged from 1.5 to 4 hr.

CONCLUSIONS

The DCF strategy gives better spectral resolution, at lower loudness levels, but equal performance on speech tests. These outcomes warrant for a longer adaptation period to study long-term outcomes and evaluate if the outcomes in the ripple tests transfer to the speech scores. Further research, for example, with respect to fitting rules and reduction of power consumption, is necessary to make the DCF strategy suitable for routine clinical application.

Take-Home Trial Comparing Fast Fourier Transformation-Based and Filter Bank-Based Cochlear Implant Speech Coding Strategies

Previous studies have demonstrated no improved or deteriorated speech intelligibility with the HiResolution Fidelity 120™ speech coding strategy (HiResF120) over the original HiRes strategy. Improved spectral and deteriorated temporal sensitivities have been shown, making it plausible that the beneficial effect in the spectral domain was offset by the worsened temporal sensitivity. We hypothesize that the implementation of fast Fourier transform (FFT) processing, instead of the traditionally used bandpass filters, explains the reduction of temporal sensitivity. In this study, spectral ripple discrimination, temporal modulation detection, and speech intelligibility in noise were assessed in a two-week take-home trial with 3 speech coding strategies: one with conventional bandpass filters (HiRes), one with FFT-based filters (HiRes FFT), and one with FFT-based filters and current steering (HiRes Optima). One participant dropped out due to discomfort with both research programs. The 10 remaining participants performed equally well on all tasks with all three speech coding strategies, implying that FFT processing does not change the ability of CI recipients to discriminate spectral or temporal information or speech understanding.

Restoring speech perception with cochlear implants by spanning defective electrode contacts

CONCLUSION

Even with six defective contacts, spanning can largely restore speech perception with the HiRes 120 speech processing strategy to the level supported by an intact electrode array. Moreover, the sound quality is not degraded.

OBJECTIVES

Previous studies have demonstrated reduced speech perception scores (SPS) with defective contacts in HiRes 120. This study investigated whether replacing defective contacts by spanning, i.e. current steering on non-adjacent contacts, is able to restore speech recognition to the level supported by an intact electrode array.

METHODS

Ten adult cochlear implant recipients (HiRes90K, HiFocus1J) with experience with HiRes 120 participated in this study. Three different defective electrode arrays were simulated (six separate defective contacts, three pairs or two triplets). The participants received three take-home strategies and were asked to evaluate the sound quality in five predefined listening conditions. After 3 weeks, SPS were evaluated with monosyllabic words in quiet and in speech-shaped background noise.

RESULTS

The participants rated the sound quality equal for all take-home strategies. SPS with background noise were equal for all conditions tested. However, SPS in quiet (85% phonemes correct on average with the full array) decreased significantly with increasing spanning distance, with a 3% decrease for each spanned contact.

Pediatric Evaluation of the ClearVoice™ Speech Enhancement Algorithm in Everyday Life

ClearVoice™ enables Advanced Bionics cochlear implant users to improve their speech understanding in difficult listening environments, without compromising performance in quiet situations. The aim of the study was to evaluate the benefits of ClearVoice in children. Children between six and fourteen years of age randomly tested two modalities of ClearVoice for one month each. The baseline program, HiRes 120™, and both ClearVoice programs were evaluated with a sentence test in quiet and noise. Parents and teachers completed a questionnaire related to everyday noisy situations. The switchover to ClearVoice was uneventful for both modalities. Adjustments to thresholds and comfort levels were required. Seven out of the nine children preferred a ClearVoice program. No impact of ClearVoice on performance in quiet was observed and both modalities of ClearVoice improved speech understanding in noise compared to the baseline program, significantly with ClearVoice high. Positive outcomes were obtained from the questionnaires and discussions with parents and children. This study showed that children benefited from using ClearVoice in their daily life. There was a clear trend towards improved speech understanding in noise with ClearVoice, without affecting performance in quiet; therefore ClearVoice can be used by children all day, without having to change programs.