Syllable-rate-adjusted-modulation (SRAM) predicts clear and conversational speech intelligibility

Introduction

Objectively predicting speech intelligibility is important in both telecommunication and human-machine interaction systems. The classic method relies on signal-to-noise ratios (SNR) to successfully predict speech intelligibility. One exception is clear speech, in which a talker intentionally articulates as if speaking to someone who has hearing loss or is from a different language background. As a result, at the same SNR, clear speech produces higher intelligibility than conversational speech. Despite numerous efforts, no objective metric can successfully predict the clear speech benefit at the sentence level.

Methods

We proposed a Syllable-Rate-Adjusted-Modulation (SRAM) index to predict the intelligibility of clear and conversational speech. The SRAM used as short as 1 s speech and estimated its modulation power above the syllable rate. We compared SRAM with three reference metrics: envelope-regression-based speech transmission index (ER-STI), hearing-aid speech perception index version 2 (HASPI-v2) and short-time objective intelligibility (STOI), and five automatic speech recognition systems: Amazon Transcribe, Microsoft Azure Speech-To-Text, Google Speech-To-Text, wav2vec2 and Whisper.

Results

SRAM outperformed the three reference metrics (ER-STI, HASPI-v2 and STOI) and the five automatic speech recognition systems. Additionally, we demonstrated the important role of syllable rate in predicting speech intelligibility by comparing SRAM with the total modulation power (TMP) that was not adjusted by the syllable rate.

Discussion

SRAM can potentially help understand the characteristics of clear speech, screen speech materials with high intelligibility, and convert conversational speech into clear speech.

Predictive coding and stochastic resonance as fundamental principles of auditory phantom perception

Mechanistic insight is achieved only when experiments are employed to test formal or computational models. Furthermore, in analogy to lesion studies, phantom perception may serve as a vehicle to understand the fundamental processing principles underlying healthy auditory perception. With a special focus on tinnitus-as the prime example of auditory phantom perception-we review recent work at the intersection of artificial intelligence, psychology and neuroscience. In particular, we discuss why everyone with tinnitus suffers from (at least hidden) hearing loss, but not everyone with hearing loss suffers from tinnitus. We argue that intrinsic neural noise is generated and amplified along the auditory pathway as a compensatory mechanism to restore normal hearing based on adaptive stochastic resonance. The neural noise increase can then be misinterpreted as auditory input and perceived as tinnitus. This mechanism can be formalized in the Bayesian brain framework, where the percept (posterior) assimilates a prior prediction (brain's expectations) and likelihood (bottom-up neural signal). A higher mean and lower variance (i.e. enhanced precision) of the likelihood shifts the posterior, evincing a misinterpretation of sensory evidence, which may be further confounded by plastic changes in the brain that underwrite prior predictions. Hence, two fundamental processing principles provide the most explanatory power for the emergence of auditory phantom perceptions: predictive coding as a top-down and adaptive stochastic resonance as a complementary bottom-up mechanism. We conclude that both principles also play a crucial role in healthy auditory perception. Finally, in the context of neuroscience-inspired artificial intelligence, both processing principles may serve to improve contemporary machine learning techniques.

Audiometric Validation of a Smart Watch Decibel Meter

This diagnostic study assesses the performance of the Apple Watch Noise application in comparison with a class 1 sound level meter.

Adopting Change and Incorporating Technological Advancements in Audiology Education, Research, and Clinical Practice

PURPOSE

With the rapid development of new technologies and resources, many avenues exist to adapt and grow as a profession. Embracing change can lead to growth, evolution, and new opportunities. Audiologists have the potential to harness many of these technological advancements to improve patient health care. Adoption and incorporation of these new technologies will likely benefit educational experiences, research methods, clinical practice, and clinical outcomes.

METHOD

This commentary highlights some historical perspectives and accepted practices while illustrating opportunities to embrace new ideas and technologies. We also provide examples of how such adoption may yield positive outcomes. Specifically, we address embracing technology in audiology education, how artificial intelligence may influence patient performance in realistic listening scenarios, the convergence between hearing aids and consumer electronics, and the emergence of audiology telehealth services and their inclusion in clinical practice. Models of change are also discussed and related to audiology.

CONCLUSION

This commentary aims to be a call to action for the entire profession of audiology to consider conscientiously the adoption of useful, evidence-based technological advancements in education, research, and clinical practice.

Celebrating the one millionth cochlear implant

Cochlear implants have been the most successful neural prosthesis, with one million users globally. Researchers used the source-filter model and speech vocoder to design the modern multi-channel implants, allowing implantees to achieve 70%-80% correct sentence recognition in quiet, on average. Researchers also used the cochlear implant to help understand basic mechanisms underlying loudness, pitch, and cortical plasticity. While front-end processing advances improved speech recognition in noise, the unilateral implant speech recognition in quiet has plateaued since the early 1990s. This lack of progress calls for action on re-designing the cochlear stimulating interface and collaboration with the general neurotechnology community.

Harnessing the Power of Artificial Intelligence in Otolaryngology and the Communication Sciences

Use of artificial intelligence (AI) is a burgeoning field in otolaryngology and the communication sciences. A virtual symposium on the topic was convened from Duke University on October 26, 2020, and was attended by more than 170 participants worldwide. This review presents summaries of all but one of the talks presented during the symposium; recordings of all the talks, along with the discussions for the talks, are available at https://www.youtube.com/watch?v=ktfewrXvEFg and https://www.youtube.com/watch?v=-gQ5qX2v3rg . Each of the summaries is about 2500 words in length and each summary includes two figures. This level of detail far exceeds the brief summaries presented in traditional reviews and thus provides a more-informed glimpse into the power and diversity of current AI applications in otolaryngology and the communication sciences and how to harness that power for future applications.

Tele-Audiology: Current State and Future Directions

The importance of tele-audiology has been heightened by the current COVID-19 pandemic. The present article reviews the current state of tele-audiology practice while presenting its limitations and opportunities. Specifically, this review addresses: (1) barriers to hearing healthcare, (2) tele-audiology services, and (3) tele-audiology key issues, challenges, and future directions. Accumulating evidence suggests that tele-audiology is a viable service delivery model, as remote hearing screening, diagnostic testing, intervention, and rehabilitation can each be completed reliably and effectively. The benefits of tele-audiology include improved access to care, increased follow-up rates, and reduced travel time and costs. Still, significant logistical and technical challenges remain from ensuring a secure and robust internet connection to controlling ambient noise and meeting all state and federal licensure and reimbursement regulations. Future research and development, especially advancements in artificial intelligence, will continue to increase tele-audiology acceptance, expand remote care, and ultimately improve patient satisfaction.

Electric hearing and tinnitus suppression by noninvasive ear stimulation

While noninvasive brain stimulation is convenient and cost effective, its utility is limited by the substantial distance between scalp electrodes and their intended neural targets in the head. The tympanic membrane, or eardrum, is a thin flap of skin deep in an orifice of the head that may serve as a port for improved efficiency of noninvasive stimulation. Here we chose the cochlea as a target because it resides in the densest bone of the skull and is adjacent to many deep-brain-stimulation structures. We also tested the hypothesis that noninvasive electric stimulation of the cochlea may restore neural activities that are missing in acoustic stimulation. We placed an electrode in the ear canal or on the tympanic membrane in 25 human adults (10 females) and compared their stimulation efficiency by characterizing the electrically-evoked auditory sensation. Relative to ear canal stimulation, tympanic membrane stimulation was four times more likely to produce an auditory percept, required eight times lower electric current to reach the threshold and produced two-to-four times more linear suprathreshold responses. We further measured tinnitus suppression in 14 of the 25 subjects who had chronic tinnitus. Compared with ear canal stimulation, tympanic membrane stimulation doubled both the probability (22% vs. 55%) and the amount (-15% vs. -34%) of tinnitus suppression. These findings extended previous work comparing evoked perception and tinnitus suppression between electrodes placed in the ear canal and on the scalp. Together, the previous and present results suggest that the efficiency of conventional scalp-based noninvasive electric stimulation can be improved by at least one order of magnitude via tympanic membrane stimulation. This increased efficiency is most likely due to the shortened distance between the electrode placed on the tympanic membrane and the targeted cochlea. The present findings have implications for the management of tinnitus by offering a potential alternative to interventions using invasive electrical stimulation such as cochlear implantation, or other non-invasive transcranial electrical stimulation methods.

Tinnitus Is Associated With Improved Cognitive Performance in Non-hispanic Elderly With Hearing Loss

Because hearing loss is a high-risk factor for cognitive decline, tinnitus, a comorbid condition of hearing loss, is often presumed to impair cognition. The present cross-sectional study aimed to delineate the interaction of tinnitus and cognition in the elderly with and without hearing loss after adjusting for covariates in race, age, sex, education, pure tone average, hearing aids, and physical well-being. Participants included 643 adults (60–69 years old; 51.3% females) from the National Health and Nutrition Examination Survey (NHANES, 2011–2012), and 1,716 (60–69 years old; 60.4% females) from the Hispanic Community Health Study (HCHS, 2008–2011). Multivariable linear and binary logistic regression was used to assess the association between tinnitus and cognition in the two sub-cohorts of normal hearing (NHANES, n = 508; HCHS, n = 1264) and hearing loss (NHANES, n = 135; HCHS, n = 453). Cognitive performance was measured as a composite z-score from four cognitive tests: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD)-word learning, CERAD-animal fluency, CERAD-word list recall, and the digit symbol substitution test (DSST) in NHANES, and a comparable Hispanic version of these four tests in HCHS. Multivariable linear regression revealed no association between tinnitus and cognition, except for the NHANES (non-Hispanic) participants with hearing loss, where the presence of tinnitus was associated with improved cognitive performance (Mean = 0.3; 95% CI, 0.1–0.5; p, 0.018). Using the 25th percentile score of the control (i.e., normal hearing and no tinnitus) as a threshold for poor cognitive performance, the absence of tinnitus increased the risk for poor cognitive performance (OR = 5.6, 95% CI, 1.9–17.2; p, 0.002). Sensitivity analysis found a positive correlation between tinnitus duration and cognitive performance in the NHANES cohort [F(4,140), 2.6; p, 0.037]. The present study finds no evidence for the assumption that tinnitus impairs cognitive performance in the elderly. On the contrary, tinnitus is associated with improved cognitive performance in the non-Hispanic elderly with hearing loss. The present result suggests that race be considered as an important and relevant factor in the experimental design of tinnitus research. Future longitudinal and imaging studies are needed to validate the present findings and understand their mechanisms.

Task-dependent effects of nicotine treatment on auditory performance in young-adult and elderly human nonsmokers

Electrophysiological studies show that nicotine enhances neural responses to characteristic frequency stimuli. Previous behavioral studies partially corroborate these findings in young adults, showing that nicotine selectively enhances auditory processing in difficult listening conditions. The present work extended previous work to include both young and older adults and assessed the nicotine effect on sound frequency and intensity discrimination. Hypotheses were that nicotine improves auditory performance and that the degree of improvement is inversely proportional to baseline performance. Young (19-23 years old) normal-hearing nonsmokers and elderly (61-80) nonsmokers with normal hearing between 500 and 2000 Hz received nicotine gum (6 mg) or placebo gum in a single-blind, randomized crossover design. Participants performed three experiments (frequency discrimination, frequency modulation identification, and intensity discrimination) before and after treatment. The perceptual differences were analyzed between pre- and post-treatment, as well as between post-treatment nicotine and placebo conditions as a function of pre-treatment baseline performance. Compared to pre-treatment performance, nicotine significantly improved frequency discrimination. Compared to placebo, nicotine significantly improved performance for intensity discrimination, and the improvement was more pronounced in the elderly with lower baseline performance. Nicotine had no effect on frequency modulation identification. Nicotine effects are task-dependent, reflecting possible interplays of subjects, tasks and neural mechanisms.

Tinnitus and hyperacusis: Central noise, gain and variance

Tinnitus is a phantom auditory sensation in the absence of external sounds, while hyperacusis is an atypical sensitivity to external sounds that leads them to be perceived as abnormally loud or even painful. Both conditions may reflect the brain's over-compensation for reduced input from the ear. The present work differentiates between two compensation models: The additive central noise compensates for hearing loss and is likely to generate tinnitus, whereas the multiplicative central gain compensates for hidden hearing loss and is likely to generate hyperacusis. Importantly, both models predict increased variance in central representations of sounds, especially a nonlinear increase in variance by the central gain. The increased central variance limits the amount of central compensation and reduces temporal synchrony, which can explain the insufficient central gain reported in the literature. Future studies need to collect trial-by-trial firing variance data so that the present variance-based model can be falsified.

Rapid adaptation to non-native speech is impaired in cochlear implant users

To examine difficulties experienced by cochlear implant (CI) users when perceiving non-native speech, intelligibility of non-native speech was compared in conditions with single and multiple alternating talkers. Compared to listeners with normal hearing, no rapid talker-dependent adaptation was observed and performance was approximately 40% lower for CI users following increased exposure in both talker conditions. Results suggest that lower performance for CI users may stem from combined effects of limited spectral resolution, which diminishes perceptible differences across accents, and limited access to talker-specific acoustic features of speech, which reduces the ability to adapt to non-native speech in a talker-dependent manner.

A Unified Theory of Psychophysical Laws in Auditory Intensity Perception

Psychophysical laws quantitatively relate perceptual magnitude to stimulus intensity. While most people have accepted Stevens's power function as the psychophysical law, few believe in Fechner's original idea using just-noticeable-differences (jnd) as a constant perceptual unit to educe psychophysical laws. Here I present a unified theory in hearing, starting with a general form of Zwislocki's loudness function (1965) to derive a general form of Brentano's law. I will arrive at a general form of the loudness-jnd relationship that unifies previous loudness-jnd theories. Specifically, the "slope," "proportional-jnd," and "equal-loudness, equal-jnd" theories, are three additive terms in the new unified theory. I will also show that the unified theory is consistent with empirical data in both acoustic and electric hearing. Without any free parameters, the unified theory uses loudness balance functions to successfully predict the jnd function in a wide range of hearing situations. The situations include loudness recruitment and its jnd functions in sensorineural hearing loss and simultaneous masking, loudness enhancement and the midlevel hump in forward and backward masking, abnormal loudness and jnd functions in cochlear implant subjects. Predictions of these loudness-jnd functions were thought to be questionable at best in simultaneous masking or not possible at all in forward masking. The unified theory and its successful applications suggest that although the specific form of Fechner's law needs to be revised, his original idea is valid in the wide range of hearing situations discussed here.

Nicotine enhances auditory processing in healthy and normal-hearing young adult nonsmokers

RATIONALE

Electrophysiological studies show that systemic nicotine narrows frequency receptive fields and increases gain in neural responses to characteristic frequency stimuli. We postulated that nicotine enhances related auditory processing in humans.

OBJECTIVES

The main hypothesis was that nicotine improves auditory performance. A secondary hypothesis was that the degree of nicotine-induced improvement depends on the individual's baseline performance.

METHODS

Young (18-27 years old), normal-hearing nonsmokers received nicotine (Nicorette gum, 6mg) or placebo gum in a single-blind, randomized, crossover design. Subjects performed four experiments involving tone-in-noise detection, temporal gap detection, spectral ripple discrimination, and selective auditory attention before and after treatment. The perceptual differences between posttreatment nicotine and placebo conditions were measured and analyzed as a function of the pre-treatment baseline performance.

RESULTS

Nicotine significantly improved performance in the more difficult tasks of tone-in-noise detection and selective attention (effect size = - 0.3) but had no effect on relatively easier tasks of temporal gap detection and spectral ripple discrimination. The two tasks showing significant nicotine effects further showed no baseline-dependent improvement.

CONCLUSIONS

Nicotine improves auditory performance in difficult listening situations. The present results support future investigation of nicotine effects in clinical populations with auditory processing deficits or reduced cholinergic activation.

Input-Output Functions in Human Heads Obtained With Cochlear Implant and Transcranial Electric Stimulation

OBJECTIVES

Electric stimulation is used to treat a number of neurologic disorders such as epilepsy and depression. However, delivering the required current to far-field neural targets is often ineffective because of current spread through low-impedance pathways. Here, the specific aims are to develop an empirical measure for current passing through the human head and to optimize stimulation strategies for targeting deeper structures, including the auditory nerve, by utilizing the cochlear implant (CI).

MATERIALS AND METHODS

Outward input/output (I/O) functions were obtained by CI stimulation and recording scalp potentials in five CI subjects. Conversely, inward I/O functions were obtained by noninvasive transcranial electric stimulation (tES) and recording intracochlear potentials using the onboard recording capability of the CI.

RESULTS

I/O measures indicate substantial current spread, with a maximum of 2.2% gain recorded at the inner ear target during tES (mastoid-to-mastoid electrode configuration). Similarly, CI stimulation produced a maximum of 1.1% gain at the scalp electrode nearest the CI return electrode. Gain varied with electrode montage according to a point source model that accounted for distances between the stimulating and recording electrodes. Within the same electrode montages, current gain patterns varied across subjects suggesting the importance of tissue properties, geometry, and electrode positioning.

CONCLUSION

These results provide a novel objective measure of electric stimulation in the human head, which can help to optimize stimulation parameters that improve neural excitation of deep structures by reducing the influence of current spread.

Human Sensation of Transcranial Electric Stimulation

Noninvasive transcranial electric stimulation is increasingly being used as an advantageous therapy alternative that may activate deep tissues while avoiding drug side-effects. However, not only is there limited evidence for activation of deep tissues by transcranial electric stimulation, its evoked human sensation is understudied and often dismissed as a placebo or secondary effect. By systematically characterizing the human sensation evoked by transcranial alternating-current stimulation, we observed not only stimulus frequency and electrode position dependencies specific for auditory and visual sensation but also a broader presence of somatic sensation ranging from touch and vibration to pain and pressure. We found generally monotonic input-output functions at suprathreshold levels, and often multiple types of sensation occurring simultaneously in response to the same electric stimulation. We further used a recording circuit embedded in a cochlear implant to directly and objectively measure the amount of transcranial electric stimulation reaching the auditory nerve, a deep intercranial target located in the densest bone of the skull. We found an optimal configuration using an ear canal electrode and low-frequency (<300 Hz) sinusoids that delivered maximally ~1% of the transcranial current to the auditory nerve, which was sufficient to produce sound sensation even in deafened ears. Our results suggest that frequency resonance due to neuronal intrinsic electric properties need to be explored for targeted deep brain stimulation and novel brain-computer interfaces.

Development and Clinical Introduction of the Nurotron Cochlear Implant Electrode Array

As the only medical device used in the treatment for deafness, the cochlear implant has benefited to more than half a million individuals worldwide. However, the device has limited penetration due to its high cost, especially in low- and middle-income countries. China alone has 27.8 million deaf people, but less than 100,000 of them have received a cochlear implant. The Nurotron Venus device was developed to address the need for an affordable yet safe and effective cochlear implant. The present study describes the design, development, and evaluation of the Nurotron intracochlear electrode array. The standard array is 22 mm in length from the round window marker to the apical tip of the carrier and has 24 electrodes, with a surface area of 0.32 mm2 and center-to-center spacing of 0.85 mm. The Nurotron array has been tested to meet the mechanical, chemical, and electrical requirements specified by the ISO Standard 14708-07. Human temporal bone and clinical trial results showed that the Nurotron array is easy to insert (7.8/10 rating with 10 indicating the highest ease of use) and has a low complication rate (12.5%) of severe insertion trauma while achieving high device stability and reliability (6 array failures in 43,000 patient years of experience). As a critical component, the Nurotron array has contributed to the high level of Nurotron implant speech performance, equivalent to that produced by other existing devices. The Nurotron device has benefited 10,000 deaf people and helped reduce the unit cost from US$25,000 in 2011 to US$4,620 in 2017 through the Chinese Government Tender Program. New, slim, and micromachined electrodes are being developed to further improve performance and accessibility.

Design, Fabrication, and Evaluation of a Parylene Thin-Film Electrode Array for Cochlear Implants

OBJECTIVE

To improve the existing manually assembled cochlear implant electrode arrays, a thin-film electrode array (TFEA) was microfabricated having a maximum electrode density of 15 sites along an 8-mm length, with each site having a 75 μm × 1.8 μm (diameter × height) disk electrode.

METHODS

The microfabrication method adopted photoresist transferring, lift-off, two-step oxygen plasma etching, and fuming nitric acid release to reduce lift-off complexity, protect the metal layer, and increase the release efficiency.

RESULTS

Systematic in vitro characterization showed that the TFEA's bending stiffness was 6.40 × 10-10 N·m2 near the base and 1.26 × 10-10 N·m2 near the apex. The TFEA electrode produced an average impedance of 16 kΩ and a maximum current limit of 800 μA, measured with 1-kHz sinusoidal current using monopolar stimulation in saline. A TFEA prototype was implanted in a cat cochlea to obtain in vivo measurements of electrically evoked auditory brainstem and inferior colliculus responses to monopolar stimulation with 41-μs/phase biphasic pulses. Both physiological responses produced a threshold of ∼300 μA and a dynamic range of 5-8 dB above the threshold. Compared with existing arrays, the present TFEA had 104 times less bending stiffness, 97% less electrode area, and comparable physiological thresholds.

CONCLUSION

Using a simplified structure and stable fabrication method, the present TEFA produced physical and physiological performance comparable to existing commercial devices.

SIGNIFICANCE

The present TFEA represents a step closer toward an automated process replacing the labor-intensive and expensive manual assembly of the cochlear implant electrode arrays.

Tinnitus Treatment Using Noninvasive and Minimally Invasive Electric Stimulation: Experimental Design and Feasibility

Noninvasive transcranial or minimally invasive transtympanic electric stimulation may offer a desirable treatment option for tinnitus because it can activate the deafferented auditory nerve fibers while posing little to no risk to hearing. Here, we built a flexible research interface to generate and control accurately charge-balanced current stimulation as well as a head-mounted instrument capable of holding a transtympanic electrode steady for hours. We then investigated the short-term effect of a limited set of electric stimulation parameters on tinnitus in 10 adults with chronic tinnitus. The preliminary results showed that 63% of conditions of electric stimulation produced some degree of tinnitus reduction, with total disappearance of tinnitus in six subjects in response to at least one condition. The present study also found significant side effects such as visual, tactile, and even pain sensations during electric stimulation. In addition to masking and residual inhibition, neuroplasticity is likely involved in the observed tinnitus reduction. To translate the present electric stimulation into a safe and effective tinnitus treatment option, we need to optimize stimulation parameters that activate the deafferented auditory nerve fibers and reliably suppress tinnitus, with minimal side effects and tolerable sensations. Noninvasive or minimally invasive electric stimulation can be integrated with sound therapy, invasive cochlear implants, or other forms of coordinated stimulation to provide a systematic strategy for tinnitus treatment or even a cure.

Electro-tactile stimulation (ETS) enhances cochlear-implant Mandarin tone recognition

Objective

Electro-acoustic stimulation (EAS) is an effective method to enhance cochlear-implant performance in individuals who have residual low-frequency acoustic hearing. To help the majority of cochlear implant users who do not have any functional residual acoustic hearing, electro-tactile stimulation (ETS) may be used because tactile sensation has a frequency range and perceptual capabilities similar to that produced by acoustic stimulation in the EAS users.

Methods

Following up the first ETS study showing enhanced English sentence recognition in noise,¹ the present study evaluated the effect of ETS on Mandarin tone recognition in noise in two groups of adult Mandarin-speaking individuals. The first group included 11 normal-hearing individuals who listened to a 4-channel, noise-vocoded, cochlear-implant simulation. The second group included 1 unilateral cochlear-implant user and 2 bilateral users with each of their devices being tested independently. Both groups participated in a 4-alternative, forced-choice task, in which they had to identify a tone that was presented in noise at a 0-dB signal-to-noise ratio via electric stimulation (actual or simulated cochlear implants), tactile stimulation or the combined ETS.

Results

While electric or tactile stimulation alone produced similar tone recognition (∼40% correct), the ETS enhanced the cochlear-implant tone recognition by 17–18 percentage points. The size of the present ETS enhancement effect was similar to that of the previously reported EAS effect on Mandarin tone recognition. Psychophysical analysis on tactile sensation showed an important role of frequency discrimination in the ETS enhancement.

Conclusion

Tactile stimulation can potentially enhance Mandarin tone recognition in cochlear-implant users who do not have usable residual acoustic hearing. To optimize this potential, high fundamental frequencies need to be transposed to a 100–200 Hz range.

Challenges in Improving Cochlear Implant Performance and Accessibility

Here I identify two gaps in cochlear implants that have been limiting their performance and acceptance. First, cochlear implant performance has remained largely unchanged, despite the number of publications tripling per decade in the last 30 years. Little has been done so far to address a fundamental limitation in the electrode-to-neuron interface, with the electrode size being a thousand times larger than the neuron diameter while the number of electrodes being a thousand times less. Both the small number and the large size of electrodes produce broad spatial activation and poor frequency resolution that limit current cochlear implant performance. Second, a similarly rapid growth in cochlear implant volume has not produced an expected decrease in unit price in the same period. The high cost contributes to low market penetration rate, which is about 20% in developed countries and less than 1% in developing countries. I will discuss changes needed in both research strategy and business practice to close the gap between prosthetic and normal hearing as well as that between haves and have-nots.

Objective and subjective evaluations of the Nurotron Venus cochlear implant system via animal experiments and clinical trials

CONCLUSION

This study described objective and subjective evaluations of the Nurotron® Venus™ Cochlear Implant System and indicated that this system produced a satisfactory performance.

OBJECTIVE

To observe the performance of the Nurotron® Venus™ cochlear implant (CI) system via electrophysiological and psychophysical evaluations.

METHODS

A 26-electrode CI system was specially designed. The performance of MRI in animal and cadaveric head experiments, EABR in cats experiment, the correlation between ESRT and C level, and psychophysics evaluations in clinical trials were observed.

RESULTS

In the animal and cadaveric head experiments, magnet dislocation could not be prevented in the 1.5 T MRI without removal of the internal magnet. The EABR was clearly elicited in cat experiment. In the clinical trial, the ESRT was strongly correlated with C level (p < 0.001). The human clinical trial involving 57 post-lingually deafened native Mandarin-speaking patients was performed. Residual hearing protection in the implanted ear at each audiometric frequency was observed in 27.5-46.3% patients post-operatively. A pitch ranking test revealed that place pitches were generally ordered from apical to basal electrodes. The recognitions of the perceptions of 301 disyllabic words, environment sounds, disyllabic words, and numerals were significantly better than the pre-operative performance and reached plateaus.

Central Auditory Processing of Temporal and Spectral-Variance Cues in Cochlear Implant Listeners

Cochlear implant (CI) listeners have difficulty understanding speech in complex listening environments. This deficit is thought to be largely due to peripheral encoding problems arising from current spread, which results in wide peripheral filters. In normal hearing (NH) listeners, central processing contributes to segregation of speech from competing sounds. We tested the hypothesis that basic central processing abilities are retained in post-lingually deaf CI listeners, but processing is hampered by degraded input from the periphery. In eight CI listeners, we measured auditory nerve compound action potentials to characterize peripheral filters. Then, we measured psychophysical detection thresholds in the presence of multi-electrode maskers placed either inside (peripheral masking) or outside (central masking) the peripheral filter. This was intended to distinguish peripheral from central contributions to signal detection. Introduction of temporal asynchrony between the signal and masker improved signal detection in both peripheral and central masking conditions for all CI listeners. Randomly varying components of the masker created spectral-variance cues, which seemed to benefit only two out of eight CI listeners. Contrastingly, the spectral-variance cues improved signal detection in all five NH listeners who listened to our CI simulation. Together these results indicate that widened peripheral filters significantly hamper central processing of spectral-variance cues but not of temporal cues in post-lingually deaf CI listeners. As indicated by two CI listeners in our study, however, post-lingually deaf CI listeners may retain some central processing abilities similar to NH listeners.

Amplitude modulation reduces loudness adaptation to high-frequency tones

Long-term loudness perception of a sound has been presumed to depend on the spatial distribution of activated auditory nerve fibers as well as their temporal firing pattern. The relative contributions of those two factors were investigated by measuring loudness adaptation to sinusoidally amplitude-modulated 12-kHz tones. The tones had a total duration of 180 s and were either unmodulated or 100%-modulated at one of three frequencies (4, 20, or 100 Hz), and additionally varied in modulation depth from 0% to 100% at the 4-Hz frequency only. Every 30 s, normal-hearing subjects estimated the loudness of one of the stimuli played at 15 dB above threshold in random order. Without any amplitude modulation, the loudness of the unmodulated tone after 180 s was only 20% of the loudness at the onset of the stimulus. Amplitude modulation systematically reduced the amount of loudness adaptation, with the 100%-modulated stimuli, regardless of modulation frequency, maintaining on average 55%-80% of the loudness at onset after 180 s. Because the present low-frequency amplitude modulation produced minimal changes in long-term spectral cues affecting the spatial distribution of excitation produced by a 12-kHz pure tone, the present result indicates that neural synchronization is critical to maintaining loudness perception over time.

Development and evaluation of the Nurotron 26-electrode cochlear implant system

Although the cochlear implant has been widely acknowledged as the most successful neural prosthesis, only a fraction of hearing-impaired people who can potentially benefit from a cochlear implant have actually received one due to its limited awareness, accessibility, and affordability. To help overcome these limitations, a 26-electrode cochlear implant has been developed to receive China's Food and Drug Administration (CFDA) approval in 2011 and Conformité Européenne (CE) Marking in 2012. The present article describes design philosophy, system specification, and technical verification of the Nurotron device, which includes advanced digital signal processing and 4 current sources with multiple amplitude resolutions that not only are compatible with perceptual capability but also allow interleaved or simultaneous stimulation. The article also presents 3-year longitudinal evaluation data from 60 human subjects who have received the Nurotron device. The objective measures show that electrode impedance decreased within the first month of device use, but was stable until a slight increase at the end of two years. The subjective loudness measures show that electric stimulation threshold was stable while the maximal comfort level increased over the 3 years. Mandarin sentence recognition increased from the pre-surgical 0%-correct score to a plateau of about 80% correct with 6-month use of the device. Both indirect and direct comparisons indicate indistinguishable performance differences between the Nurotron system and other commercially available devices. The present 26-electrode cochlear implant has already helped to lower the price of cochlear implantation in China and will likely contribute to increased cochlear implant access and success in the rest of the world. This article is part of a Special Issue entitled <Lasker Award>.

Accurate guitar tuning by cochlear implant musicians

Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task.

Objective assessment of spectral ripple discrimination in cochlear implant listeners using cortical evoked responses to an oddball paradigm

Cochlear implants (CIs) can partially restore functional hearing in deaf individuals. However, multiple factors affect CI listener's speech perception, resulting in large performance differences. Non-speech based tests, such as spectral ripple discrimination, measure acoustic processing capabilities that are highly correlated with speech perception. Currently spectral ripple discrimination is measured using standard psychoacoustic methods, which require attentive listening and active response that can be difficult or even impossible in special patient populations. Here, a completely objective cortical evoked potential based method is developed and validated to assess spectral ripple discrimination in CI listeners. In 19 CI listeners, using an oddball paradigm, cortical evoked potential responses to standard and inverted spectrally rippled stimuli were measured. In the same subjects, psychoacoustic spectral ripple discrimination thresholds were also measured. A neural discrimination threshold was determined by systematically increasing the number of ripples per octave and determining the point at which there was no longer a significant difference between the evoked potential response to the standard and inverted stimuli. A correlation was found between the neural and the psychoacoustic discrimination thresholds (R² = 0.60, p<0.01). This method can objectively assess CI spectral resolution performance, providing a potential tool for the evaluation and follow-up of CI listeners who have difficulty performing psychoacoustic tests, such as pediatric or new users.

Abnormal pitch perception produced by cochlear implant stimulation

Contemporary cochlear implants with multiple electrode stimulation can produce good speech perception but poor music perception. Hindered by the lack of a gold standard to quantify electric pitch, relatively little is known about the nature and extent of the electric pitch abnormalities and their impact on cochlear implant performance. Here we overcame this obstacle by comparing acoustic and electric pitch perception in 3 unilateral cochlear-implant subjects who had functionally usable acoustic hearing throughout the audiometric frequency range in the non-implant ear. First, to establish a baseline, we measured and found slightly impaired pure tone frequency discrimination and nearly perfect melody recognition in all 3 subjects' acoustic ear. Second, using pure tones in the acoustic ear to match electric pitch induced by an intra-cochlear electrode, we found that the frequency-electrode function was not only 1-2 octaves lower, but also 2 times more compressed in frequency range than the normal cochlear frequency-place function. Third, we derived frequency difference limens in electric pitch and found that the equivalent electric frequency discrimination was 24 times worse than normal-hearing controls. These 3 abnormalities are likely a result of a combination of broad electric field, distant intra-cochlear electrode placement, and non-uniform spiral ganglion cell distribution and survival, all of which are inherent to the electrode-nerve interface in contemporary cochlear implants. Previous studies emphasized on the "mean" shape of the frequency-electrode function, but the present study indicates that the large "variance" of this function, reflecting poor electric pitch discriminability, is the main factor limiting contemporary cochlear implant performance.

Cochlear implant artifact attenuation in late auditory evoked potentials: a single channel approach

Recent evidence suggests that late auditory evoked potentials (LAEP) provide a useful objective metric of performance in cochlear implant (CI) subjects. However, the CI produces a large electrical artifact that contaminates LAEP recordings and confounds their interpretation. Independent component analysis (ICA) has been used in combination with multi-channel recordings to effectively remove the artifact. The applicability of the ICA approach is limited when only single channel data are needed or available, as is often the case in both clinical and research settings. Here we developed a single-channel, high sample rate (125 kHz), and high bandwidth (0-100 kHz) acquisition system to reduce the CI stimulation artifact. We identified two different artifacts in the recording: 1) a high frequency artifact reflecting the stimulation pulse rate, and 2) a direct current (DC, or pedestal) artifact that showed a non-linear time varying relationship to pulse amplitude. This relationship was well described by a bivariate polynomial. The high frequency artifact was completely attenuated by a 35 Hz low-pass filter for all subjects (n = 22). The DC artifact could be caused by an impedance mismatch. For 27% of subjects tested, no DC artifact was observed when electrode impedances were balanced to within 1 kΩ. For the remaining 73% of subjects, the pulse amplitude was used to estimate and then attenuate the DC artifact. Where measurements of pulse amplitude were not available (as with standard low sample rate systems), the DC artifact could be estimated from the stimulus envelope. The present artifact removal approach allows accurate measurement of LAEPs from CI subjects from single channel recordings, increasing their feasibility and utility as an accessible objective measure of CI function.

Loudness adaptation accompanying ribbon synapse and auditory nerve disorders

Abnormal auditory adaptation is a standard clinical tool for diagnosing auditory nerve disorders due to acoustic neuromas. In the present study we investigated auditory adaptation in auditory neuropathy owing to disordered function of inner hair cell ribbon synapses (temperature-sensitive auditory neuropathy) or auditory nerve fibres. Subjects were tested when afebrile for (i) psychophysical loudness adaptation to comfortably-loud sustained tones; and (ii) physiological adaptation of auditory brainstem responses to clicks as a function of their position in brief 20-click stimulus trains (#1, 2, 3 … 20). Results were compared with normal hearing listeners and other forms of hearing impairment. Subjects with ribbon synapse disorder had abnormally increased magnitude of loudness adaptation to both low (250 Hz) and high (8000 Hz) frequency tones. Subjects with auditory nerve disorders had normal loudness adaptation to low frequency tones; all but one had abnormal adaptation to high frequency tones. Adaptation was both more rapid and of greater magnitude in ribbon synapse than in auditory nerve disorders. Auditory brainstem response measures of adaptation in ribbon synapse disorder showed Wave V to the first click in the train to be abnormal both in latency and amplitude, and these abnormalities increased in magnitude or Wave V was absent to subsequent clicks. In contrast, auditory brainstem responses in four of the five subjects with neural disorders were absent to every click in the train. The fifth subject had normal latency and abnormally reduced amplitude of Wave V to the first click and abnormal or absent responses to subsequent clicks. Thus, dysfunction of both synaptic transmission and auditory neural function can be associated with abnormal loudness adaptation and the magnitude of the adaptation is significantly greater with ribbon synapse than neural disorders.

Rate and onset cues can improve cochlear implant synthetic vowel recognition in noise

Understanding speech-in-noise is difficult for most cochlear implant (CI) users. Speech-in-noise segregation cues are well understood for acoustic hearing but not for electric hearing. This study investigated the effects of stimulation rate and onset delay on synthetic vowel-in-noise recognition in CI subjects. In experiment I, synthetic vowels were presented at 50, 145, or 795 pulse/s and noise at the same three rates, yielding nine combinations. Recognition improved significantly if the noise had a lower rate than the vowel, suggesting that listeners can use temporal gaps in the noise to detect a synthetic vowel. This hypothesis is supported by accurate prediction of synthetic vowel recognition using a temporal integration window model. Using lower rates a similar trend was observed in normal hearing subjects. Experiment II found that for CI subjects, a vowel onset delay improved performance if the noise had a lower or higher rate than the synthetic vowel. These results show that differing rates or onset times can improve synthetic vowel-in-noise recognition, indicating a need to develop speech processing strategies that encode or emphasize these cues.

Central masking with bilateral cochlear implants

Across bilateral cochlear implants, contralateral threshold shift has been investigated as a function of electrode difference between the masking and probe electrodes. For contralateral electric masking, maximum threshold elevations occurred when the position of the masker and probe electrode was approximately place-matched across ears. The amount of masking diminished with increasing masker-probe electrode separation. Place-dependent masking occurred in both sequentially implanted ears, and was not affected by the masker intensity or the time delay from the masker onset. When compared to previous contralateral masking results in normal hearing, the similarities between place-dependent central masking patterns suggest comparable mechanisms of overlapping excitation in the central auditory nervous system.

Micromachined electrode arrays with form-fitting profile for auditory nerve prostheses

This paper reports the design, fabrication and simulation of a novel micromachined electrode array with a form-fitting profile for use in auditory nerve prostheses. A 10times10 electrode array is created in a 1mm² area using bulk micromachining technology. The space between the individual electrodes within the array is filled with a layer of SU-8 molded to conform to the curved surface of the auditory nerve. This layer enables the implant to be secured to the auditory nerve and to have a good sealing between the array and the nerve tissue after insertion. An electrical model for a single electrode is built. Both mechanical and electrochemical finite element analyses (FEA) of the array are also performed.

Temporary suppression of tinnitus by modulated sounds

Despite high prevalence of tinnitus and its impact on quality life, there is no cure for tinnitus at present. Here, we report an effective means to temporarily suppress tinnitus by amplitude- and frequency-modulated tones. We systematically explored the interaction between subjective tinnitus and 17 external sounds in 20 chronic tinnitus sufferers. The external sounds included traditionally used unmodulated stimuli such as pure tones and white noise and dynamically modulated stimuli known to produce sustained neural synchrony in the central auditory pathway. All external sounds were presented in a random order to all subjects and at a loudness level that was just below tinnitus loudness. We found some tinnitus suppression in terms of reduced loudness by at least one of the 17 stimuli in 90% of the subjects, with the greatest suppression by amplitude-modulated tones with carrier frequencies near the tinnitus pitch for tinnitus sufferers with relatively normal loudness growth. Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus. The long-term effects of the modulated sounds on tinnitus and the underlying mechanisms remain to be investigated.

Tinnitus suppression by electric stimulation of the auditory nerve

Electric stimulation of the auditory nerve via a cochlear implant (CI) has been observed to suppress tinnitus, but parameters of an effective electric stimulus remain unexplored. Here we used CI research processors to systematically vary pulse rate, electrode place, and current amplitude of electric stimuli, and measure their effects on tinnitus loudness and stimulus loudness as a function of stimulus duration. Thirteen tinnitus subjects who used CIs were tested, with nine (70%) being "Responders" who achieved greater than 30% tinnitus loudness reduction in response to at least one stimulation condition and the remaining four (30%) being "Non-Responders" who had less than 30% tinnitus loudness reduction in response to any stimulus condition tested. Despite large individual variability, several interesting observations were made between stimulation parameters, tinnitus characteristics, and tinnitus suppression. If a subject's tinnitus was suppressed by one stimulus, then it was more likely to be suppressed by another stimulus. If the tinnitus contained a "pulsating" component, then it would be more likely suppressed by a given combination of stimulus parameters than tinnitus without these components. There was also a disassociation between the subjects' clinical speech processor and our research processor in terms of their effectiveness in tinnitus suppression. Finally, an interesting dichotomy was observed between loudness adaptation to electric stimuli and their effects on tinnitus loudness, with the Responders exhibiting higher degrees of loudness adaptation than the Non-Responders. Although the mechanisms underlying these observations remain to be resolved, their clinical implications are clear. When using a CI to manage tinnitus, the clinical processor that is optimized for speech perception needs to be customized for optimal tinnitus suppression.

Towards a closed-loop cochlear implant system: application of embedded monitoring of peripheral and central neural activity

Although the cochlear implant (CI) is widely considered the most successful neural prosthesis, it is essentially an open-loop system that requires extensive initial fitting and frequent tuning to maintain a high, but not necessarily optimal, level of performance. Two developments in neuroscience and neuroengineering now make it feasible to design a closed-loop CI. One development is the recording and interpretation of evoked potentials (EPs) from the peripheral to the central nervous system. The other is the embedded hardware and software of a modern CI that allows recording of EPs. We review EPs that are pertinent to behavioral functions from simple signal detection and loudness growth to speech discrimination and recognition. We also describe signal processing algorithms used for electric artifact reduction and cancellation, critical to the recording of electric EPs. We then present a conceptual design for a closed-loop CI that utilizes in an innovative way the embedded implant receiver and stimulators to record short latency compound action potentials ( ~1 ms), auditory brainstem responses (1-10 ms) and mid-to-late cortical potentials (20-300 ms). We compare EPs recorded using the CI to EPs obtained using standard scalp electrodes recording techniques. Future applications and capabilities are discussed in terms of the development of a new generation of closed-loop CIs and other neural prostheses.

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.

The relative phonetic contributions of a cochlear implant and residual acoustic hearing to bimodal speech perception

The addition of low-passed (LP) speech or even a tone following the fundamental frequency (F0) of speech has been shown to benefit speech recognition for cochlear implant (CI) users with residual acoustic hearing. The mechanisms underlying this benefit are still unclear. In this study, eight bimodal subjects (CI users with acoustic hearing in the non-implanted ear) and eight simulated bimodal subjects (using vocoded and LP speech) were tested on vowel and consonant recognition to determine the relative contributions of acoustic and phonetic cues, including F0, to the bimodal benefit. Several listening conditions were tested (CI/Vocoder, LP, T(F0-env), CI/Vocoder + LP, CI/Vocoder + T(F0-env)). Compared with CI/Vocoder performance, LP significantly enhanced both consonant and vowel perception, whereas a tone following the F0 contour of target speech and modulated with an amplitude envelope of the maximum frequency of the F0 contour (T(F0-env)) enhanced only consonant perception. Information transfer analysis revealed a dual mechanism in the bimodal benefit: The tone representing F0 provided voicing and manner information, whereas LP provided additional manner, place, and vowel formant information. The data in actual bimodal subjects also showed that the degree of the bimodal benefit depended on the cutoff and slope of residual acoustic hearing.

Combined spectral and temporal enhancement to improve cochlear-implant speech perception

The present study examined the effect of combined spectral and temporal enhancement on speech recognition by cochlear-implant (CI) users in quiet and in noise. The spectral enhancement was achieved by expanding the short-term Fourier amplitudes in the input signal. Additionally, a variation of the Transient Emphasis Spectral Maxima (TESM) strategy was applied to enhance the short-duration consonant cues that are otherwise suppressed when processed with spectral expansion. Nine CI users were tested on phoneme recognition tasks and ten CI users were tested on sentence recognition tasks both in quiet and in steady, speech-spectrum-shaped noise. Vowel and consonant recognition in noise were significantly improved with spectral expansion combined with TESM. Sentence recognition improved with both spectral expansion and spectral expansion combined with TESM. The amount of improvement varied with individual CI users. Overall the present results suggest that customized processing is needed to optimize performance according to not only individual users but also listening conditions.

Fundamental frequency is critical to speech perception in noise in combined acoustic and electric hearing

Cochlear implant (CI) users have been shown to benefit from residual low-frequency hearing, specifically in pitch related tasks. It remains unclear whether this benefit is dependent on fundamental frequency (F0) or other acoustic cues. Three experiments were conducted to determine the role of F0, as well as its frequency modulated (FM) and amplitude modulated (AM) components, in speech recognition with a competing voice. In simulated CI listeners, the signal-to-noise ratio was varied to estimate the 50% correct response. Simulation results showed that the F0 cue contributes to a significant proportion of the benefit seen with combined acoustic and electric hearing, and additionally that this benefit is due to the FM rather than the AM component. In actual CI users, sentence recognition scores were collected with either the full F0 cue containing both the FM and AM components or the 500-Hz low-pass speech cue containing the F0 and additional harmonics. The F0 cue provided a benefit similar to the low-pass cue for speech in noise, but not in quiet. Poorer CI users benefited more from the F0 cue than better users. These findings suggest that F0 is critical to improving speech perception in noise in combined acoustic and electric hearing.

Ipsilateral masking between acoustic and electric stimulations

Residual acoustic hearing can be preserved in the same ear following cochlear implantation with minimally traumatic surgical techniques and short-electrode arrays. The combined electric-acoustic stimulation significantly improves cochlear implant performance, particularly speech recognition in noise. The present study measures simultaneous masking by electric pulses on acoustic pure tones, or vice versa, to investigate electric-acoustic interactions and their underlying psychophysical mechanisms. Six subjects, with acoustic hearing preserved at low frequencies in their implanted ear, participated in the study. One subject had a fully inserted 24 mm Nucleus Freedom array and five subjects had Iowa/Nucleus hybrid implants that were only 10 mm in length. Electric masking data of the long-electrode subject showed that stimulation from the most apical electrodes produced threshold elevations over 10 dB for 500, 625, and 750 Hz probe tones, but no elevation for 125 and 250 Hz tones. On the contrary, electric stimulation did not produce any electric masking in the short-electrode subjects. In the acoustic masking experiment, 125-750 Hz pure tones were used to acoustically mask electric stimulation. The acoustic masking results showed that, independent of pure tone frequency, both long- and short-electrode subjects showed threshold elevations at apical and basal electrodes. The present results can be interpreted in terms of underlying physiological mechanisms related to either place-dependent peripheral masking or place-independent central masking.

Spatial channel interactions in cochlear implants

The modern multi-channel cochlear implant is widely considered to be the most successful neural prosthesis owing to its ability to restore partial hearing to post-lingually deafened adults and to allow essentially normal language development in pre-lingually deafened children. However, the implant performance varies greatly in individuals and is still limited in background noise, tonal language understanding, and music perception. One main cause for the individual variability and the limited performance in cochlear implants is spatial channel interaction from the stimulating electrodes to the auditory nerve and brain. Here we systematically examined spatial channel interactions at the physical, physiological, and perceptual levels in the same five modern cochlear implant subjects. The physical interaction was examined using an electric field imaging technique, which measured the voltage distribution as a function of the electrode position in the cochlea in response to the stimulation of a single electrode. The physiological interaction was examined by recording electrically evoked compound action potentials as a function of the electrode position in response to the stimulation of the same single electrode position. The perceptual interactions were characterized by changes in detection threshold as well as loudness summation in response to in-phase or out-of-phase dual-electrode stimulation. To minimize potentially confounding effects of temporal factors on spatial channel interactions, stimulus rates were limited to 100 Hz or less in all measurements. Several quantitative channel interaction indexes were developed to define and compare the width, slope and symmetry of the spatial excitation patterns derived from these physical, physiological and perceptual measures. The electric field imaging data revealed a broad but uniformly asymmetrical intracochlear electric field pattern, with the apical side producing a wider half-width and shallower slope than the basal side. In contrast, the evoked compound action potential and perceptual channel interaction data showed much greater individual variability. It is likely that actual reduction in neural and higher level interactions, instead of simple sharpening of the electric current field, would be the key to predicting and hopefully improving the variable cochlear implant performance. The present results are obtained with auditory prostheses but can be applied to other neural prostheses, in which independent spatial channels, rather than a high stimulation rate, are critical to their performance.

Binaural unmasking with multiple adjacent masking electrodes in bilateral cochlear implant users

Bilateral cochlear implant (BiCI) users gain an advantage in noisy situations from a second implant, but their bilateral performance falls short of normal hearing listeners. Channel interactions due to overlapping electrical fields between electrodes can impair speech perception, but its role in limiting binaural hearing performance has not been well characterized. To address the issue, binaural masking level differences (BMLD) for a 125 Hz tone in narrowband noise were measured using a pair of pitch-matched electrodes while simultaneously presenting the same masking noise to adjacent electrodes, representing a more realistic stimulation condition compared to prior studies that used only a single electrode pair. For five subjects, BMLDs averaged 8.9 ± 1.0 dB (mean ± s.e.) in single electrode pairs but dropped to 2.1 ± 0.4 dB when presenting noise on adjacent masking electrodes, demonstrating a negative impact of the additional maskers. Removing the masking noise from only the pitch-matched electrode pair not only lowered thresholds but also resulted in smaller BMLDs. The degree of channel interaction estimated from auditory nerve evoked potentials in three subjects was significantly and negatively correlated with BMLD. The data suggest that if the amount of channel interactions can be reduced, BiCI users may experience some performance improvements related to binaural hearing.

Tinnitus suppression by low-rate electric stimulation and its electrophysiological mechanisms

Tinnitus is a phantom sensation of sound in the absence of external stimulation. However, external stimulation, particularly electric stimulation via a cochlear implant, has been shown to suppress tinnitus. Different from traditional methods of delivering speech sounds or high-rate (>2000 Hz) stimulation, the present study found a unique unilaterally-deafened cochlear implant subject whose tinnitus was completely suppressed by a low-rate (<100 Hz) stimulus, delivered at a level softer than tinnitus to the apical part of the cochlea. Taking advantage of this novel finding, the present study compared both event-related and spontaneous cortical activities in the same subject between the tinnitus-present and tinnitus-suppressed states. Compared with the results obtained in the tinnitus-present state, the low-rate stimulus reduced cortical N100 potentials while increasing the spontaneous alpha power in the auditory cortex. These results are consistent with previous neurophysiological studies employing subjects with and without tinnitus and shed light on both tinnitus mechanism and treatment.

An integrated vestibular-cochlear prosthesis for restoring balance and hearing

An integrated vestibular-cochlear implant can be rapidly prototyped and clinically tested by modifying an existing modern cochlear implant. The modifications include addition of gyroscope sensors and reallocation of several electrodes that are normally used for auditory nerve stimulation to the semicircular canals, while sharing the external DSP processor and the internal receiver/stimulator. This paper discusses the validation issues related to hardware and software design that arise in integrating electric hearing and balance onto a single device. The device's initially targeted population will be deaf individuals who also have vestibular impairment since there is a strong ethical justification for vestibular implantation along with minimal additional surgical risk. Because of widespread usage of ototoxic drugs and unique genetic mutations, the patient population with both impaired hearing and balance function is especially prevalent in Asian countries such as China and India. Should such an integrated vestibular-cochlear implant be verified, it could be used to restore balance or treat a wide array of vestibular disorders.