Cochlear implants: some likely next steps

Suppression of the acoustically evoked auditory-nerve response by electrical stimulation in the cochlea of the guinea pig

There is increasing interest in the use of electro-acoustical stimulation in people with a cochlear implant that have residual low-frequency hearing in the implanted ear. This raises the issue of how electrical and acoustical stimulation interact in the cochlea. We have investigated the effect of electrical stimulation on the acoustically evoked compound action potential (CAP) in normal-hearing guinea pigs. CAPs were evoked by tone bursts, and electric stimuli were delivered at the base of the cochlea using extracochlear electrodes. CAPs could be suppressed by electrical stimulation under various conditions. The dependence of CAP suppression on several parameters was investigated, including frequency and level of the acoustic stimulus, current level of the electric stimulus and the interval between electric and acoustic stimulus (EAI). Most pronounced suppression was observed when CAPs were evoked with high-frequency tones of low level. Suppression increased with current level and at high currents low-frequency evoked CAPs could also be suppressed. Suppression was typically absent several milliseconds after the electric stimulus. Suppression mediated by direct neural responses and hair cell mediated (electrophonic) responses is discussed. We conclude that the high-frequency part of the cochlea can be stimulated electrically with little detrimental effects on CAPs evoked by low-frequency tones.

Molecular Motors as Components of Future Medical Devices and Engineered Materials

A new frontier in the development of prosthetic devices is the design of nanoscale systems which replace, augment, or support individual cells. Similar to cells, such devices will require the ability to generate mechanical movement, either for transport or actuation. Here, the development of nanoscale transport systems, which integrate biomolecular motors, is reviewed. To date, close to 100 publications have explored the design of such “molecular shuttles” based on the integration of synthetic molecules, nano- and microparticles, and micropatterned structures with kinesin and myosin motors and their associated cytoskeletal filaments, microtubules, and actin filaments. Tremendous progress has been made in addressing the key challenges of guiding, loading, and controlling the shuttles, providing a foundation for the exploration of applications in medicine and engineering.

Expression of Wnt receptors in adult spiral ganglion neurons: frizzled 9 localization at growth cones of regenerating neurites

Little is known about signaling pathways, besides those of neurotrophic factors, that are operational in adult spiral ganglion neurons. In patients with sensorineural hearing loss, such pathways could eventually be targeted to stimulate and guide neurite outgrowth from the remnants of the spiral ganglion towards a cochlear implant, thereby improving the fidelity of sound transmission. To systematically identify neuronal receptors for guidance cues in the adult cochlea, we conducted a genome-wide cDNA microarray screen with 2-month-old CBA/CaJ mice. A meta-analysis of our data and those from older mice in two other studies revealed the presence of neuronal transmembrane receptors that represent all four established guidance pathways--ephrin, netrin, semaphorin, and slit--in the mature cochlea as late as 15 months. In addition, we observed the expression of all known receptors for the "wingless-related MMTV integration site" (Wnt) morphogens, whose neuronal guidance function has only recently been recognized. In situ hybridizations located the mRNAs of the Wnt receptors frizzled 1, 4, 6, 9, and 10 specifically in adult spiral ganglion neurons. Finally, frizzled 9 protein was found in the growth cones of adult spiral ganglion neurons that were regenerating neurites in culture. We conclude from our results that adult spiral ganglion neurons are poised to respond to neurite damage, owing to the constitutive expression of a large and diverse collection of guidance receptors. Wnt signaling, in particular, emerges as a candidate pathway for guiding neurite outgrowth towards a cochlear implant after sensorineural hearing loss.

Sensitivity to interaural time difference with bilateral cochlear implants: Development over time and effect of interaural electrode spacing

Sensitivity to interaural time difference (ITD) in constant-amplitude pulse trains was measured in four sequentially implanted bilateral cochlear implant (CI) subjects. The sensitivity measurements were made as a function of time beginning directly after the second ear was implanted, continued for periods of months before subjects began wearing bilateral sound processors, and extended for months while the subjects used bilateral sound processors in day-to-day listening. Measurements were also made as a function of the relative position of the left/right electrodes. The two subjects with the shortest duration of binaural deprivation before implantation demonstrated ITD sensitivity soon after second-ear implantation (before receiving the second sound processor), while the other two did not demonstrate sensitivity until after months of daily experience using bilateral processors. The interaural mismatch in electrode position required to decrease ITD sensitivity by a factor of 2 (half-width) for CI subjects was five times greater than the half-width for interaural carrier-frequency disparity in normal-hearing subjects listening to sinusoidally amplitude-modulated high-frequency tones. This large half-width is likely to contribute to poor binaural performance in CI users, especially in environments with multiple broadband sound sources.

An improved speech processing strategy for cochlear implants based on an active nonlinear filterbank model of the biological cochlea

The purpose of this study was to improve the speech processing strategy for cochlear implants (CIs) based on a nonlinear time-varying filter model of a biological cochlea. The level-dependent frequency response characteristic of the basilar membrane is known to produce robust formant representation and speech perception in noise. A dual resonance nonlinear (DRNL) model was adopted because it is simpler than other adaptive nonlinear models of the basilar membrane and can be readily incorporated into the CI speech processor. Spectral analysis showed that formant information is more saliently represented at the output of the proposed CI speech processor compared to the conventional strategy in noisy conditions. Acoustic simulation and hearing experiments showed that the DRNL-based nonlinear strategy improves speech performance in a speech-spectrum-shaped noise.

Flexible carbon nanotubes electrode for neural recording

This paper demonstrates a novel flexible carbon nanotubes (CNTs) electrode array for neural recording. In this device, the CNTs electrode arrays are partially embedded into the flexible Parylene-C film using a batch microfabrication process. Through this fabrication process, the CNTs can be exposed to increase the total sensing area of an electrode. Thus, the flexible CNTs electrode of low impedance is realized. In application, the flexible CNTs electrode has been employed to record the neural signal of a crayfish nerve cord for in vitro recording. The measurements demonstrate the superior performance of the presented flexible CNTs electrode with low impedance (11.07 kohms at 1 kHz) and high peak-to-peak amplitude action potential (about 410 microV). In addition, the signal-to-noise ratio (SNR) of the presented flexible CNTs electrode is about 257, whereas the SNR of the reference (a pair of Teflon-coated silver wires) is only 79. The simultaneous recording of the flexible CNTs electrode array is also demonstrated. Moreover, the flexible CNTs electrode has been employed to successfully record the spontaneous spikes from the crayfish nerve cord. The amplitude of the spontaneous peak-to-peak response is about 25 microV.

Combined electro-acoustic stimulation: a beneficial union?

BACKGROUND

The most pressing problem facing cochlear implant research is no longer making artificial hearing a reality. Instead, it is to develop devices that can more clearly reflect the capabilities of the human auditory system. Current cochlear implants rarely provide adequate pitch perception. As hearing loss commonly affects higher, more than lower frequencies, a possible solution is to preserve acoustic hearing at low frequencies by inserting a short electrode array and thus deliver combined electro-acoustic stimulation (EAS).

OBJECTIVE OF REVIEW

To determine whether individuals with severe-to-profound high-frequency hearing loss have realised this predicted benefit of combined EAS, over conventional cochlear implants, with respect to pitch.

TYPE OF REVIEW

A systematic review of publications pertaining to the benefits of combined EAS over conventional cochlear implantation, with specific reference to pitch perception.

SEARCH STRATEGY

A systematic literature search was conducted across multiple databases and supplemented by searching the reference lists of relevant trials and identified reviews.

RESULTS

The included studies suggest an overall benefit of combined EAS, over conventional cochlear implants, with respect to pitch. In addition, (i) 13% sustained a total loss of low-frequency hearing post-implantation of the short electrode array and, (ii) 24% had >20 dB hearing loss across all frequencies and/or total hearing loss.

CONCLUSIONS

For patients with severe-to-profound high-frequency hearing loss combined EAS appears to offer a significant, everyday, long-term benefit. However, further clinical trials with larger numbers of candidates are necessary to confirm this finding. The risks involved cannot be ignored, but there is potential for a variety of strategies to improve the safety margin.

Microfabricated implants for applications in therapeutic delivery, tissue engineering, and biosensing

By adapting microfabrication techniques originally developed in the microelectronics industry novel devices for drug delivery, tissue engineering and biosensing have been engineered for in vivo use. Implant microfabrication uses a broad range of techniques including photolithography, and micromachining to create devices with features ranging from 0.1 to hundreds of microns with high aspect ratios and precise features. Microfabrication offers device feature scale that is relevant to the tissues and cells to which they are applied, as well as offering ease of en masse fabrication, small device size, and facile incorporation of integrated circuit technology. Utilizing these methods, drug delivery applications have been developed for in vivo use through many delivery routes including intravenous, oral, and transdermal. Additionally, novel microfabricated tissue engineering approaches propose therapies for the cardiovascular, orthopedic, and ocular systems, among others. Biosensing devices have been designed to detect a variety of analytes and conditions in vivo through both enzymatic-electrochemical reactions and sensor displacement through mechanical loading. Overall, the impact of microfabricated devices has had an impact over a broad range of therapies and tissues. This review addresses many of these devices and highlights their fabrication as well as discusses materials relevant to microfabrication techniques.

Comparison of the body-worn CIS-PRO + and the behind-the-ear-worn TEMPO + cochlear implant systems in Finnish-speaking adult CI users: any differences in results with experienced listeners?

CONCLUSION

The results indicate that the need for upgrading the processor and/or speech coding strategy should be considered individually, if the processor and coding strategy are functioning properly and a good level of speech perception has been achieved.

OBJECTIVES

Our aim was to study the intra-individual differences of the body-worn CIS-PRO + and the behind-the-ear-worn TEMPO + cochlear implant systems used in the MED-EL Combi40/Combi40 + implants.

SUBJECTS AND METHODS

The hearing level, sentence, word and phoneme recognition of eight adult subjects were determined in an ABA study design. Additionally, a self-assessment questionnaire was used. Mean scores and 95% confidence intervals, and individual scores were analysed.

RESULTS

The subjects tended to score slightly better on word and phoneme recognition with CIS-PRO+ and CIS strategy than with TEMPO+ and CIS+, but there were no statistically significant differences. Subjectively the participants ranked speech perception and discussion in noise to be slightly easier with TEMPO+ and CIS+. Six of the eight subjects preferred TEMPO+ and CIS+ and two of eight preferred CIS-PRO+ with CIS or number-of-maxima.

Cochlear implants: a remarkable past and a brilliant future

The aims of this paper are to (i) provide a brief history of cochlear implants; (ii) present a status report on the current state of implant engineering and the levels of speech understanding enabled by that engineering; (iii) describe limitations of current signal processing strategies; and (iv) suggest new directions for research. With current technology the "average" implant patient, when listening to predictable conversations in quiet, is able to communicate with relative ease. However, in an environment typical of a workplace the average patient has a great deal of difficulty. Patients who are "above average" in terms of speech understanding, can achieve 100% correct scores on the most difficult tests of speech understanding in quiet but also have significant difficulty when signals are presented in noise. The major factors in these outcomes appear to be (i) a loss of low-frequency, fine structure information possibly due to the envelope extraction algorithms common to cochlear implant signal processing; (ii) a limitation in the number of effective channels of stimulation due to overlap in electric fields from electrodes; and (iii) central processing deficits, especially for patients with poor speech understanding. Two recent developments, bilateral implants and combined electric and acoustic stimulation, have promise to remediate some of the difficulties experienced by patients in noise and to reinstate low-frequency fine structure information. If other possibilities are realized, e.g., electrodes that emit drugs to inhibit cell death following trauma and to induce the growth of neurites toward electrodes, then the future is very bright indeed.

Biomimetic brain machine interfaces for the control of movement

Quite recently, it has become possible to use signals recorded simultaneously from large numbers of cortical neurons for real-time control. Such brain machine interfaces (BMIs) have allowed animal subjects and human patients to control the position of a computer cursor or robotic limb under the guidance of visual feedback. Although impressive, such approaches essentially ignore the dynamics of the musculoskeletal system, and they lack potentially critical somatosensory feedback. In this mini-symposium, we will initiate a discussion of systems that more nearly mimic the control of natural limb movement. The work that we will describe is based on fundamental observations of sensorimotor physiology that have inspired novel BMI approaches. We will focus on what we consider to be three of the most important new directions for BMI development related to the control of movement. (1) We will present alternative methods for building decoders, including structured, nonlinear models, the explicit incorporation of limb state information, and novel approaches to the development of decoders for paralyzed subjects unable to generate an output signal. (2) We will describe the real-time prediction of dynamical signals, including joint torque, force, and EMG, and the real-time control of physical plants with dynamics like that of the real limb. (3) We will discuss critical factors that must be considered to incorporate somatosensory feedback to the BMI user, including its potential benefits, the differing representations of sensation and perception across cortical areas, and the changes in the cortical representation of tactile events after spinal injury.

Neural and behavioral sensitivity to interaural time differences using amplitude modulated tones with mismatched carrier frequencies

Bilateral cochlear implantation is intended to provide the advantages of binaural hearing, including sound localization and better speech recognition in noise. In most modern implants, temporal information is carried by the envelope of pulsatile stimulation, and thresholds to interaural time differences (ITDs) are generally high compared to those obtained in normal hearing observers. One factor thought to influence ITD sensitivity is the overlap of neural populations stimulated on each side. The present study investigated the effects of acoustically stimulating bilaterally mismatched neural populations in two related paradigms: rabbit neural recordings and human psychophysical testing. The neural coding of interaural envelope timing information was measured in recordings from neurons in the inferior colliculus of the unanesthetized rabbit. Binaural beat stimuli with a 1-Hz difference in modulation frequency were presented at the best modulation frequency and intensity as the carrier frequencies at each ear were varied. Some neurons encoded envelope ITDs with carrier frequency mismatches as great as several octaves. The synchronization strength was typically nonmonotonically related to intensity. Psychophysical data showed that human listeners could also make use of binaural envelope cues for carrier mismatches of up to 2-3 octaves. Thus, the physiological and psychophysical data were broadly consistent, and suggest that bilateral cochlear implants should provide information sufficient to detect envelope ITDs even in the face of bilateral mismatch in the neural populations responding to stimulation. However, the strongly nonmonotonic synchronization to envelope ITDs suggests that the limited dynamic range with electrical stimulation may be an important consideration for ITD encoding.

Hybrid cochlear implantation: clinical results and critical review in 13 cases

OBJECTIVE

To substantiate the benefits of hybrid cochlear implantation (CI) in patients with residual low-frequency hearing.

STUDY DESIGN

Prospective study of patients in a manufacturer-sponsored clinical trial.

SETTING

Independent referral center for CI.

PATIENTS

Thirteen patients who met candidacy criteria for a hybrid CI. The 10 women and 3 men had a mean age of 51 years.

INTERVENTION

Preoperative evaluation, CI with a Nucleus Hybrid cochlear implant, subsequent programming, and diagnostic testing.

MAIN OUTCOME MEASURES

Benefits of high-frequency electrical stimulation from the hybrid CI as measured by conventional audiometry, consonant-nucleus-consonant monosyllabic word and Bamford-Kowal-Bench sentence in noise testing at quarterly intervals per protocol.

RESULTS

Follow-up ranged from 3 to 24 months. All 13 patients had preserved hearing immediately postoperative. However, one lost residual hearing 7 days postoperatively, and 2 patients had delayed hearing losses at 2 and 24 months, the latter apparently due to barotrauma; however, this was not conclusive. Another had a bilateral symmetrically progressive hearing loss. Six patients showed changes in low-frequency hearing less than 10 dB; 2 showed changes in the range 11 to 20 dB; 2, 21 to 30 dB; and 3, more than 50 dB. Eleven of 13 had improved consonant-nucleus-consonant words ranging up to 83% when tested with hearing aid + CI in the operated ear. Four subjects exhibited improvement in Bamford-Kowal-Bench sentence in noise testing, although only one subject showed a significant decline associated with bilateral progression in hearing impairment.

CONCLUSION

Combined electrical and acoustical hearing can result in significant improvement in speech understanding. Only one patient lost residual hearing as a direct result of surgery. Two others had delayed losses. There are no absolute predictive factors as to success with hybrid CI, just as there are none for conventional CI. Similarly, wide variation in results may occur. Further studies may clarify factors involved in such variation.

Sensitivity to interaural time differences in the inferior colliculus with bilateral cochlear implants

Bilateral cochlear implantation attempts to increase performance over a monaural prosthesis by harnessing the binaural processing of the auditory system. Although many bilaterally implanted human subjects discriminate interaural time differences (ITDs), a major cue for sound localization and signal detection in noise, their performance is typically poorer than that of normal-hearing listeners. We developed an animal model of bilateral cochlear implantation to study neural ITD sensitivity for trains of electric current pulses delivered via bilaterally implanted intracochlear electrodes. We found that a majority of single units in the inferior colliculus of acutely deafened, anesthetized cats are sensitive to ITD and that electric ITD tuning is as sharp as found for acoustic stimulation with broadband noise in normal-hearing animals. However, the sharpness and shape of ITD tuning often depended strongly on stimulus intensity; some neurons had dynamic ranges of ITD sensitivity as low as 1 dB. We also found that neural ITD sensitivity was best at pulse rates below 100 Hz and decreased with increasing pulse rate. This rate limitation parallels behavioral ITD discrimination in bilaterally implanted individuals. The sharp neural ITD sensitivity found with electric stimulation at the appropriate intensity is encouraging for the prospect of restoring the functional benefits of binaural hearing in bilaterally implanted human subjects and suggests that neural plasticity resulting from previous deafness and deprivation of binaural experience may play a role in the poor ITD discrimination with current bilateral implants.

Acoustic-electric interactions in the guinea pig auditory nerve: simultaneous and forward masking of the electrically evoked compound action potential

The study investigated the time course of the effects of acoustic and electric stimulation on the electrically evoked compound action potential (ECAP). Adult guinea pigs were used in acute experimental sessions. Bursts of acoustic noise and high-rate (5000 pulses/s) electric pulse trains were used as maskers. Biphasic electric pulses were used as probes. ECAPs were recorded from the auditory nerve trunk. Simultaneous masking of the ECAP with acoustic noise featured an onset effect and a decrease in the amount of masking to a steady state. It was characterized by a two-component exponential function. The amount of masking increased with masker level and decreased with probe level. Post-stimulatory ECAP recovery often featured a non-monotonic time course, described by a three-component exponent. Electric maskers produced similar post-stimulatory effects in hearing and acutely deafened subjects. Acoustic stimulation affects the ECAP in a level- and time-dependent manner. Simultaneous masking follows a time course comparable to that of adaptation to an acoustic stimulus. Refractoriness, spontaneous activity, and adaptation are suggested to play a role in ECAP recovery. Post-stimulatory changes in synchrony, possibly due to recovery of spontaneous activity and an additional hair-cell independent mechanism, are hypothesized to contribute to the observed non-monotonicity of recovery.

Speech perception and localization with adults with bilateral sequential cochlear implants

This investigation reports measures of binaural hearing of all of our seven adults who have received sequential bilateral cochlear implants (range of time between implantation of 6 yr/8 mo and 17 yr). All subjects used both devices in everyday life. The internal array, number of channels, rate, and signal processing strategies were usually quite different between devices. Speech recognition was tested by using words in quiet and sentences in noise with the sentence stimuli presented from the front and the noise presented from the front, the right, or the left at a 90 degrees angle. Bilateral localization was tested by using an everyday sounds test with stimuli presented from one of eight loudspeakers. Results showed that all subjects received a significant bilateral improvement on at least one speech perception test compared to either implant alone. Four of seven subjects with bilateral devices demonstrated some (root-mean-square error below 30 degrees ) localization abilities. The two subjects tested unilaterally before receiving a second implant showed a bilateral improvement on localization after implantation of the second side. We conclude that sequential implants can be beneficial even after many years of monaural use and even with very different cochlear implants.

The surprising performance of present-day cochlear implants

The speech reception performance of a recipient of the Clarion CII implant was evaluated with a comprehensive set of tests. The same tests were administered for a group of six subjects with normal hearing. Scores for the implant subject were not different from the scores for the normal-hearing subjects, for seven of the nine tests, including the most difficult test used in standard clinical practice. These results are both surprising and encouraging, in that the implant provides only a very crude mimicking of only some aspects of the normal physiology.

Some benefits and limitations of binaural cochlear implants and our ability to measure them

We review new recognition and localization skills in patients using one or two cochlear implant(s). We observed one unilateral patient who showed localization performance above chance. We also provide evidence for binaural processing in bilateral cochlear implant patients, even when tested with speech from the front without noise. We unsuccessfully attempted to find correlations between localization and squelch, between these variables and pre-implant threshold differences, or these variables and post-implant recognition differences. We strongly believe that new tests are needed to examine the potential benefit of two implants. We describe three tests that we use to show a binaural advantage: cued recognition, movement direction, and recognition with multiple jammers.

A model neural interface based on functional chemical stimulation

While functional electrical stimulation has been applied to treat a variety of neurological disorders, it cannot mimic function that is primarily achieved using neurochemical means. In this work, we present a neurotransmitter-based prosthetic interface in the form of a flexible microdevice that selectively releases chemical pulses through an aperture in a polymer membrane. The release profiles through the aperture are controlled by microfluidic switching in an underlying channel network. The profiles have been characterized using fluorescence microscopy as a function of pulse duration and frequency. Hippocampal neurons were cultured on the microdevices and cell stimulation via glutamate delivery was detected using calcium imaging. The release properties could be tuned to repeatedly elicit discrete action potentials in cells seeded proximate to the aperture, including single cell stimulation at 2 Hz. This model neural interface based on functional chemical stimulation may provide the biomimetic platform necessary to restore physiological pathways and function that electrical stimulation cannot fundamentally address.

Experimente zur Perzeption prosodischer Merkmale mit Kochleaimplantaten

BACKGROUND AND OBJECTIVE

Prosody has a myriad of linguistic functions and involves specific aspects of speech, such as stress, intonation and pauses. The underlying acoustic quantities (amplitude envelope, pitch frequency, and temporal structure) can be processed and transmitted by cochlear implants (CI) only to a limited extent. At present, no adequate tests are available in the German-speaking world for evaluation of the perception of prosodic elements. Different experiments have been conducted to address several prosodic cues, and the results are to be used as a basis for appropriate tests.

METHODS

Various prosodic materials were used for the experiments. Discrimination was measured for minimal pairs differing in frequency and/or duration, accents in words and phrases, questions versus statements and phrasing. Measurements were performed in ten normal-hearing subjects and five with cochlear implants.

RESULTS AND CONCLUSIONS

In all test modules, the subjects with normal hearing proved to have high discrimination rates of 96-100%. The test of word stresses was problematic because the results were influenced by different confounders. The other measurements did prove to be basically suitable for use in the subjects with implants. Early results revealed that the subjects with CI had few problems with prosodic cues based on the temporal structure, the outcome being similar to that of the subjects with normal hearing in these tests. In contrast, the performance of subjects with CI in perceiving prosodic cues based on amplitude variations and, especially, on alterations in pitch frequency was worse, even though some of them achieved very good results in these tests too. These preliminary tests can form the basis for development of a German-language prosody test battery with a limited number of subtests addressing different prosodic cues.

Learning to discriminate interaural time differences: an exploratory study with amplitude-modulated stimuli

The advent of bilateral cochlear implants (CIs) has increased interest in learning on binaural tasks, and studies in normal-hearing listeners provide important background information. However, few studies have considered learning with discrimination of interaural time difference (ITD). Here, learning with ITD was explored using stimuli that are more relevant to bilateral CIs than used previously. Inexperienced listeners were trained with envelope-based ITD using high-frequency amplitude-modulated tones with or without an interaural carrier frequency difference (IFD), the former to simulate asymmetrical bilateral CI insertions. All were tested with and without IFD before and after training. In most listeners, ITD thresholds improved substantially with training, not necessarily reaching asymptote after 3,000 trials. In these, the magnitude and time-course of learning was larger than anticipated from a previous study with low-frequency ITD. Learning generalized across IFD and the effect of IFD on ITD thresholds at post-test was smaller than reported previously. These results have implications for studies of bilateral CIs, such as the need to provide extensive training to avoid over-estimating any apparent 'impairment'.

A Feasibility Study of PZT Thin-Film Microactuators for Hybrid Cochlear Implants

Hybrid cochlear implants would integrate electric and acoustic auditory stimulation into a single unit to rehabilitate patients with sensori-neural hearing loss. Conceptually, hybrid cochlear implants consist of an electrode array, as in traditional cochlear implants, and an acoustic microactuator to generate pressure waves inside the cochlea. To enable hybrid cochlear implants, one must develop acoustic actuators small enough to be placed directly into the cochlea. In this study, the microactuators consist of a silicon diaphragm and a Lead-Zirconate-Titanate Oxide (PZT) thin film. Two actuators are tested. For the first actuator, the diaphragm size is 1.1 mm by 1.1 mm, the diaphragm thickness is about 12 m, and the PZT film thickness is 1 μm. The microactuator is tested in an unloaded condition (in air) and a loaded condition (with water and glass sheets) equivalent to a loading of 17 Pa. The microactuator presents a constant displacement of 16 nm, when the driving voltage is sinusoidal with amplitude of 5 V and frequency ranging from 500 Hz to 10 kHz. For the second actuator, the diaphragm size is 800 μm by 800 μm, the diaphragm thickness is 1 μm, and the PZT film thickness remains 1 m. The second actuator presents a displacement of 6 nm, when the sinusoidal driving voltage is 7.5 V in amplitude. Given that the motion of the stapes in normal hearing is 10-30 nm when the incoming sound pressure is 1 Pa (i.e.

An improved speech processor for cochlear implant based on active nonlinear model of biological cochlea

The purpose of this study was to improve speech perception performance of cochlear implant (CI) under noise by a speech processing strategy based on nonlinear time-varying filter model of biological cochlea, which is beneficial in preserving spectral cues for speech perception. A dual resonance nonlinear model was applied to implement this feature. Time-frequency analysis indicated that formant information was more clearly represented at the output of CI speech processor, especially under noise. Acoustic simulation and hearing experiment also showed the superiority of the proposed strategy in that vowel perception score was notably enhanced. It was also observed that the AN responses to the stimulation pulses produced by the proposed strategy encode the formant information faithfully. Since the proposed strategy can be employed in CI devices without modification of hardwares, a significant contribution for the improvement of speech perception capability of CI implantees is expected.

Representation of acoustic signals in the human cochlea in presence of a cochlear implant electrode

BACKGROUND

In subjects with remaining low frequency hearing, combined electric-acoustic stimulation (EAS) of the auditory system is a new therapeutic perspective. Intracochlear introduction of a cochlear implant electrode, however, may alter the biomechanical properties of the inner ear and thus affect perception of acoustic stimuli.

STUDY DESIGN

Based on histological observations of morphologic changes after cochlear implantation in cadaveric and post mortem studies the effects of basilar membrane (BM) stiffening in the ascending basal and middle turns of the cochlea due to close contact of the BM with the electrode were simulated in a 3D-computational finite element model of the inner ear. To verify our simulated results, pre- and postoperative pure-tone audiograms of 13 subjects with substantial residual hearing, who underwent cochlear implantation, were evaluated.

RESULTS

In the scenario of partial BM-fixation, acoustic energy of middle (2 kHz) and high (6 kHz) frequency was focused basally and apically to the fixed section, increasing BM displacement amplitudes up to 6 dB at a stimulation level of 94 dB (SPL). Lower frequencies were not affected by fixation in the basal and middle turn of the cochlea. In implanted subjects, a small but significant decrease of thresholds was observed at 1.5 kHz, a place in tonotopy adjacent to the tip region of the implanted electrode.

CONCLUSION

Our model suggests that stiffening of the basilar membrane adjacent to an implanted electrode into the basal and middle cochlear turn did not affect BM movement in the low frequency area. Focussing of acoustic energy may increase perception in regions adjacent to the fixed section. Observations in implanted subjects were concordant with our model predictions. High frequencies, however, should not be amplified in patients using EAS to avoid disturbances in discrimination due to tonotopically incorrect frequency representation.

Neural stimulation with a carbon nanotube microelectrode array

We present a novel prototype neural interface using vertically aligned multiwalled carbon nanotube (CNT) pillars as microelectrodes. Functionalized hydrophilic CNT microelectrodes offer a high charge injection limit (1-1.6 mC/cm2) without faradic reactions. The first repeated in vitro stimulation of hippocampal neurons with CNT electrodes is demonstrated. These results suggest that CNTs are capable of providing far safer and more efficacious solutions for neural prostheses than previous metal electrode approaches.

Bilateral cochlear implants in children: localization acuity measured with minimum audible angle

OBJECTIVE

To evaluate sound localization acuity in a group of children who received bilateral (BI) cochlear implants in sequential procedures and to determine the extent to which BI auditory experience affects sound localization acuity. In addition, to investigate the extent to which a hearing aid in the nonimplanted ear can also provide benefits on this task.

DESIGN

Two groups of children participated, 13 with BI cochlear implants (cochlear implant + cochlear implant), ranging in age from 3 to 16 yrs, and six with a hearing aid in the nonimplanted ear (cochlear implant + hearing aid), ages 4 to 14 yrs. Testing was conducted in large sound-treated booths with loudspeakers positioned on a horizontal arc with a radius of 1.5 m. Stimuli were spondaic words recorded with a male voice. Stimulus levels typically averaged 60 dB SPL and were randomly roved between 56 and 64 dB SPL (+/-4 dB rove); in a few instances, levels were held fixed (60 dB SPL). Testing was conducted by using a "listening game" platform via computerized interactive software, and the ability of each child to discriminate sounds presented to the right or left was measured for loudspeakers subtending various angular separations. Minimum audible angle thresholds were measured in the BI (cochlear implant + cochlear implant or cochlear implant + hearing aid) listening mode and under monaural conditions.

RESULTS

Approximately 70% (9/13) of children in the cochlear implant + cochlear implant group discriminated left/right for source separations of <or=20 degrees , and, of those, 77% (7/9) performed better when listening bilaterally than with either cochlear implant alone. Several children were also able to perform the task when using a single cochlear implant, under some conditions. Minimum audible angle thresholds were better in the first cochlear implant than the second cochlear implant listening mode for nearly all (8/9) subjects. Repeated testing of a few individual subjects over a 2-yr period suggests that robust improvements in performance occurred with increased auditory experience. Children who wore hearing aids in the nonimplanted ear were at times also able to perform the task. Average group performance was worse than that of the children with BI cochlear implants when both ears were activated (cochlear implant + hearing aid versus cochlear implant + cochlear implant) but not significantly different when listening with a single cochlear implant.

CONCLUSIONS

Children with sequential BI cochlear implants represent a unique population of individuals who have undergone variable amounts of auditory deprivation in each ear. Our findings suggest that many but not all of these children perform better on measures of localization acuity with two cochlear implants compared with one and are better at the task than children using the cochlear implant + hearing aid. These results must be interpreted with caution, because benefits on other tasks as well as the long-term benefits of BI cochlear implants are yet to be fully understood. The factors that might contribute to such benefits must be carefully evaluated in large populations of children using a variety of measures.

Are Cochlear Implant Patients Suffering From Perceptual Dissonance?

Cochlear implants provide functional hearing to the majority of recipients and have gained widespread acceptance clinically, but the range of performance remains great and largely unexplained. Designs for implanted electrodes and electronics have converged, whereas novel speech processing strategies have proliferated. For each patient, the fitting audiologist must sort empirically through options that produce large but idiosyncratic differences in both objective performance and subjective preference. This review and analysis suggests that the place-pitch and rate-pitch theories on which cochlear implants have been designed are incomplete. The missing component may be related to the phase-locking of auditory nerve activity to both acoustic and electrical stimulation. This component is likely to be highly distorted by electrical stimulation but its importance as one of several different pitch encoding mechanisms may vary widely among patients. Systematic means to control these putative phase effects using modern, high-speed, and high-density cochlear implants may make it possible to identify more efficiently the best strategy for a given patient and to minimize the perceptual confusion that arises from conflicting cues.

Minimum audible angle, just noticeable interaural differences and speech intelligibility with bilateral cochlear implants using clinical speech processors

Sound localization and speech intelligibility were assessed in 5 patients implanted bilaterally with Medel C40+ or Medel C40 cochlear implant (CI) systems. The minimum audible angle (MAA) around the head in the horizontal plane was assessed in patients with bilateral CI using white noise bursts of 1000 ms duration presented from a loudspeaker mounted on a rotating boom and compared with the MAA of age-matched normal hearing controls. Spatial discrimination was found to be good in front and in the back of the head with near-normal MAA values (patients: 3-8 degrees , controls: 1-4 degrees ). In contrast, poor performance on the sides was found (patients: 30 to over 45 degrees , controls 7-10 degrees ). Bilateral CI significantly improved spatial discrimination in front for all patients, when compared with the use of either CI alone. Just noticeable differences (JNDs) in interaural intensity and time were assessed using white noise bursts (1000 ms duration; 50 ms linear ramp). In addition, interaural time JNDs were assessed using click trains (800 ms duration, 40 mus clicks, 50 Hz) and noise bursts in which either only the envelope or only the fine structure was shifted in time. In comparison with normal hearing controls, patients with bilateral CI showed near-normal interaural intensity JNDs but substantially poorer interaural time JNDs depending on the type of stimulus. In contrast to envelope onset/offset cues, interaural fine structure time differences were not perceived by the patients using CI systems employing the continuous interleaved sampling strategy without synchronization between their pulse stimulation times. Speech intelligibility in quiet and CCITT noise from the side (+/-90 degrees ) was assessed using the German HSM sentence test and was significantly better when using bilateral CI in comparison with either unilateral CI, mainly due to a head shadow effect. These favorable results are in agreement with the patients' subjective experiences assessed with a questionnaire and support the use of bilateral CI.

Two New Directions in Speech Processor Design for Cochlear Implants

Two new approaches to the design of speech processors for cochlear implants are described. The first aims to represent "fine structure" or "fine frequency" information in a way that it can be perceived and used by patients, and the second aims to provide a closer mimicking than was previously possible of the signal processing that occurs in the normal cochlea.

Evaluation of speech perception in noise in cochlear implanted adults

Aim: to evaluate the effects of different signal-to-noise ratios on speech recognition obtained by the use of cochlear implant (CI); to compare the speech recognition in noise with different types of multichannel cochlear implants (CIs) and to evaluate the degree of difficulty for speech understanding in noise in daily life situations. Study design: cohort transversal. Material and Method: Forty adults with post-lingual hearing loss implanted with Nucleus 22, Nucleus 24, Combi 40, Combi 40+ and Clarion. We evaluated the recognition for CPA sentences in quiet and in S/N +15, +10 and +5 dB. We also applied the Social Hearing Handicap Index (SHHI) questionnaire for self-assessment in daily life. Results and Conclusion: All the implanted adults presented a significant reduction in the scores for sentences recognition as the S/N decreased. The medians´ curve for sentence recognition reached 50% in the signal-to-noise ratio of +10 dB. There was no statistically significant difference in sentences’ recognition scores and difficulty scores obtained with the SHHI, for all types of implants. The difficulties of implanted adults were rare in quiet and occasional in noisy situations according to SHHI questionnaire.

Auditory cortical activation and speech perception in cochlear implant users: Effects of implant experience and duration of deafness

This study aimed to investigate the relationship between outcome following cochlear implantation and auditory cortical activation. It also studied the effects of length of implant use and duration of deafness on the auditory cortical activations. Cortical activity resulting from auditory stimulation was measured using [(18)F]FDG positron emission tomography. In a group of 18 experienced adult cochlear implant users, we found a positive correlation between speech perception and activations in both the primary and association auditory cortices. This correlation was present in a subgroup of experienced implant users but absent in a group of new implant users with similar speech perception abilities. There was a significant negative correlation between duration of deafness and auditory cortical activation. This study gives insights into the relationship between implant speech perception and auditory cortical activation and the influence of duration of preceding deafness and implant experience.

Bioengineering Solutions for Hearing Loss and Related Disorders

Advances in digital signal processing, microelectronics, and power technology have produced devices that have contributed significantly to the quality of life and communication abilities of individuals with hearing impairment and tinnitus. Future technological developments will expand the benefits of current devices and offer new treatments for otologic disorders.

How cochlear implants encode speech

PURPOSE OF REVIEW

This review summarizes the history of cochlear implant signal processing and provides the rationale underlying current approaches. Present strategies are explained and recent research findings are summarized. It is suggested how these results may drive future advancements in signal processing.

RECENT FINDINGS

Substantial advances have been made in our understanding of the spectral and temporal cues necessary for cochlear implant recipients to perceive music, speech in noise, and interaural timing. It is clear that higher levels of both spectral and temporal resolution, as well as better loudness and pitch coding are necessary for higher levels of performance. These factors are highly interrelated, however, and are beneficial for differing aspects of hearing. Signal processing algorithms incorporating these findings are under active development and some are currently undergoing clinical investigation.

SUMMARY

Current implant devices, and those soon to be available, have substantial untapped potential to improve the auditory experience of their recipients. It is likely that in the near future, recent findings on pitch and loudness perception, as well as techniques to better emulate the normal functions of the cochlea will result in much higher levels of prosthetic hearing fidelity than are possible today. As the performance of these remarkable devices continues to improve, the population of hearing-impaired individuals who can benefit from implantation is likely to increase significantly.

Parental decision-making in considering cochlear implant technology for a deaf child

OBJECTIVES

Advances in cochlear implant (CI) technology have increased the complexity of treating childhood deafness. We compare parental decision-making, values, beliefs, and preferences between parents of eligible and ineligible children in considering cochlear implants.

METHODS

Surveys were obtained from 83 hearing parents of deaf children. A subset of 50 parents also underwent semi-structured interviews. Nine hypothetical outcomes, ranging from mainstream success to poor mainstream outcome were created to measure parents' overall preferences and preference for specific outcomes for their child who is deaf.

RESULTS

Among parents of eligible children (n = 50), approximately 2/3 considered implantation (n = 33). The other 1/3 did not consider implantation. Parents who were eligible but did not consider implantation placed significantly lower priority on mainstream success over bilingual success (P < 0.03), and on the child's ability to speak versus sign (P < 0.02). They also showed significantly higher concerns on the cost of services in general and on the availability of resources offered at the local school district (both P > 0.05). Parents of ineligible children (n = 30) rarely considered implantation, even if they showed similar aspirations in mainstream outcomes (P = 0.003). Semi-structured interview data supported these findings.

CONCLUSIONS

The decision to consider cochlear implantation is strongly influenced by the eligibility and by professionals' recommendations. However, for some parents, the decision goes beyond eligibility and is determined by parental preferences, goals, values, and beliefs. This highlights the importance of careful audiologic evaluation and professionals' awareness of and sensitivity to parental goals, values, and beliefs in evaluating the child's candidacy.

CILAB – ein PC-basierter Laborsprachprozessor zur Implementierung und Evaluierung neuer Stimulationsstrategien für Cochlea-Implantate / CILAB – a PC Based Laboratory Sound Processor for Cochlear Implants

CILab is a computer-based versatile laboratory system for the implementation and evaluation of innovative stimulation strategies for cochlear implants. In contrast to existing laboratory systems the entire signal processing from the input signal to the creation of the data word for the implant is effected with the aid of a personal computer (PC). This permits rapid implementation of new stimulation strategies or psycho-acoustic tests. Real-time audio processing is also possible by using the CILab as a cochlear implant speech processor. The laboratory system has been employed with success for the evaluation of new strategies and numerous psycho-acoustic tests.

Trends in cochlear implants

More than 60,000 people worldwide use cochlear implants as a means to restore functional hearing. Although individual performance variability is still high, an average implant user can talk on the phone in a quiet environment. Cochlear-implant research has also matured as a field, as evidenced by the exponential growth in both the patient population and scientific publication. The present report examines current issues related to audiologic, clinical, engineering, anatomic, and physiologic aspects of cochlear implants, focusing on their psychophysical, speech, music, and cognitive performance. This report also forecasts clinical and research trends related to presurgical evaluation, fitting protocols, signal processing, and postsurgical rehabilitation in cochlear implants. Finally, a future landscape in amplification is presented that requires a unique, yet complementary, contribution from hearing aids, middle ear implants, and cochlear implants to achieve a total solution to the entire spectrum of hearing loss treatment and management.

Update on bilateral cochlear implantation

PURPOSE OF REVIEW

Providing a unilateral cochlear implant in a patient with a profound bilateral hearing loss has now been a standard clinical practice for more than a decade. Although results are often very good, normal hearing has not been restored. One exciting opportunity to improve hearing in this population is to provide a second implant. However, it is not obvious that bilateral electrical stimulation can be integrated by the central nervous system. This article describes binaural hearing and reviews currently published articles on binaural cochlear implants.

RECENT FINDINGS

Controlled laboratory trials have focused on distinguishing different categories of potential binaural advantages. A potential summation effect occurs when the same stimulus is available at two ears. Listening in noise with two ears should be better than listening with one ear when the additional ear is away from the noise. This head shadow benefit results from acoustic effects, not physiologic ones. When the second ear is added near the noise source, a binaural squelch benefit can occur, requiring neural integration from both sides. Finally, two ears may improve sound localization. Binaural implantees generally benefit from head shadow effects. Only some benefit from summation and squelch effects. Most, but not all, show improved horizontal plane localization.

SUMMARY

It is now appropriate to begin experimental studies of binaural cochlear implants. Preliminary results show promise to improve head shadow, a physical advantage, and sound localization. Some benefits have been observed for improved summation and squelch. These findings have demonstrated that the brain can integrate electrical stimulation from the two ears. Future studies will be required to maximize this binaural hearing.