Masking patterns for monopolar and phantom electrode stimulation in cochlear implants

Recent Advances in Cochlear Implant Electrode Array Design Parameters

Cochlear implants are neural implant devices that aim to restore hearing in patients with severe sensorineural hearing impairment. Here, the main goal is to successfully place the electrode array in the cochlea to stimulate the auditory nerves through bypassing damaged hair cells. Several electrode and electrode array parameters affect the success of this technique, but, undoubtedly, the most important one is related to electrodes, which are used for nerve stimulation. In this paper, we provide a comprehensive resource on the electrodes currently being used in cochlear implant devices. Electrode materials, shape, and the effect of spacing between electrodes on the stimulation, stiffness, and flexibility of electrode-carrying arrays are discussed. The use of sensors and the electrical, mechanical, and electrochemical properties of electrode arrays are examined. A large library of preferred electrodes is reviewed, and recent progress in electrode design parameters is analyzed. Finally, the limitations and challenges of the current technology are discussed along with a proposal of future directions in the field.

An Instrumented Cochlea Model for the Evaluation of Cochlear Implant Electrical Stimulus Spread

Cochlear implants use electrical stimulation of the auditory nerve to restore the sensation of hearing to deaf people. Unfortunately, the stimulation current spreads extensively within the cochlea, resulting in “blurring” of the signal, and hearing that is far from normal. Current spread can be indirectly measured using the implant electrodes for both stimulating and sensing, but this provides incomplete information near the stimulating electrode due to electrode-electrolyte interface effects. Here, we present a 3D-printed “unwrapped” physical cochlea model with integrated sensing wires. We integrate resistors into the walls of the model to simulate current spread through the cochlear bony wall, and “tune” these resistances by calibration with an in-vivo electrical measurement from a cochlear implant patient. We then use this model to compare electrical current spread under different stimulation modes including monopolar, bipolar and tripolar configurations. Importantly, a trade-off is observed between stimulation amplitude and current focusing among different stimulation modes. By combining different stimulation modes and changing intracochlear current sinking configurations in the model, we explore this trade-off between stimulation amplitude and focusing further. These results will inform clinical strategies for use in delivering speech signals to cochlear implant patients.

The Effect of Phantom Stimulation and Pseudomonophasic Pulse Shapes on Pitch Perception by Cochlear Implant Listeners

It has been suggested that a specialized high-temporal-acuity brainstem pathway can be activated by stimulating more apically in the cochlea than is achieved by cochlear implants (CIs) when programmed with contemporary clinical settings. We performed multiple experiments to test the effect on pitch perception of phantom stimulation and asymmetric current pulses, both supposedly stimulating beyond the most apical electrode of a CI. The two stimulus types were generated using a bipolar electrode pair, composed of the most apical electrode of the array and a neighboring, more basal electrode. Experiment 1 used a pitch-ranking procedure where neural excitation was shifted apically or basally using so-called phantom stimulation. No benefit of apical phantom stimulation was found on the highest rate up to which pitch ranks increased (upper limit), nor on the slopes of the pitch-ranking function above 300 pulses per second (pps). Experiment 2 used the same procedure to study the effects of apical pseudomonophasic pulses, where the locus of excitation was manipulated by changing stimulus polarity. A benefit of apical stimulation was obtained for the slopes above 300 pps. Experiment 3 used an adaptive rate discrimination procedure and found a small but significant benefit of both types of apical stimulation. Overall, the results show some benefit for apical stimulation on temporal pitch processing at high pulse rates but reveal that the effect is smaller and more variable across listeners than suggested by previous research. The results also provide some indication that the benefit of apical stimulation may decline over time since implantation.

Dynamic current steering with phantom electrode in cochlear implants

Phantom electrode (PE) stimulation can extend the lower limit of pitch perception with cochlear implants (CIs) by using simultaneous out-of-phase stimulation of the most apical primary electrode and the adjacent basal compensating electrode. The total electrical field may push the excitation pattern beyond the most apical electrode to elicit a lower pitch, depending on the ratio of current between the compensating and primary electrodes (i.e., the compensation coefficient σ). This study tested the hypothesis that dynamic current steering of PE stimuli can be implemented by varying σ over time to encode spectral details in low frequencies. To determine the range of σ for current steering and the corresponding current levels, Experiment 1 tested CI users' loudness balance and pitch ranking of static PE stimuli with σ from 0 to 0.6 in steps of 0.2. It was found that the equal-loudness most comfortable level significantly increased with σ and can be modeled by a piecewise linear function of σ. Consistent with the previous findings, higher σ elicited either lower or similar pitches without salient pitch reversals than lower σ. Based on the results of Experiment 1, Experiment 2 created flat, rising, and falling pitch contours of 300-1000 ms using dynamic PE stimuli with time-varying σ from 0 to 0.6 and equal-loudness current levels. In a pitch contour identification (PCI) task, CI users scored 80% and above on average. Increasing the stimulus duration from 300 to 1000 ms slightly but did not significantly improve the PCI scores. Across subjects, the 1000-ms PCI scores in Experiment 2 were significantly correlated with the cumulative pitch-ranking sensitivity in Experiment 1. It is thus feasible to use dynamic current steering with PE to encode low-frequency pitch cues for CI users.

Effectiveness of Phantom Stimulation in Shifting the Pitch Percept in Cochlear Implant Users

OBJECTIVES

Phantom electrode stimulation was developed for cochlear implant (CI) systems to provide a lower pitch percept by stimulating more apical regions of the cochlea, without inserting the electrode array deeper into the cochlea. Phantom stimulation involves simultaneously stimulating a primary and a compensating electrode with opposite polarity, thereby shifting the electrical field toward the apex and eliciting a lower pitch percept. The current study compared the effect sizes (in shifts of place of excitation) of multiple phantom configurations by matching the perceived pitch with phantom stimulation to that perceived with monopolar stimulation. Additionally, the effects of electrode location, type of electrode array, and stimulus level on the perceived pitch were investigated.

DESIGN

Fifteen adult advanced bionics CI users participated in this study, which included four experiments to eventually measure the shifts in place of excitation with five different phantom configurations. The proportions of current delivered to the compensating electrode, expressed as σ, were 0.5, 0.6, 0.7, and 0.8 for the symmetrical biphasic pulses (SBC0.5, SBC0.6, SBC0.7, and SBC0.8) and 0.75 for the pseudomonophasic pulse shape (PSA0.75). A pitch discrimination experiment was first completed to determine which basal and apical electrode contacts should be used for the subsequent experiments. An extensive loudness balancing experiment followed where both the threshold level (T-level) and most comfortable level (M-level) were determined to enable testing at multiple levels of the dynamic range. A pitch matching experiment was then performed to estimate the shift in place of excitation at the chosen electrode contacts. These rough shifts were then used in the subsequent experiment, where the shifts in place of excitation were determined more accurately.

RESULTS

Reliable data were obtained from 20 electrode contacts. The average shifts were 0.39, 0.53, 0.64, 0.76, and 0.53 electrode contacts toward the apex for SBC0.5, SBC0.6, SBC0.7, SBC0.8, and PSA0.75, respectively. When only the best configurations per electrode contact were included, the average shift in place of excitation was 0.92 electrode contacts (range: 0.25 to 2.0). While PSA0.75 leads to equal results as the SBC configurations in the apex, it did not result in a significant shift at the base. The shift in place of excitation was significantly larger at the apex and with lateral wall electrode contacts. The stimulus level did not affect the shift.

CONCLUSIONS

Phantom stimulation results in significant shifts in place of excitation, especially at the apical part of the electrode array. The phantom configuration that leads to the largest shift in place of excitation differs between subjects. Therefore, the settings of the phantom electrode should be individualized so that the phantom stimulation is optimized for each CI user. The real added value to the sound quality needs to be established in a take-home trial.

Use of Research Interfaces for Psychophysical Studies With Cochlear-Implant Users

A growing number of laboratories are using research interfaces to conduct experiments with cochlear-implant (CI) users. Because these interfaces bypass a subject’s clinical sound processor, several concerns exist regarding safety and stimulation levels. Here we suggest best-practice approaches for how to safely and ethically perform this type of research and highlight areas of limited knowledge where further research is needed to help clarify safety limits. The article is designed to provide an introductory level of technical detail about the devices and the effects of electrical stimulation on perception and neurophysiology. From this, we summarize what should be the best practices in the field, based on the literature and our experience. Findings from the review of the literature suggest that there are three main safety concerns: (a) to prevent biological or neural damage, (b) to avoid presentation of uncomfortably loud sounds, and (c) to ensure that subjects have control over stimulus presentation. Researchers must pay close attention to the software–hardware interface to ensure that the three main safety concerns are closely monitored. An important area for future research will be the determination of the amount of biological damage that can occur from electrical stimulation from a CI placed in the cochlea, not in direct contact with neural tissue. As technology used in research with CIs evolve, some of these approaches may change. However, the three main safety principles outlined here are not anticipated to undergo change with technological advances.

Perceptual changes with monopolar and phantom electrode stimulation

Phantom electrode (PE) stimulation is achieved by simultaneously stimulating out-of-phase from two adjacent intra-cochlear electrodes with different amplitudes. If the basal electrode stimulates with a smaller amplitude than the apical electrode of the pair, the resulting electrical field is pushed away from the basal electrode producing a lower pitch. There is great interest in using PE stimulation in a processing strategy as it can be used to provide stimulation to regions of the cochlea located more apically than the most apical contact on the electrode array. The result is that even lower pitch sensations can be provided without additional risk of a deeper insertion. However, it is unknown if there are perceptual differences between monopolar (MP) and PE stimulation other than a shift in place pitch. Furthermore, it is unknown if the effect and magnitude of changing from MP to PE stimulation is dependent on electrode location. This study investigates the perceptual differences (including pitch and other sound quality differences) at multiple electrode positions using MP and PE stimulation using both a multidimensional scaling procedure (MDS) and a traditional scaling procedure. 10 Advanced Bionics users reported the perceptual distances between 5 single electrode (typically 1, 3, 5, 7, and 9) stimuli in either MP or PE (σ = 0.5) mode. Subjects were asked to report how perceptually different each pair of stimuli were using any perceived differences except loudness. Subsequently, each stimulus was presented in isolation and subjects scaled how "high" or how "clean" each sounded. Results from the MDS task suggest that perceptual differences between MP and PE stimulation can be explained by a single dimension. The traditional scaling suggests that the single dimension is place pitch. PE stimulation elicits lower pitch perceptions in all cochlear regions. Analysis of Cone Beam Computer Tomography (CBCT) data suggests that PE stimulation may be more effective at the apical part of the cochlea. PE stimulation can be used for new sound coding strategies in order to extend the pitch range for cochlear implant (CI) users without perceptual side effects.

Spatial Selectivity in Cochlear Implants: Effects of Asymmetric Waveforms and Development of a Single-Point Measure

Three experiments studied the extent to which cochlear implant users' spatial selectivity can be manipulated using asymmetric waveforms and tested an efficient method for comparing spatial selectivity produced by different stimuli. Experiment 1 measured forward-masked psychophysical tuning curves (PTCs) for a partial tripolar (pTP) probe. Maskers were presented on bipolar pairs separated by one unused electrode; waveforms were either symmetric biphasic ("SYM") or pseudomonophasic with the short high-amplitude phase being either anodic ("PSA") or cathodic ("PSC") on the more apical electrode. For the SYM masker, several subjects showed PTCs consistent with a bimodal excitation pattern, with discrete excitation peaks on each electrode of the bipolar masker pair. Most subjects showed significant differences between the PSA and PSC maskers consistent with greater masking by the electrode where the high-amplitude phase was anodic, but the pattern differed markedly across subjects. Experiment 2 measured masked excitation patterns for a pTP probe and either a monopolar symmetric biphasic masker ("MP_SYM") or pTP pseudomonophasic maskers where the short high-amplitude phase was either anodic ("TP_PSA") or cathodic ("TP_PSC") on the masker's central electrode. Four of the five subjects showed significant differences between the masker types, but again the pattern varied markedly across subjects. Because the levels of the maskers were chosen to produce the same masking of a probe on the same channel as the masker, it was correctly predicted that maskers that produce broader masking patterns would sound louder. Experiment 3 exploited this finding by using a single-point measure of spread of excitation to reveal significantly better spatial selectivity for TP_PSA compared to TP_PSC maskers.

Pure-Tone Masking Patterns for Monopolar and Phantom Electrical Stimulation in Cochlear Implants

OBJECTIVES

Monopolar stimulation of the most apical electrode produces the lowest pitch sensation in cochlear implants clinically. A phantom electrode that uses out-of-phase electrical stimulation between the most apical and the neighboring basal electrode can produce a lower pitch sensation than that associated with the most apical electrode. However, because of the absence of contacts beyond the apical tip of the array, the ability to assess the spread of electrical excitation associated with phantom stimulation is limited in the typical cochlear implant subject with no residual hearing. In the present study, the spread of electrical excitation associated with monopolar and phantom stimulation of the most apical electrode was assessed using electrical masking of acoustic thresholds in cochlear implant subjects with residual, low-frequency, acoustic hearing.

DESIGN

Eight subjects with an Advanced Bionics cochlear implant and residual hearing in the implanted ear participated in this study (nine ears in total). Unmasked and masked thresholds for acoustic pure tones were measured at 125, 250, 500, 750, 1000, and 2000 Hz in the presence of monopolar and phantom electrode stimulation presented at the apical-most end of the array. The current compensation for phantom electrode stimulation was fixed at 50%. The two electrical maskers were loudness balanced. Differences between the unmasked and masked acoustic thresholds can be attributed to (1) the electrical stimulus-induced interference in the transduction/conduction of the acoustic signal through cochlear periphery and the auditory nerve and/or (2) masking at the level of the central auditory system.

RESULTS

The results show a significant elevation in pure-tone thresholds in the presence of the monopolar and phantom electrical maskers. The unmasked thresholds were subtracted from the masked thresholds to derive masking patterns as a function of the acoustic probe frequency. The masking patterns show that phantom stimulation was able to produce more masking than that associated with the monopolar stimulation of the most apical electrode.

CONCLUSION

These results suggest that for some cochlear implant subjects, phantom electrode stimulation can shift the neural stimulation pattern more apically in the cochlea, which is consistent with reports that phantom electrode stimulation produces lower pitch sensations than those associated with monopolar stimulation of the most apical electrode alone.

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

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

The Relationship Between Insertion Angles, Default Frequency Allocations, and Spiral Ganglion Place Pitch in Cochlear Implants

OBJECTIVES

Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hertz, but the electrode arrays are not designed to reach the most apical regions of the cochlea, which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal-hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear implant systems that are most commonly used in the United States.

DESIGN

The angular insertion of each of the electrodes on four different electrode arrays (MED-EL Standard, MED-EL Flex28, Advanced Bionics HiFocus 1J, and Cochlear Contour Advance) was estimated from X-ray. For the angular location of each electrode on each electrode array, the predicted spiral ganglion frequency was estimated. The predicted spiral ganglion frequency was compared with the center frequency provided by the corresponding electrode using the manufacturer's default frequency-to-electrode allocation.

RESULTS

Differences across devices were observed for the place of stimulation for frequencies below 650 Hz. Longer electrode arrays (i.e., the MED-EL Standard and Flex28) demonstrated smaller deviations from the spiral ganglion map than the other electrode arrays. For insertion angles up to approximately 270°, the frequencies presented at a given location were typically approximately an octave below what would be expected by a spiral ganglion frequency map, while the deviations were larger for angles deeper than 270°. For frequencies above 650 Hz, the frequency to angle relationship was consistent across all four electrode models.

CONCLUSIONS

A mismatch was observed between the predicted frequency and the default frequency provided by every electrode on all electrode arrays. The mismatch can be reduced by changing the default frequency allocations, inserting electrodes deeper into the cochlea, or allowing cochlear implant users to adapt to the mismatch. Further studies are required to fully assess the clinical significance of the frequency mismatch.

Reduction in spread of excitation from current focusing at multiple cochlear locations in cochlear implant users

Channel interaction from a broad spread of excitation is likely to be a limiting factor in performance by cochlear implant users. Although partial tripolar stimulation has been shown to reduce spread of excitation, the magnitude of the reduction is highly variable across subjects. Because the reduction in spread of excitation is typically only measured at one electrode for a given subject, the degree of variability across cochlear locations is unknown. The first goal of the present study was to determine if the reduction in spread of excitation observed from partial tripolar current focusing systematically varies across the cochlea. The second goal was to measure the variability in reduction of spread of excitation relative to monopolar stimulation across the cochlea. The third goal was to expand upon previous results that suggest that scaling of verbal descriptors can be used to predict the reduction in spread of excitation, by increasing the limited number of sites previously evaluated and verify the relationships remain with the larger dataset. The spread of excitation for monopolar and partial tripolar stimulation was measured at 5 cochlear locations using a psychophysical forward masking task. Results of the present study suggest that although partial tripolar stimulation typically reduces spread of excitation, the degree of reduction in spread of excitation was found to be highly variable and no effect of cochlear location was found. Additionally, subjective scaling of certain verbal descriptors (Clean/Dirty, Pure/Noisy) correlated with the reduction in spread of excitation suggesting sound quality scaling might be used as a quick clinical estimate of channels providing a reduction in spread of excitation. This quick scaling technique might help clinicians determine which patients would be most likely to benefit from a focused strategy.

Excitation Patterns of Standard and Steered Partial Tripolar Stimuli in Cochlear Implants

Current steering in partial tripolar (pTP) mode has been shown to improve pitch perception and spectral resolution with cochlear implants (CIs). In this mode, a fraction (σ) of the main electrode current is returned within the cochlea and steered between the basal and apical flanking electrodes (with a proportion of α and 1 - α, respectively). Pitch generally decreases when α increases from 0 to 1, although the salience of pitch change varies across CI users. This study aimed to identify the mechanism of pitch changes with pTP-mode current steering and the factors contributing to the intersubject variability in pitch-ranking sensitivity. The electrical fields were measured for steered pTP stimuli on the same main electrode with α = 0, 0.5, and 1 in five implanted ears using electrical field imaging (EFI). The related excitation patterns were also measured physiologically using evoked compound action potential (ECAP) and psychophysically using psychophysical forward masking (PFM). Consistent with the pitch-ranking results in this study, the EFI, ECAP, and PFM centroids shifted apically with increasing α. An apical shift was also observed for the PFM peak but not for the EFI or ECAP peak. The pattern width was similar with different α values within a given measure (e.g., EFI, ECAP, or PFM), but the ECAP patterns were broader than the EFI and PFM patterns, possibly because ECAP was measured with smaller σ values than EFI and PFM. The amount of pattern shift with α depended on σ (i.e., the total amount of current used for steering) but was not correlated with the pitch-ranking sensitivity across subjects. The results revealed that the pitch changes elicited by pTP-mode current steering were not only driven by the shifts of excitation centroid.

Auditory implant research at the House Ear Institute 1989-2013

The House Ear Institute (HEI) had a long and distinguished history of auditory implant innovation and development. Early clinical innovations include being one of the first cochlear implant (CI) centers, being the first center to implant a child with a cochlear implant in the US, developing the auditory brainstem implant, and developing multiple surgical approaches and tools for Otology. This paper reviews the second stage of auditory implant research at House - in-depth basic research on perceptual capabilities and signal processing for both cochlear implants and auditory brainstem implants. Psychophysical studies characterized the loudness and temporal perceptual properties of electrical stimulation as a function of electrical parameters. Speech studies with the noise-band vocoder showed that only four bands of tonotopically arrayed information were sufficient for speech recognition, and that most implant users were receiving the equivalent of 8-10 bands of information. The noise-band vocoder allowed us to evaluate the effects of the manipulation of the number of bands, the alignment of the bands with the original tonotopic map, and distortions in the tonotopic mapping, including holes in the neural representation. Stimulation pulse rate was shown to have only a small effect on speech recognition. Electric fields were manipulated in position and sharpness, showing the potential benefit of improved tonotopic selectivity. Auditory training shows great promise for improving speech recognition for all patients. And the Auditory Brainstem Implant was developed and improved and its application expanded to new populations. Overall, the last 25 years of research at HEI helped increase the basic scientific understanding of electrical stimulation of hearing and contributed to the improved outcomes for patients with the CI and ABI devices. This article is part of a Special Issue entitled .

Design and evaluation of a cochlear implant strategy based on a "Phantom" channel

Unbalanced bipolar stimulation, delivered using charge balanced pulses, was used to produce "Phantom stimulation", stimulation beyond the most apical contact of a cochlear implant's electrode array. The Phantom channel was allocated audio frequencies below 300 Hz in a speech coding strategy, conveying energy some two octaves lower than the clinical strategy and hence delivering the fundamental frequency of speech and of many musical tones. A group of 12 Advanced Bionics cochlear implant recipients took part in a chronic study investigating the fitting of the Phantom strategy and speech and music perception when using Phantom. The evaluation of speech in noise was performed immediately after fitting Phantom for the first time (Session 1) and after one month of take-home experience (Session 2). A repeated measures of analysis of variance (ANOVA) within factors strategy (Clinical, Phantom) and interaction time (Session 1, Session 2) revealed a significant effect for the interaction time and strategy. Phantom obtained a significant improvement in speech intelligibility after one month of use. Furthermore, a trend towards a better performance with Phantom (48%) with respect to F120 (37%) after 1 month of use failed to reach significance after type 1 error correction. Questionnaire results show a preference for Phantom when listening to music, likely driven by an improved balance between high and low frequencies.

Evaluation of a cochlear-implant processing strategy incorporating phantom stimulation and asymmetric pulses

OBJECTIVE

To evaluate a speech-processing strategy in which the lowest frequency channel is conveyed using an asymmetric pulse shape and "phantom stimulation", where current is injected into one intra-cochlear electrode and where the return current is shared between an intra-cochlear and an extra-cochlear electrode. This strategy is expected to provide more selective excitation of the cochlear apex, compared to a standard strategy where the lowest-frequency channel is conveyed by symmetric pulses in monopolar mode. In both strategies all other channels were conveyed by monopolar stimulation.

DESIGN

Within-subjects comparison between the two strategies. Four experiments: (1) discrimination between the strategies, controlling for loudness differences, (2) consonant identification, (3) recognition of lowpass-filtered sentences in quiet, (4) sentence recognition in the presence of a competing speaker.

STUDY SAMPLE

Eight users of the Advanced Bionics CII/Hi-Res 90k cochlear implant.

RESULTS

Listeners could easily discriminate between the two strategies but no consistent differences in performance were observed.

CONCLUSIONS

The proposed method does not improve speech perception, at least in the short term.

Electrode spanning with partial tripolar stimulation mode in cochlear implants

The perceptual effects of electrode spanning (i.e., the use of nonadjacent return electrodes) in partial tripolar (pTP) mode were tested on a main electrode EL8 in five cochlear implant (CI) users. Current focusing was controlled by σ (the ratio of current returned within the cochlea), and current steering was controlled by α (the ratio of current returned to the basal electrode). Experiment 1 tested whether asymmetric spanning with α = 0.5 can create additional channels around standard pTP stimuli. It was found that in general, apical spanning (i.e., returning current to EL6 rather than EL7) elicited a pitch between those of standard pTP stimuli on main electrodes EL8 and EL9, while basal spanning (i.e., returning current to EL10 rather than EL9) elicited a pitch between those of standard pTP stimuli on main electrodes EL7 and EL8. The pitch increase caused by apical spanning was more salient than the pitch decrease caused by basal spanning. To replace the standard pTP channel on the main electrode EL8 when EL7 or EL9 is defective, experiment 2 tested asymmetrically spanned pTP stimuli with various α, and experiment 3 tested symmetrically spanned pTP stimuli with various σ. The results showed that pitch increased with decreasing α in asymmetric spanning, or with increasing σ in symmetric spanning. Apical spanning with α around 0.69 and basal spanning with α around 0.38 may both elicit a similar pitch as the standard pTP stimulus. With the same σ, the symmetrically spanned pTP stimulus was higher in pitch than the standard pTP stimulus. A smaller σ was thus required for symmetric spanning to match the pitch of the standard pTP stimulus. In summary, electrode spanning is an effective field-shaping technique that is useful for adding spectral channels and handling defective electrodes with CIs.

Loudness summation using focused and unfocused electrical stimulation

With a cochlear implant, when stimulation from multiple channels is interleaved, the perceived loudness is greater than the loudness associated with any of the individual channels presented in isolation. This phenomenon is known as loudness summation. This study examined if loudness summation with monopolar and tripolar stimulation were equivalent at two loudnesses and two spacing configurations. Results suggest that loudness summation is similar for monopolar and tripolar modes. However, larger summation differences were observed for softer sounds and louder sounds with a larger spatial separation. The results are consistent with the idea that loudness summation is dependent on channel interaction and have implications for implementing current-focused processing strategies.