The effect of increased channel interaction on speech perception with cochlear implants

Channel crosstalk detected using ECAP measurements is associated with poorer speech perception in cochlear implant users

The number and independence of channels in cochlear implants (CI) has long been considered to influence speech recognition, particularly in competing background noise. Measures of channel independence have been obtained via psychophysical and objective means, relying on interactions between probe and masker signals delivered on different channels. In the current study, electrically evoked compound action potentials (ECAP) obtained from 32 Nucleus CI recipients tested at one basal and one apical position were performed using a standard spread-of-excitation procedure. An alternative analysis method, comparing masked responses only, revealed distant maskers as effective or more effective than same-electrode maskers in 13/32 cases. This appears to indicate substantial crosstalk between channels, covering up to nine intracochlear electrodes in one subject. Subjects with atypical responses and no other limiting factors had significantly poorer sentence recognition in noise compared with those with no detected peripheral or cognitive limiting factors. We propose that channel crosstalk detected via ECAPs may be a biomarker for poor or patchy neural survival that leads to poorer speech perception in CI recipients.

Impact of reduced spectral resolution on temporal-coherence-based source segregation

Hearing-impaired listeners struggle to understand speech in noise, even when using cochlear implants (CIs) or hearing aids. Successful listening in noisy environments depends on the brain's ability to organize a mixture of sound sources into distinct perceptual streams (i.e., source segregation). In normal-hearing listeners, temporal coherence of sound fluctuations across frequency channels supports this process by promoting grouping of elements belonging to a single acoustic source. We hypothesized that reduced spectral resolution-a hallmark of both electric/CI (from current spread) and acoustic (from broadened tuning) hearing with sensorineural hearing loss-degrades segregation based on temporal coherence. This is because reduced frequency resolution decreases the likelihood that a single sound source dominates the activity driving any specific channel; concomitantly, it increases the correlation in activity across channels. Consistent with our hypothesis, our physiologically inspired computational model of temporal-coherence-based segregation predicts that CI current spread reduces comodulation masking release (CMR; a correlate of temporal-coherence processing) and speech intelligibility in noise. These predictions are consistent with our online behavioral data with simulated CI listening. Our model also predicts smaller CMR with increasing levels of outer-hair-cell damage. These results suggest that reduced spectral resolution relative to normal hearing impairs temporal-coherence-based segregation and speech-in-noise outcomes.

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

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

Investigating the Effect of Blurring and Focusing Current in Cochlear Implant Users with the Panoramic ECAP Method

PURPOSE

For some cochlear implants (CIs), it is possible to focus electrical stimulation by partially returning current from the active electrode to nearby, intra-cochlear electrodes (partial tripolar (pTP) stimulation). Another method achieves the opposite: "blurring" by stimulating multiple electrodes simultaneously. The Panoramic ECAP (PECAP) method provides a platform to investigate their effects in detail by measuring electrically evoked compound action potentials and estimating current spread and neural responsiveness along the length of the CI electrode array. We investigate how sharpening and broadening the electrical current spread are reflected in PECAP estimates.

METHODS

PECAP measurements were recorded at most comfortable level in 12 ears of Advanced Bionics CI users. Focused thresholds were also determined. For the electrodes with the highest and lowest focused thresholds, additional PECAP measurements were recorded while stimulating in pTP mode and in "blurred" mode with 3 or 5 adjacent electrodes simultaneously stimulated. Current spread and neural responsiveness were then estimated along the electrode array using PECAP.

RESULTS

PECAP revealed increased current spread estimates across participants for blurred stimulation of the targeted electrodes towards the apex of the cochlea. Variable results for pTP stimulation were found, with two of eight ears appearing to drive a small group-level effect of increased current spread.

CONCLUSION

When stimulating multiple electrodes simultaneously, PECAP detected localized increases in current spread towards the apex (but not the base) of the cochlea. pTP stimulation showed mixed effects on PECAP current spread estimates. These findings are in line with behavioral speech perception studies and have implications for cochlear implant optimization.

Increased listening effort and decreased speech discrimination at high presentation sound levels in acoustic hearing listeners and cochlear implant users

The sounds we experience in our everyday communication can vary greatly in terms of level and background noise depending on the environment. Paradoxically, increasing the sound intensity may lead to worsened speech understanding, especially in noise. This is known as the "Rollover" phenomenon. There have been limited studies on rollover and how it is experienced differentially across aging groups, for those with and without hearing loss, as well as cochlear implant (CI) users. There is also mounting evidence that listening effort plays an important role in challenging listening conditions and can be directly quantified with objective measures such as pupil dilation. We found that listening effort was modulated by sound level and that rollover occurred primarily in the presence of background noise. The effect on listening effort was exacerbated by age and hearing loss in acoustic listeners, with greatest effect in older listeners with hearing loss, while there was no effect in CI users. The age- and hearing-dependent effects of rollover highlight the potential negative impact of amplification to high sound levels and therefore has implications for effective treatment of age-related hearing loss.

Recovering speech intelligibility with deep learning and multiple microphones in noisy-reverberant situations for people using cochlear implants

For cochlear implant (CI) listeners, holding a conversation in noisy and reverberant environments is often challenging. Deep-learning algorithms can potentially mitigate these difficulties by enhancing speech in everyday listening environments. This study compared several deep-learning algorithms with access to one, two unilateral, or six bilateral microphones that were trained to recover speech signals by jointly removing noise and reverberation. The noisy-reverberant speech and an ideal noise reduction algorithm served as lower and upper references, respectively. Objective signal metrics were compared with results from two listening tests, including 15 typical hearing listeners with CI simulations and 12 CI listeners. Large and statistically significant improvements in speech reception thresholds of 7.4 and 10.3 dB were found for the multi-microphone algorithms. For the single-microphone algorithm, there was an improvement of 2.3 dB but only for the CI listener group. The objective signal metrics correctly predicted the rank order of results for CI listeners, and there was an overall agreement for most effects and variances between results for CI simulations and CI listeners. These algorithms hold promise to improve speech intelligibility for CI listeners in environments with noise and reverberation and benefit from a boost in performance when using features extracted from multiple microphones.

Neural Decoding of the Speech Envelope: Effects of Intelligibility and Spectral Degradation

During continuous speech perception, endogenous neural activity becomes time-locked to acoustic stimulus features, such as the speech amplitude envelope. This speech-brain coupling can be decoded using non-invasive brain imaging techniques, including electroencephalography (EEG). Neural decoding may provide clinical use as an objective measure of stimulus encoding by the brain-for example during cochlear implant listening, wherein the speech signal is severely spectrally degraded. Yet, interplay between acoustic and linguistic factors may lead to top-down modulation of perception, thereby complicating audiological applications. To address this ambiguity, we assess neural decoding of the speech envelope under spectral degradation with EEG in acoustically hearing listeners (n = 38; 18-35 years old) using vocoded speech. We dissociate sensory encoding from higher-order processing by employing intelligible (English) and non-intelligible (Dutch) stimuli, with auditory attention sustained using a repeated-phrase detection task. Subject-specific and group decoders were trained to reconstruct the speech envelope from held-out EEG data, with decoder significance determined via random permutation testing. Whereas speech envelope reconstruction did not vary by spectral resolution, intelligible speech was associated with better decoding accuracy in general. Results were similar across subject-specific and group analyses, with less consistent effects of spectral degradation in group decoding. Permutation tests revealed possible differences in decoder statistical significance by experimental condition. In general, while robust neural decoding was observed at the individual and group level, variability within participants would most likely prevent the clinical use of such a measure to differentiate levels of spectral degradation and intelligibility on an individual basis.

Speech Perception as a Function of the Number of Channels and Channel Interaction in Cochlear Implant Simulation

Objective

Speech perception relies on precise spectral and temporal cues. However, cochlear implant (CI) processing is confined to a limited frequency range, affecting the information transmitted to the auditory system. This study analyzes the influence of channel interaction and the number of channels on word recognition scores (WRS) within the CI simulation framework.

Methods

Two distinct experiments were conducted. The first experiment (n=29, average age =23 years, 14 females) evaluated the number of channels using eight, twelve, sixteen, and 22 channel vocoded and nonvocoded word lists for WRS assessment. The second experiment (n=29, average age =25 years, 16 females) explored channel interaction across low, middle, and high-interaction conditions.

Results

In the first experiment, participants scored 57.93%, 80.97%, 83.59%, 91.03%, and 95.45% under 8, 12, 16, and 22-channel vocoder and non-vocoder conditions, respectively. The number of vocoder channels significantly affected WRS, with significant differences observed in all conditions except between the 12-channel and 16-channels (p<0.01). In the second experiment, the participants scored 2.2%, 20.6%, and 50.6% under high, mid, and low interaction conditions, respectively. Statistically significant differences were observed across all channel interaction conditions (p<0.01).

Conclusions

While the number of channels had a notable impact on WRS, it is essential to note that certain conditions (12 vs. 16) did not yield statistically significant differences. The observed differences in WRS were eclipsed by the pronounced effects of channel interaction. Notably, all conditions in the channel interaction experiment exhibited statistically significant differences. These findings underscore the paramount importance of prioritizing channel interaction in signal processing and CI fitting.

Effects of spectral smearing on speech understanding and masking release in simulated bilateral cochlear implants

Differences in spectro-temporal degradation may explain some variability in cochlear implant users' speech outcomes. The present study employs vocoder simulations on listeners with typical hearing to evaluate how differences in degree of channel interaction across ears affects spatial speech recognition. Speech recognition thresholds and spatial release from masking were measured in 16 normal-hearing subjects listening to simulated bilateral cochlear implants. 16-channel sine-vocoded speech simulated limited, broad, or mixed channel interaction, in dichotic and diotic target-masker conditions, across ears. Thresholds were highest with broad channel interaction in both ears but improved when interaction decreased in one ear and again in both ears. Masking release was apparent across conditions. Results from this simulation study on listeners with typical hearing show that channel interaction may impact speech recognition more than masking release, and may have implications for the effects of channel interaction on cochlear implant users' speech recognition outcomes.

Effects of spectral degradation on gated word recognition

Although much is known about how normal-hearing listeners process spoken words under ideal listening conditions, little is known about how a degraded signal, such as speech transmitted via cochlear implants, affects the word recognition process. In this study, gated word recognition performance was measured with the goal of describing the time course of word identification by using a noise-band vocoder simulation. The results of this study demonstrate that spectral degradations can impact the temporal aspects of speech processing. These results also provide insights into the potential advantages of enhancing spectral resolution in the processing of spoken words.

A computational modelling framework for assessing information transmission with cochlear implants

Computational models are useful tools to investigate scientific questions that would be complicated to address using an experimental approach. In the context of cochlear-implants (CIs), being able to simulate the neural activity evoked by these devices could help in understanding their limitations to provide natural hearing. Here, we present a computational modelling framework to quantify the transmission of information from sound to spikes in the auditory nerve of a CI user. The framework includes a model to simulate the electrical current waveform sensed by each auditory nerve fiber (electrode-neuron interface), followed by a model to simulate the timing at which a nerve fiber spikes in response to a current waveform (auditory nerve fiber model). Information theory is then applied to determine the amount of information transmitted from a suitable reference signal (e.g., the acoustic stimulus) to a simulated population of auditory nerve fibers. As a use case example, the framework is applied to simulate published data on modulation detection by CI users obtained using direct stimulation via a single electrode. Current spread as well as the number of fibers were varied independently to illustrate the framework capabilities. Simulations reasonably matched experimental data and suggested that the encoded modulation information is proportional to the total neural response. They also suggested that amplitude modulation is well encoded in the auditory nerve for modulation rates up to 1000 Hz and that the variability in modulation sensitivity across CI users is partly because different CI users use different references for detecting modulation.

Auditory stream segregation of amplitude-modulated narrowband noise in cochlear implant users and individuals with normal hearing

Voluntary stream segregation was investigated in cochlear implant (CI) users and normal-hearing (NH) listeners using a segregation-promoting objective approach which evaluated the role of spectral and amplitude-modulation (AM) rate separations on stream segregation and its build-up. Sequences of 9 or 3 pairs of A and B narrowband noise (NBN) bursts were presented which differed in either center frequency of the noise band, the AM-rate, or both. In some sequences (delayed sequences), the last B burst was delayed by 35 ms from their otherwise-steady temporal position. In the other sequences (no-delay sequences), the last B bursts were temporally advanced from 0 to 10 ms. A single interval yes/no procedure was utilized to measure participants’ sensitivity (d′) in identifying delayed vs. no-delay sequences. A higher d′ value showed the higher ability to segregate the A and B subsequences. For NH listeners, performance improved with each spectral separation. However, for CI users, performance was only significantly better for the condition with the largest spectral separation. Additionally, performance was significantly poorer for the largest AM-rate separation than for the condition with no AM-rate separation for both groups. The significant effect of sequence duration in both groups indicated that listeners made more improvement with lengthening the duration of stimulus sequences, supporting the build-up effect. The results of this study suggest that CI users are less able than NH listeners to segregate NBN bursts into different auditory streams when they are moderately separated in the spectral domain. Contrary to our hypothesis, our results indicate that AM-rate separation may interfere with the segregation of streams of NBN. Additionally, our results add evidence to the literature that CI users build up stream segregation at a rate comparable to NH listeners, when the inter-stream spectral separations are adequately large.

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

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

Intra-Cochlear Current Spread Correlates with Speech Perception in Experienced Adult Cochlear Implant Users

Broader intra-cochlear current spread (ICCS) implies higher cochlear implant (CI) channel interactions. This study aimed to investigate the relationship between ICCS and speech intelligibility in experienced CI users. Using voltage matrices collected for impedance measurements, an individual exponential spread coefficient (ESC) was computed. Speech audiometry was performed to determine the intelligibility at 40 dB Sound Pressure Level (SPL) and the 50% speech reception threshold: I40 and SRT50 respectively. Correlations between ESC and either I40 or SRT50 were assessed. A total of 36 adults (mean age: 50 years) with more than 11 months (mean: 34 months) of CI experience were included. In the 21 subjects for whom all electrodes were active, ESC was moderately correlated with both I40 (r = −0.557, p = 0.009) and SRT50 (r = 0.569, p = 0.007). The results indicate that speech perception performance is negatively affected by the ICCS. Estimates of current spread at the closest vicinity of CI electrodes and prior to any activation of auditory neurons are indispensable to better characterize the relationship between CI stimulation and auditory perception in cochlear implantees.

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

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