Temporal Response Properties of the Auditory Nerve in Implanted Children with Auditory Neuropathy Spectrum Disorder and Implanted Children with Sensorineural Hearing Loss

Assessing Neural Synchrony in the Cochlear Nerve to Electrical Stimulation in Children With Auditory Neuropathy Spectrum Disorder

OBJECTIVES

This study reported phase locking values (PLVs) that quantified the trial-to-trial phase coherence of electrically evoked compound action potentials in children with auditory neuropathy spectrum disorders (ANSD) and children with Gap Junction Beta 2 (GJB2) mutations, a patient population without noticeable cochlear nerve damage.

DESIGN

PLVs were measured at three electrode locations in 11 children with ANSD and 11 children with GJB2 mutations. Smaller PLVs indicated poorer neural synchrony. A linear mixed-effects model was used to compare PLVs measured at different electrode locations between participant groups.

RESULTS

After controlling for the stimulation level effect, children with ANSD had smaller PLVs than children with GJB2 mutations at all three electrode locations.

CONCLUSIONS

Cochlear-implanted children with ANSD show poorer peripheral neural synchrony than children with GJB2 mutations.

The Effects of Stimulus Repetition Rate on Electrically Evoked Auditory Brainstem Potentials in Postlingually Deafened Adult Cochlear Implant Recipients

Background: By using outcome prediction scores, it is possible to distinguish between good and poor performers with cochlear implants (CI) after CI implantation. The reasons for poor performance, despite good basic conditions, can be manifold. On the one hand, the postoperative fitting may be inadequate; on the other, neurophysiological disease processes may impair speech understanding with a CI. These disease processes are not yet fully understood. In acoustics, it is known that the auditory brainstem responses (ABR) and their latencies and amplitudes allow differential diagnosis based on reference values for normal-hearing individuals. The aim of this study was to provide reference values for electrically evoked brainstem responses (EABRs) in terms of rate-dependent latencies and amplitudes. Methods: 20 ears of 18 experienced adult CI recipients with a predicted and measured good postoperative word recognition score were recruited from the clinic's patient pool. In the same stimulation mode and intensity we measured latencies and interpeak-latencies of EABRs and electrically evoked compound action potentials (ECAPs). With a defined supra-threshold stimulation intensity above the individual ECAP threshold, we applied stimulation at several rates between 11 and 91 stimuli per second. Results: We found rate dependences for EABR latency t3 and t5 in the order of 0.19 ms and 0.37 ms, respectively, while ECAP was not affected by rate. Correspondingly, the interpeak intervals' rate dependences for t5-t1, t5-t3 and t3-t1 were of the order of 0.37 ms, 0.18 ms and 0.19 ms. Comparing the EABR amplitudes between the stimulation rates 11/s and 81/s, we found that at 81/s the amplitudes were significantly reduced down: to 73% for A3 and 81% for A5. These rate dependences of latency and amplitude in EABR have characteristics comparable to those of acoustic ABR. Conclusions: These data may serve to provide reference values for EABR and ECAP latencies, interpeak intervals and amplitudes with respect to stimulation rate. Altered response patterns of ECAPs and EABRs to normalised stimulation modes could be used in the future to describe and classify neuropathological processes in a better-differentiated way.

The Relationship Between Cochlear Implant Speech Perception Outcomes and Electrophysiological Measures of the Electrically Evoked Compound Action Potential

OBJECTIVE

This study assessed the relationship between electrophysiological measures of the electrically evoked compound action potential (eCAP) and speech perception scores measured in quiet and in noise in postlingually deafened adult cochlear implant (CI) users. It tested the hypothesis that how well the auditory nerve (AN) responds to electrical stimulation is important for speech perception with a CI in challenging listening conditions.

DESIGN

Study participants included 24 postlingually deafened adult CI users. All participants used Cochlear Nucleus CIs in their test ears. In each participant, eCAPs were measured at multiple electrode locations in response to single-pulse, paired-pulse, and pulse-train stimuli. Independent variables included six metrics calculated from the eCAP recordings: the electrode-neuron interface (ENI) index, the neural adaptation (NA) ratio, NA speed, the adaptation recovery (AR) ratio, AR speed, and the amplitude modulation (AM) ratio. The ENI index quantified the effectiveness of the CI electrodes in stimulating the targeted AN fibers. The NA ratio indicated the amount of NA at the AN caused by a train of constant-amplitude pulses. NA speed was defined as the speed/rate of NA. The AR ratio estimated the amount of recovery from NA at a fixed time point after the cessation of pulse-train stimulation. AR speed referred to the speed of recovery from NA caused by previous pulse-train stimulation. The AM ratio provided a measure of AN sensitivity to AM cues. Participants' speech perception scores were measured using Consonant-Nucleus-Consonant (CNC) word lists and AzBio sentences presented in quiet, as well as in noise at signal-to-noise ratios (SNRs) of +10 and +5 dB. Predictive models were created for each speech measure to identify eCAP metrics with meaningful predictive power.

RESULTS

The ENI index and AR speed individually explained at least 10% of the variance in most of the speech perception scores measured in this study, while the NA ratio, NA speed, the AR ratio, and the AM ratio did not. The ENI index was identified as the only eCAP metric that had unique predictive power for each of the speech test results. The amount of variance in speech perception scores (both CNC words and AzBio sentences) explained by the eCAP metrics increased with increased difficulty under the listening condition. Over half of the variance in speech perception scores measured in +5 dB SNR noise (both CNC words and AzBio sentences) was explained by a model with only three eCAP metrics: the ENI index, NA speed, and AR speed.

CONCLUSIONS

Of the six electrophysiological measures assessed in this study, the ENI index is the most informative predictor for speech perception performance in CI users. In agreement with the tested hypothesis, the response characteristics of the AN to electrical stimulation are more important for speech perception with a CI in noise than they are in quiet.

Relationships Between the Auditory Nerve's Ability to Recover From Neural Adaptation, Cortical Encoding of and Perceptual Sensitivity to Within-channel Temporal Gaps in Postlingually Deafened Adult Cochlear Implant Users

OBJECTIVE

As a step toward identifying the origin of the across-electrode variation in within-channel gap detection thresholds (GDTs) measured in individual cochlear implant (CI) users, this study assessed the relationships between the auditory nerve's (AN's) ability to recover from neural adaptation, cortical encoding of and perceptual sensitivity to within-channel temporal gaps in postlingually deafened adult CI users.

DESIGN

Study participants included 11 postlingually deafened adults with Cochlear Nucleus devices, including three bilaterally implanted participants. In each of the 14 ears tested, recovery from neural adaptation of the AN was measured using electrophysiological measures of the electrically evoked compound action potential at up to four electrode locations. The two CI electrodes in each ear showing the largest difference in the speed of adaptation recovery were selected for assessing within-channel temporal GDT. GDTs were measured using both psychophysical and electrophysiological procedures. Psychophysical GDTs were evaluated using a three-alternative, forced-choice procedure, targeting 79.4% correct on the psychometric function. Electrophysiological GDTs were measured using the electrically evoked auditory event-related potential (eERP) evoked by temporal gaps embedded in electrical pulse trains (i.e., the gap-eERP). Objective GDT was defined as the shortest temporal gap that could evoke a gap-eERP. Related-samples Wilcoxon Signed Rank test was used to compare psychophysical GDTs and objective GDTs measured at all CI electrode locations. It was also used to compare psychophysical GDTs and objective GDTs measured at the two CI electrode locations with different speeds or amounts of adaptation recovery of the AN. A Kendall Rank correlation test was used to assess the correlation between GDTs measured at the same CI electrode location using psychophysical or electrophysiological procedures.

RESULTS

Objective GDTs were significantly larger than those measured using psychophysical procedures. There was a significant correlation between objective and psychophysical GDTs. GDTs could not be predicted based on the amount or the speed of adaptation recovery of the AN.

CONCLUSIONS

Electrophysiological measures of the eERP evoked by temporal gaps can potentially be used to assess within-channel GDT in CI users who cannot provide reliable behavioral responses. The difference in adaptation recovery of the AN is not the primary factor accounting for the across-electrode variation in GDT in individual CI users.

Intracochlear electrocochleography findings in cochlear implant recipients with auditory neuropathy spectrum disorder

OBJECTIVES

This study aimed to compare intracochlear electrocochleography (ECochG) findings in a group of cochlear implant (CI) recipients with auditory neuropathy spectrum disorder (ANSD) with a group of CI recipients with sensorineural hearing loss (SNHL). Auditory outcome and spectral resolution findings were also compared among CI recipients with and without cochlear microphonic (CM) responses.

METHODS

This single-center, prospective cohort study was undertaken at a tertiary referral center. CM responses by the intracochlear ECochG test were recorded in CI recipients at 0.25-2 kHz. Speech, spatial, and hearing quality (SSQ) outcomes and spectral resolution measured with the spectral-temporally modulated ripple test were obtained for each recipient. The study included 62 implanted ears in 46 recipients, of which 59% (n = 27) were male and 41% (n = 19) were female. Twenty-nine ears with ANSD and 33 ears with SNHL were included. The mean age of the participants was 11 years. The results compared the intracochlear ECochG findings of the ANSD group with those of the SNHL group.

RESULTS

Participants were divided into two groups with and without obtainable CM responses. CM responses were obtained in 13 of 29 ears in the ANSD group and 14 of 33 ears in the SNHL group. CM thresholds obtained were better according to behavioral audiometric responses in some frequencies in the ANSD group. No significant difference was found in the auditory outcome and spectral resolution among CI recipients with and without CM responses.

CONCLUSIONS

Intracochlear ECochG has a limited potential clinical value for monitoring ANSD. CM thresholds obtained using ECochG may not reflect behavioral hearing thresholds.

Relationships Between the Auditory Nerve Sensitivity to Amplitude Modulation, Perceptual Amplitude Modulation Rate Discrimination Sensitivity, and Speech Perception Performance in Postlingually Deafened Adult Cochlear Implant Users

OBJECTIVE

This study assessed the relationships between the salience of amplitude modulation (AM) cues encoded at the auditory nerve (AN), perceptual sensitivity to changes in AM rate (i.e., AM rate discrimination threshold, AMRDT), and speech perception scores in postlingually deafened adult cochlear implant (CI) users.

DESIGN

Study participants were 18 postlingually deafened adults with Cochlear Nucleus devices, including five bilaterally implanted patients. For each of 23 implanted ears, neural encoding of AM cues at 20 Hz at the AN was evaluated at seven electrode locations across the electrode array using electrophysiological measures of the electrically evoked compound action potential (eCAP). The salience of AM neural encoding was quantified by the Modulated Response Amplitude Ratio (MRAR). Psychophysical measures of AMRDT for 20 Hz modulation were evaluated in 16 ears using a three-alternative, forced-choice procedure, targeting 79.4% correct on the psychometric function. AMRDT was measured at up to five electrode locations for each test ear, including the electrode pair that showed the largest difference in the MRAR. Consonant-Nucleus-Consonant (CNC) word scores presented in quiet and in speech-shaped noise at a signal to noise ratio (SNR) of +10 dB were measured in all 23 implanted ears. Simulation tests were used to assess the variations in correlation results when using the MRAR and AMRDT measured at only one electrode location in each participant to correlate with CNC word scores. Linear Mixed Models (LMMs) were used to evaluate the relationship between MRARs/AMRDTs measured at individual electrode locations and CNC word scores. Spearman Rank correlation tests were used to evaluate the strength of association between CNC word scores measured in quiet and in noise with (1) the variances in MRARs and AMRDTs, and (2) the averaged MRAR or AMRDT across multiple electrodes tested for each participant.

RESULTS

There was no association between the MRAR and AMRDT. Using the MRAR and AMRDT measured at only one, randomly selected electrode location to assess their associations with CNC word scores could lead to opposite conclusions. Both the results of LMMs and Spearman Rank correlation tests showed that CNC word scores measured in quiet or at 10 dB SNR were not significantly correlated with the MRAR or AMRDT. In addition, the results of Spearman Rank correlation tests showed that the variances in MRARs and AMRDTs were not significantly correlated with CNC word scores measured in quiet or in noise.

CONCLUSIONS

The difference in AN sensitivity to AM cues is not the primary factor accounting for the variation in AMRDTs measured at different stimulation sites within individual CI users. The AN sensitivity to AM per se may not be a crucial factor for CNC word perception in quiet or at 10 dB SNR in postlingually deafened adult CI users. Using electrophysiological or psychophysical results measured at only one electrode location to correlate with speech perception scores in CI users can lead to inaccurate, if not wrong, conclusions.

SpeedCAP: An Efficient Method for Estimating Neural Activation Patterns Using Electrically Evoked Compound Action-Potentials in Cochlear Implant Users

OBJECTIVES

Electrically evoked compound action-potentials (ECAPs) can be recorded using the electrodes in a cochlear implant (CI) and represent the synchronous responses of the electrically stimulated auditory nerve. ECAPs can be obtained using a forward-masking method that measures the neural response to a probe and masker electrode separately and in combination. The panoramic ECAP (PECAP) analyses measured ECAPs obtained using multiple combinations of masker and probe electrodes and uses a nonlinear optimization algorithm to estimate current spread from each electrode and neural health along the cochlea. However, the measurement of ECAPs from multiple combinations of electrodes is too time consuming for use in clinics. Here, we propose and evaluate SpeedCAP, a speedy method for obtaining the PECAP measurements that minimizes recording time by exploiting redundancies between multiple ECAP measures.

DESIGN

In the first study, 11 users of Cochlear Ltd. CIs took part. ECAPs were recorded using the forward-masking artifact-cancelation technique at the most comfortable loudness level (MCL) for every combination of masker and probe electrodes for all active electrodes in the users' MAPs, as per the standard PECAP recording paradigm. The same current levels and recording parameters were then used to collect ECAPs in the same users with the SpeedCAP method. The ECAP amplitudes were then compared between the two conditions, as were the corresponding estimates of neural health and current spread calculated using the PECAP method previously described by Garcia et al. The second study measured SpeedCAP intraoperatively in 8 CI patients and with all maskers and probes presented at the same current level to assess feasibility. ECAPs for the subset of conditions where the masker and probe were presented on the same electrode were compared with those obtained using the slower approach leveraged by the standard clinical software.

RESULTS

Data collection time was reduced from ≈45 to ≈8 minutes. There were no significant differences between normalized root mean squared error (RMSE) repeatability metrics for post-operative PECAP and SpeedCAP data, nor for the RMSEs calculated between PECAP and SpeedCAP data. The comparison achieved 80% power to detect effect sizes down to 8.2% RMSE. When between-participant differences were removed, both the neural-health (r = 0.73) and current-spread (r = 0.65) estimates were significantly correlated (p < 0.0001, df = 218) between SpeedCAP and PECAP conditions across all electrodes, and showed RMSE errors of 12.7 ± 4.7% and 16.8 ± 8.8%, respectively (with the ± margins representing 95% confidence intervals). Valid ECAPs were obtained in all patients in the second study, demonstrating intraoperative feasibility of SpeedCAP. No significant differences in RMSEs were detectable between post- and intra-operative ECAP measurements, with the comparison achieving 80% power to detect effect sizes down to 13.3% RMSE.

CONCLUSIONS

The improved efficiency of SpeedCAP provides time savings facilitating multi-electrode ECAP recordings in routine clinical practice. SpeedCAP data collection is sufficiently quick to record intraoperatively, and adds no more than 8.2% error to the ECAP amplitudes. Such measurements could thereafter be submitted to models such as PECAP to provide patient-specific patterns of neural activation to inform programming of clinical MAPs and identify causes of poor performance at the electrode-nerve interface of CI users. The speed and accuracy of these measurements also opens up a wide range of additional research questions to be addressed.

Comparison of response properties of the electrically stimulated auditory nerve reported in human listeners and in animal models

Cochlear implants (CIs) provide acoustic information to implanted patients by electrically stimulating nearby auditory nerve fibers (ANFs) which then transmit the information to higher-level neural structures for further processing and interpretation. Computational models that simulate ANF responses to CI stimuli enable the exploration of the mechanisms underlying CI performance beyond the capacity of in vivo experimentation alone. However, all ANF models developed to date utilize to some extent anatomical/morphometric data, biophysical properties and/or physiological data measured in non-human animal models. This review compares response properties of the electrically stimulated auditory nerve (AN) in human listeners and different mammalian models. Properties of AN responses to single pulse stimulation, paired-pulse stimulation, and pulse-train stimulation are presented. While some AN response properties are similar between human listeners and animal models (e.g., increased AN sensitivity to single pulse stimuli with long interphase gaps), there are some significant differences. For example, the AN of most animal models is typically more sensitive to cathodic stimulation while the AN of human listeners is generally more sensitive to anodic stimulation. Additionally, there are substantial differences in the speed of recovery from neural adaptation between animal models and human listeners. Therefore, results from animal models cannot be simply translated to human listeners. Recognizing the differences in responses of the AN to electrical stimulation between humans and other mammals is an important step for creating ANF models that are more applicable to various human CI patient populations.

Postlingually Deafened Adult Cochlear Implant Users With Prolonged Recovery From Neural Adaptation at the Level of the Auditory Nerve Tend to Have Poorer Speech Perception Performance

OBJECTIVE

This study investigated the effects of two temporal response properties of the auditory nerve (i.e., neural adaptation and recovery from neural adaptation) on speech perception performance in postlingually deafened adult cochlear implant (CI) users.

DESIGN

Study participants included 18 postlingually deafened adults who were Cochlear Nucleus device users with a full electrode array insertion in the test ear(s). Neural adaptation and adaptation recovery of the auditory nerve (AN) were evaluated using electrophysiological measures of the electrically evoked compound action potential (eCAP). The amount of neural adaptation was quantified by the adaptation index within three time windows: 0 to 8.89 (window 1), 44.44 to 50.00 (window 2), and 94.44 to 100.00 ms (window 3). The speed of neural adaptation was estimated using a two-parameter power law function. To evaluate adaptation recovery of the AN, eCAPs to the last pulse of the 100-ms pulse train were recorded at masker-probe-intervals ranging from 1.054 to 256 ms in logarithmic steps. The amount of adaptation recovery was quantified by the adaptation recovery ratio. The time-constant of adaptation recovery was estimated using an exponential function with up to three components. Speech perception performance was evaluated by measuring consonant-nucleus-consonant (CNC) word scores presented in quiet and in speech-shaped noise at a signal-to-noise ratio (SNR) of +10 dB. One-tailed Pearson Product Moment correlation tests were used (1) to assess the associations among parameters of neural adaptation and adaptation recovery and (2) to evaluate the strength of association between these parameters and CNC word scores measured in quiet and in noise. The contributions of different parameters quantifying neural adaptation and adaptation recovery on speech perception scores were evaluated using multivariable linear regression analyses.

RESULTS

The Pearson Product Moment correlation coefficient demonstrated a moderate, negative correlation between the speed of adaptation recovery and CNC word scores measured in quiet and in noise. The speed of adaptation recovery accounted for 14.1% of variability in CNC word scores measured in quiet and 16.7% of variability in CNC word scores measured in noise. The correlation strengths between CNC word scores and the adaptation index, the adaptation recovery ratio and the speed of neural adaptation ranged from negligible to weak.

CONCLUSIONS

The speed of adaptation recovery plays a more important role than other features of neural adaptation and adaptation recovery of the AN in speech perception in postlingually deafened adult CI users. Patients with prolonged adaptation recovery tend to show poorer speech perception performance.

Neural Adaptation of the Electrically Stimulated Auditory Nerve Is Not Affected by Advanced Age in Postlingually Deafened, Middle-aged, and Elderly Adult Cochlear Implant Users

OBJECTIVE

This study aimed to investigate the associations between advanced age and the amount and the speed of neural adaptation of the electrically stimulated auditory nerve (AN) in postlingually deafened adult cochlear implant (CI) users.

DESIGN

Study participants included 26 postlingually deafened adult CI users, ranging in age between 28.7 and 84.0 years (mean: 63.8 years, SD: 14.4 years) at the time of testing. All study participants used a Cochlear Nucleus device with a full electrode array insertion in the test ear. The stimulus was a 100-ms pulse train with a pulse rate of 500, 900, 1800, or 2400 pulses per second (pps) per channel. The stimulus was presented at the maximum comfortable level measured at 2400 pps with a presentation rate of 2 Hz. Neural adaptation of the AN was evaluated using electrophysiological measures of the electrically evoked compound action potential (eCAP). The amount of neural adaptation was quantified by the adaptation index (AI) within three time windows: around 0 to 8 ms (window 1), 44 to 50 ms (window 2), and 94 to 100 ms (window 3). The speed of neural adaptation was quantified using a two-parameter power law estimation. In 23 participants, four electrodes across the electrode array were tested. In three participants, three electrodes were tested. Results measured at different electrode locations were averaged for each participant at each pulse rate to get an overall representation of neural adaptation properties of the AN across the cochlea. Linear-mixed models (LMMs) were used (1) to evaluate the effects of age at testing and pulse rate on the speed of neural adaptation and (2) to assess the effects of age at testing, pulse rate, and duration of stimulation (i.e., time window) on the amount of neural adaptation in these participants.

RESULTS

There was substantial variability in both the amount and the speed of neural adaptation of the AN among study participants. The amount and the speed of neural adaptation increased at higher pulse rates. In addition, larger amounts of adaptation were observed for longer durations of stimulation. There was no significant effect of age on the speed or the amount of neural adaptation.

CONCLUSIONS

The amount and the speed of neural adaptation of the AN are affected by both the pulse rate and the duration of stimulation, with higher pulse rates and longer durations of stimulation leading to faster and greater neural adaptation. Advanced age does not affect neural adaptation of the AN in postlingually deafened, middle-aged and elderly adult CI users.

Audibility emphasis of low-level sounds improves consonant identification while preserving vowel identification for cochlear implant users

Consonant perception is challenging for listeners with hearing loss, and transmission of speech over communication channels further deteriorates the acoustics of consonants. Part of the challenge arises from the short-term low energy spectro-temporal profile of consonants (for example, relative to vowels). We hypothesized that an audibility enhancement approach aimed at boosting the energy of low-level sounds would improve identification of consonants without diminishing vowel identification. We tested this hypothesis with 11 cochlear implant users, who completed an online listening experiment remotely using the media device and implant settings that they most commonly use when making video calls. Loudness growth and detection thresholds were measured for pure tone stimuli to characterize the relative loudness of test conditions. Consonant and vowel identification were measured in quiet and in speech-shaped noise for progressively difficult signal-to-noise ratios (+12, +6, 0, -6 dB SNR). These conditions were tested with and without an audibility-emphasis algorithm designed to enhance consonant identification at the source. The results show that the algorithm improves consonant identification in noise for cochlear implant users without diminishing vowel identification. We conclude that low-level emphasis of audio can improve speech recognition for cochlear implant users in the case of video calls or other telecommunications where the target speech can be preprocessed separately from environmental noise.

Characteristics of the Adaptation Recovery Function of the Auditory Nerve and Its Association With Advanced Age in Postlingually Deafened Adult Cochlear Implant Users

OBJECTIVE

This study aimed to (1) characterize the amount and the speed of recovery from neural adaptation at the auditory nerve (AN) and (2) assess their associations with advanced age in postlingually deafened adult cochlear implant users.

DESIGN

Study participants included 25 postlingually deafened adult, Cochlear Nucleus device users, ranging in age between 24.83 and 83.21 years at the time of testing. The stimulus was a 100-ms pulse train presented at four pulse rates: 500, 900, 1800, and 2400 pulses per second (pps). The pulse trains were presented at the maximum comfortable level measured for the 2400-pps pulse train. The electrically evoked compound action potential (eCAP) evoked by the last pulse of the pulse train (i.e., the probe pulse) was recorded. The remaining pulses of the pulse train served as the pulse-train masker. The time interval between the probe pulse and the last pulse of the pulse-train masker [i.e., masker-probe-interval (MPI)] systematically increased from 0.359 ms up to 256 ms. The adaptation recovery function (ARF) was obtained by plotting normalized eCAP amplitudes (re: the eCAP amplitude measured at the MPI of 256 ms) as a function of MPIs. The adaptation recovery ratio (ARR) was defined as the ratio between the eCAP amplitude measured at the MPI of 256 ms and that measured for the single-pulse stimulus presented at the same stimulation level. The time constants of the ARF were estimated using a mathematical model with an exponential function with up to three components. Generalized Linear Mixed effects Models were used to compare ARRs and time constants measured at different electrode locations and pulse rates, as well as to assess the effect of advanced age on these dependent variables.

RESULTS

There were three ARF types observed in this study. The ARF type observed in the same study participant could be different at different electrode locations and/or pulse rates. Substantial variations in both the amount and the speed of neural adaptation recovery among study participants were observed. The ARR was significantly affected by pulse rate but was not affected by electrode location. The effect of electrode location on the time constants of the ARF was not statistically significant. Pulse rate had a statistically significant effect on τ 1, but not on τ 2 or τ 3 . There was no statistically significant effect of age on the ARR or the time constants of the ARF.

CONCLUSIONS

Neural adaptation recovery processes at the AN demonstrate substantial variations among human cochlear implant users. The recovery pattern can be nonmonotonic with up to three phases. While the amount of neural adaptation recovery decreases as pulse rate increases, only the speed of the first phase of neural adaptation recovery is affected by pulse rate. Electrode location or advanced age has no robust effect on neural adaptation recovery processes at the level of the AN for a 100-ms pulse-train masker with pulse rates of 500 to 2400 pps. The lack of sufficient participants in this study who were 40 years of age or younger at the time of testing might have precluded a thorough assessment of the effect of advanced age.

Effect of Increasing Pulse Phase Duration on Neural Responsiveness of the Electrically Stimulated Cochlear Nerve

OBJECTIVES

The aim of this study is to (1) investigate the effects of increasing the pulse phase duration (PPD) on the neural response of the electrically stimulated cochlear nerve (CN) in children with CN deficiency (CND) and (2) compare the results from the CND population to those measured in children with normal-sized CNs.

DESIGN

Study participants included 30 children with CND and 30 children with normal-sized CNs. All participants used a Cochlear Nucleus device in the test ear. For each subject, electrically evoked compound action potential (eCAP) input/output (I/O) functions evoked by single biphasic pulses with different PPDs were recorded at three electrode locations across the electrode array. PPD durations tested in this study included 50, 62, 75, and 88 μsec/phase. For each electrode tested for each study participant, the amount of electrical charge corresponding to the maximum comfortable level measured for the 88 μsec PPD was used as the upper limit of stimulation. The eCAP amplitude measured at the highest electrical charge level, the eCAP threshold (i.e., the lowest level that evoked an eCAP), and the slope of the eCAP I/O function were measured. Generalized linear mixed effect models with study group, electrode location, and PPD as the fixed effects and subject as the random effect were used to compare these dependent variables measured at different electrode locations and PPDs between children with CND and children with normal-sized CNs.

RESULTS

Children with CND had smaller eCAP amplitudes, higher eCAP thresholds, and smaller slopes of the eCAP I/O function than children with normal-sized CNs. Children with CND who had fewer electrodes with a measurable eCAP showed smaller eCAP amplitudes and flatter eCAP I/O functions than children with CND who had more electrodes with eCAPs. Increasing the PPD did not show a statistically significant effect on any of these three eCAP parameters in the two subject groups tested in this study.

CONCLUSIONS

For the same amount of electrical charge, increasing the PPD from 50 to 88 μsec for a biphasic pulse with a 7 μsec interphase gap did not significantly affect CN responsiveness to electrical stimulation in human cochlear implant users. Further studies with different electrical pulse configurations are warranted to determine whether evaluating the eCAP sensitivity to changes in the PPD can be used as a testing paradigm to estimate neural survival of the CN for individual cochlear implant users.

The Effects of GJB2 or SLC26A4 Gene Mutations on Neural Response of the Electrically Stimulated Auditory Nerve in Children

OBJECTIVES

This study aimed to (1) investigate the effect of GJB2 and SLC26A4 gene mutations on auditory nerve function in pediatric cochlear implant users and (2) compare their results with those measured in implanted children with idiopathic hearing loss.

DESIGN

Participants included 20 children with biallelic GJB2 mutations, 16 children with biallelic SLC26A4 mutations, and 19 children with idiopathic hearing loss. All subjects except for two in the SLC26A4 group had concurrent Mondini malformation and enlarged vestibular aqueduct. All subjects used Cochlear Nucleus devices in their test ears. For each subject, electrophysiological measures of the electrically evoked compound action potential (eCAP) were recorded using both anodic- and cathodic-leading biphasic pulses. Dependent variables (DVs) of interest included slope of eCAP input/output (I/O) function, the eCAP threshold, and eCAP amplitude measured at the maximum comfortable level (C level) of the anodic-leading stimulus (i.e., the anodic C level). Slopes of eCAP I/O functions were estimated using statistical modeling with a linear regression function. These DVs were measured at three electrode locations across the electrode array. Generalized linear mixed effect models were used to evaluate the effects of study group, stimulus polarity, and electrode location on each DV.

RESULTS

Steeper slopes of eCAP I/O function, lower eCAP thresholds, and larger eCAP amplitude at the anodic C level were measured for the anodic-leading stimulus compared with the cathodic-leading stimulus in all subject groups. Children with GJB2 mutations showed steeper slopes of eCAP I/O function and larger eCAP amplitudes at the anodic C level than children with SLC26A4 mutations and children with idiopathic hearing loss for both the anodic- and cathodic-leading stimuli. In addition, children with GJB2 mutations showed a smaller increase in eCAP amplitude when the stimulus changed from the cathodic-leading pulse to the anodic-leading pulse (i.e., smaller polarity effect) than children with idiopathic hearing loss. There was no statistically significant difference in slope of eCAP I/O function, eCAP amplitude at the anodic C level, or the size of polarity effect on all three DVs between children with SLC26A4 mutations and children with idiopathic hearing loss. These results suggested that better auditory nerve function was associated with GJB2 but not with SLC26A4 mutations when compared with idiopathic hearing loss. In addition, significant effects of electrode location were observed for slope of eCAP I/O function and the eCAP threshold.

CONCLUSIONS

GJB2 and SLC26A4 gene mutations did not alter polarity sensitivity of auditory nerve fibers to electrical stimulation. The anodic-leading stimulus was generally more effective in activating auditory nerve fibers than the cathodic-leading stimulus, despite the presence of GJB2 or SLC26A4 mutations. Patients with GJB2 mutations appeared to have better functional status of the auditory nerve than patients with SLC26A4 mutations who had concurrent Mondini malformation and enlarged vestibular aqueduct and patients with idiopathic hearing loss.

The Effect of Pulse Polarity on Neural Response of the Electrically Stimulated Cochlear Nerve in Children With Cochlear Nerve Deficiency and Children With Normal-Sized Cochlear Nerves

OBJECTIVE

This study aimed to (1) investigate the effect of pulse polarity on neural response of the electrically stimulated cochlear nerve in children with cochlear nerve deficiency (CND) and children with normal-sized cochlear nerves and (2) compare the size of the pulse polarity effect between these two subject groups.

DESIGN

The experimental and control group included 31 children with CND and 31 children with normal-sized cochlear nerves, respectively. For each study participant, evoked compound action potential (eCAP) input/output (I/O) functions for anodic-leading and cathodic-leading biphasic stimuli were measured at three electrode locations across the electrode array. The dependent variables of interest included the eCAP amplitude measured at the maximum comfortable level of the anodic stimulus, the lowest level that could evoke an eCAP (i.e., the eCAP threshold), the slope of the eCAP I/O function estimated based on linear regression, the negative-peak (i.e., N1) latency of the eCAP, as well as the size of the pulse polarity effect on these eCAP measurements. Generalized linear mixed effect models were used to compare the eCAP amplitude, the eCAP threshold, the slope of the eCAP I/O function, and the N1 latency evoked by the anodic-leading stimulus with those measured for the cathodic-leading stimulus for children with CND and children with normal-sized cochlear nerves. Generalized linear mixed effect models were also used to compare the size of the pulse polarity effect on the eCAP between these two study groups. The one-tailed Spearman correlation test was used to assess the potential correlation between the pulse phase duration and the difference in N1 latency measured for different pulse polarities.

RESULTS

Compared with children who had normal-sized cochlear nerves, children with CND had reduced eCAP amplitudes, elevated eCAP thresholds, flatter eCAP I/O functions, and prolonged N1 latencies. The anodic-leading stimulus led to higher eCAP amplitudes, lower eCAP thresholds, and shorter N1 latencies than the cathodic-leading stimulus in both study groups. Steeper eCAP I/O functions were recorded for the anodic-leading stimulus than those measured for the cathodic-leading stimulus in children with CND, but not in children with normal-sized cochlear nerves. Group differences in the size of the pulse polarity effect on the eCAP amplitude, the eCAP threshold, or the N1 latency were not statistically significant.

CONCLUSIONS

Similar to the normal-sized cochlear nerve, the hypoplastic cochlear nerve is more sensitive to the anodic-leading than to the cathodic-leading stimulus. Results of this study do not provide sufficient evidence for proving the idea that the pulse polarity effect can provide an indication for local neural health.

The Effect of Interphase Gap on Neural Response of the Electrically Stimulated Cochlear Nerve in Children With Cochlear Nerve Deficiency and Children With Normal-Sized Cochlear Nerves

OBJECTIVES

This study aimed to compare the effects of increasing the interphase gap (IPG) on the neural response of the electrically stimulated cochlear nerve (CN) between children with CN deficiency (CND) and children with normal-sized CNs.

DESIGN

Study participants included 30 children with CND and 30 children with normal-sized CNs. All subjects were implanted with a Cochlear Nucleus device with the internal electrode array 24RE[CA] in the test ear. The stimulus was a charge-balanced, cathodic leading, biphasic pulse with a pulse-phase duration of 50 μsec. For each subject, the electrically evoked compound action potential (eCAP) input/output (I/O) function was measured for 6 IPGs (i.e., 7, 14, 21, 28, 35, and 42 μsec) at 3 electrode locations across the electrode array. For each subject and each testing electrode, the highest stimulation used to measure the eCAP I/O function was the maximum comfortable level measured with an IPG of 42 μsec. Dependent variables (DVs) were the maximum eCAP amplitude, the eCAP threshold, and the slope of the eCAP I/O function estimated using both linear and sigmoidal regression functions. For each DV, the size of the IPG effect was defined as the proportional change relative to the result measured for the 7 μsec IPG at the basal electrode location. Generalized linear mixed effect models with subject group, electrode location, and IPG duration as the fixed effects and subject as the random effect were used to compare these DVs and the size of the IPG effect on these DVs.

RESULTS

Children with CND showed smaller maximum eCAP amplitudes, higher eCAP thresholds, and smaller slopes of eCAP I/O function estimated using either linear or sigmoidal regression function than children with normal-sized CNs. Increasing the IPG duration resulted in larger maximum eCAP amplitudes, lower eCAP thresholds and larger slopes of eCAP I/O function estimated using sigmoidal regression function at all three electrode locations in both study groups. Compared with children with normal-sized CNs, children with CND showed larger IPG effects on both the maximum eCAP amplitude and the slope of the eCAP I/O function estimated using either linear or sigmoidal regression function, and a smaller IPG effect on the eCAP threshold than those measured in children with normal-sized CNs.

CONCLUSIONS

Increasing the IPG increases responsiveness of the electrically stimulated CN in both children with CND and children with normal-sized CNs. The maximum eCAP amplitude and the slope of the eCAP I/O function measured in human listeners with poorer CN survival are more sensitive to changes in the IPG. In contrast, the eCAP threshold in listeners with poorer CN survival is less sensitive to increases in the IPG. Further studies are warranted to identify the best parameters of eCAP results for predicting CN survival before this eCAP testing paradigm can be used as a clinical tool for evaluating neural health for individual cochlear implant patients.

The Sensitivity of the Electrically Stimulated Auditory Nerve to Amplitude Modulation Cues Declines With Advanced Age

OBJECTIVES

This study aimed to investigate effects of aging and duration of deafness on sensitivity of the auditory nerve (AN) to amplitude modulation (AM) cues delivered using trains of biphasic pulses in adult cochlear implant (CI) users.

DESIGN

There were 21 postlingually deaf adult CI users who participated in this study. All study participants used a Cochlear Nucleus device with a full electrode array insertion in the test ear. The stimulus was a 200-ms pulse train with a pulse rate of 2000 pulses per second. This carrier pulse train was sinusodially AM at four modulation rates (20, 40, 100, 200 Hz). The peak amplitude of the modulated pulse train was the maximum comfortable level (i.e., C level) measured for the carrier pulse train. The electrically evoked compound action potential (eCAP) to each of the 20 pulses selected over the last two AM cycles were measured. In addition, eCAPs to single pulses were measured with the probe levels corresponding to the levels of 20 selected pulses from each AM pulse train. There were seven electrodes across the array evaluated in 16 subjects (i.e., electrodes 3 or 4, 6, 9, 12, 15, 18, and 21). For the remaining five subjects, 4 to 5 electrodes were tested due to impedance issues or time constraints. The modulated response amplitude ratio (MRAR) was calculated as the ratio of the difference in the maximum and the minimum eCAP amplitude measured for the AM pulse train to that measured for the single pulse, and served as the dependent variable. Age at time of testing and duration of deafness measured/defined using three criteria served as the independent variables. Linear Mixed Models were used to assess the effects of age at testing and duration of deafness on the MRAR.

RESULTS

Age at testing had a strong, negative effect on the MRAR. For each subject, the duration of deafness varied substantially depending on how it was defined/measured, which demonstrates the difficulty of accurately measuring the duration of deafness in adult CI users. There was no clear or reliable trend showing a relationship between the MRAR measured at any AM rate and duration of deafness defined by any criteria. After controlling for the effect of age at testing, MRARs measured at 200 Hz and basal electrode locations (i.e., electrodes 3 and 6) were larger than those measured at any other AM rate and apical electrode locations (i.e., electrodes 18 and 21).

CONCLUSIONS

The AN sensitivity to AM cues implemented in the pulse-train stimulation significantly declines with advanced age. Accurately measuring duration of deafness in adult CI users is challenging, which, at least partially, might have accounted for the inconclusive findings in the relationship between the duration of deafness and the AN sensitivity to AM cues in this study.

Assessing temporal responsiveness of primary stimulated neurons in auditory brainstem and cochlear implant users

The reasons why clinical outcomes with auditory brainstem implants (ABIs) are generally poorer than with cochlear implants (CIs) are still somewhat elusive. Prior work has focused on differences in processing of spectral information due to possibly poorer tonotopic representation and higher channel interaction with ABIs than with CIs. In contrast, this study examines the hypothesis that a potential contributing reason for poor speech perception in ABI users may be the relative lack of temporal responsiveness of the primary neurons that are stimulated by the ABI. The cochlear nucleus, the site of ABI stimulation, consists of different neuron types, most of which have much more complex responses than the auditory nerve neurons stimulated by a CI. Temporal responsiveness of primary stimulated neurons was assessed in a group of ABI and CI users by measuring recovery of electrically evoked compound action potentials (ECAPs) from single-pulse forward masking. Slower ECAP recovery tended to be associated with poorer hearing outcomes in both groups. ABI subjects with the longest recovery time had no speech understanding or even no hearing sensation with their ABI device; speech perception for the one CI outlier with long ECAP recovery time was well below average. To the extent that ECAP recovery measures reveal temporal properties of the primary neurons that receive direct stimulation form neural prosthesis devices, they may provide a physiological underpinning for clinical outcomes of auditory implants. ECAP recovery measures may be used to determine which portions of the cochlear nucleus to stimulate, and possibly allow us to enhance the stimulation paradigms.

Electrophysiology and genetic testing in the precision medicine of congenital deafness: A review

BACKGROUND

Congenital hearing loss is remarkably heterogeneous, with over 130 deafness genes and thousands of variants, making for innumerable genotype/phenotype combinations. Understanding both the pathophysiology of hearing loss and molecular site of lesion along the auditory pathway permits for significantly individualized counseling. Electrophysiologic techniques such as electrocochleography (ECochG) and electrically-evoked compound action potentials (eCAP) are being studied to localize pathology and estimate residual cochlear vs. neural health. This review describes the expanding roles of genetic and electrophysiologic evaluation in the precision medicine of congenital hearing loss.The basics of genetic mutations in hearing loss and electrophysiologic testing (ECochG and eCAP) are reviewed, and how they complement each other in the diagnostics and prognostication of hearing outcomes. Used together, these measures improve the understanding of insults to the auditory system, allowing for individualized counseling for CI candidacy/outcomes or other habilitation strategies.

CONCLUSION

Despite tremendous discovery in deafness genes, the effects of individual genes on neural function remain poorly understood. Bridging the understanding between molecular genotype and neural and functional phenotype is paramount to interpreting genetic results in clinical practice. The future hearing healthcare provider must consolidate an ever-increasing amount of genetic and phenotypic information in the precision medicine of hearing loss.

Music and psychoacoustic perception abilities in cochlear implant users with auditory neuropathy spectrum disorder

OBJECTIVE

Auditory neuropathy spectrum disorder (ANSD) is a condition wherein the pre-neural or cochlear outer hair cell activity is intact, but the neural activity in the auditory nerve is disrupted. Cochlear implant (CI) can be beneficial for subjects with ANSD; however, little is known about the music perception and psychoacoustic abilities of CI users with ANSD. Music perception in CI users is a multidimensional and complex ability requiring the contribution of both auditory and nonauditory abilities. Even though auditory abilities lay the foundation, the contribution of patient-related variables such as ANSD may affect the music perception. This study aimed to evaluate the psychoacoustic and music perception abilities of CI recipients with ANSD.

STUDY DESIGN

Twelve CI users with ANSD and twelve age- and gendermatched CI users with sensorineural hearing loss (SNHL) were evaluated. Music perception abilities were measured using the Turkish version of the Clinical Assessment of Music Perception (T-CAMP) test. Psychoacoustic abilities were measured using the spectral ripple discrimination (SRD) and temporal modulation transfer function (TMTF) tests. In addition, the age of diagnosis and implantation was recorded.

RESULTS

Pitch direction discrimination (PDD), timbre recognition, SRD, and TMTF performance of CI users with ANSD were concordant with those reported in previous studies, and differences between ANSD and SNHL groups were not statistically significant. However, the ANSD group performed poorly compared with SNHL group in melody recognition subtest of T-CAMP, and the difference was statistically significant.

CONCLUSION

CI can prove beneficial for patients with ANSD with respect to their music and psychoacoustic abilities, similar to patients with SNHL, except for melody recognition. Recognition of melodies requires both auditory and non-auditory abilities, and ANSD may have an extensive but subtle effect in the life of CI users.

Pediatric Auditory Brainstem Implantation: Surgical, Electrophysiologic, and Behavioral Outcomes

OBJECTIVES

The objectives of this study were to demonstrate the safety of auditory brainstem implant (ABI) surgery and document the subsequent development of auditory and spoken language skills in children without neurofibromatosis type II (NFII).

DESIGN

A prospective, single-subject observational study of ABI in children without NFII was undertaken at the University of North Carolina at Chapel Hill. Five children were enrolled under an investigational device exemption sponsored by the investigators. Over 3 years, patient demographics, medical/surgical findings, complications, device mapping, electrophysiologic measures, audiologic outcomes, and speech and language measures were collected.

RESULTS

Five children without NFII have received ABIs to date without permanent medical sequelae, although 2 children required treatment after surgery for temporary complications. All children wear their device daily, and the benefits of sound awareness have developed slowly. Intra-and postoperative electrophysiologic measures augmented surgical placement and device programming. The slow development of audition skills precipitated limited changes in speech production but had little impact on growth in spoken language.

CONCLUSIONS

ABI surgery is safe in young children without NFII. Benefits from device use develop slowly and include sound awareness and the use of pattern and timing aspects of sound. These skills may augment progress in speech production but progress in language development is dependent upon visual communication. Further monitoring of this cohort is needed to better delineate the benefits of this intervention in this patient population.

Responsiveness of the Electrically Stimulated Cochlear Nerve in Children With Cochlear Nerve Deficiency

OBJECTIVES

This study aimed to (1) investigate the responsiveness of the cochlear nerve (CN) to a single biphasic-electrical pulse in implanted children with cochlear nerve deficiency (CND) and (2) compare their results with those measured in implanted children with normal-size CNs.

DESIGN

Participants included 23 children with CND (CND1 to CND23) and 18 children with normal-size CNs (S1 to S18). All subjects except for CND1 used Cochlear Nucleus cochlear implants with contour electrode arrays in their test ears. CND1 was implanted with a Cochlear Nucleus Freedom cochlear implant with a straight electrode array in the test ear. For each subject, the CN input/output (I/O) function and the refractory recovery function were measured using electrophysiological measures of the electrically evoked compound action potential (eCAP) at multiple electrode sites across the electrode array. Dependent variables included eCAP threshold, the maximum eCAP amplitude, slope of the I/O function, and time-constants of the refractory recovery function. Slopes of I/O functions were estimated using statistical modeling with a sigmoidal function. Recovery time-constants, including measures of the absolute refractory period and the relative refractory period, were estimated using statistical modeling with an exponential decay function. Generalized linear mixed-effect models were used to evaluate the effects of electrode site on the dependent variables measured in children with CND and to compare results of these dependent variables between subject groups.

RESULTS

The eCAP was recorded at all test electrodes in children with normal-size CNs. In contrast, the eCAP could not be recorded at any electrode site in 4 children with CND. For all other children with CND, the percentage of electrodes with measurable eCAPs decreased as the stimulating site moved in a basal-to-apical direction. For children with CND, the stimulating site had a significant effect on the slope of the I/O functions and the relative refractory period but showed no significant effect on eCAP threshold and the maximum eCAP amplitude. Children with CND had significantly higher eCAP thresholds, smaller maximum eCAP amplitudes, flatter slopes of I/O functions, and longer absolute refractory periods than children with normal-size CNs. There was no significant difference in the relative refractory period measured in these two subject groups.

CONCLUSIONS

In children with CND, the functional status of the CN varied along the length of the cochlea. Compared with children with normal-size CNs, children with CND showed reduced CN responsiveness to electrical stimuli. The prolonged CN absolute refractory period in children with CND might account for, at least partially, the observed benefit of using relatively slow pulse rate in these patients.

Relationship Between Peripheral and Psychophysical Measures of Amplitude Modulation Detection in Cochlear Implant Users

OBJECTIVE

This study investigates the relationship between electrophysiological and psychophysical measures of amplitude modulation (AM) detection. Prior studies have reported both measures of AM detection recorded separately from cochlear implant (CI) users and acutely deafened animals, but no study has made both measures in the same CI users. Animal studies suggest a progressive loss of high-frequency encoding as one ascends the auditory pathway from the auditory nerve to the cortex. Because the CI speech processor uses the envelope of an ongoing acoustic signal to modulate pulse trains that are subsequently delivered to the intracochlear electrodes, it is of interest to explore auditory nerve responses to modulated stimuli. In addition, psychophysical AM detection abilities have been correlated with speech perception outcomes. Thus, the goal was to explore how the auditory nerve responds to AM stimuli and to relate those physiologic measures to perception.

DESIGN

Eight patients using Cochlear Ltd. Implants participated in this study. Electrically evoked compound action potentials (ECAPs) were recorded using a 4000 pps pulse train that was sinusoidally amplitude modulated at 125, 250, 500, and 1000 Hz rates. Responses were measured for each pulse over at least one modulation cycle for an apical, medial, and basal electrode. Psychophysical modulation detection thresholds (MDTs) were also measured via a three-alternative forced choice, two-down, one-up adaptive procedure using the same modulation frequencies and electrodes.

RESULTS

ECAPs were recorded from individual pulses in the AM pulse train. ECAP amplitudes varied sinusoidally, reflecting the sinusoidal variation in the stimulus. A modulated response amplitude (MRA) metric was calculated as the difference in the maximal and minimum ECAP amplitudes over the modulation cycles. MRA increased as modulation frequency increased, with no apparent cutoff (up to 1000 Hz). In contrast, MDTs increased as the modulation frequency increased. This trend is inconsistent with the physiologic measures. For a fixed modulation frequency, correlations were observed between MDTs and MRAs; this trend was evident at all frequencies except 1000 Hz (although only statistically significant for 250 and 500 Hz AM rates), possibly an indication of central limitations in processing of high modulation frequencies. Finally, peripheral responses were larger and psychophysical thresholds were lower in the apical electrodes relative to basal and medial electrodes, which may reflect better cochlear health and neural survival evidenced by lower preoperative low-frequency audiometric thresholds and steeper growth of neural responses in ECAP amplitude growth functions for apical electrodes.

CONCLUSIONS

Robust ECAPs were recorded for all modulation frequencies tested. ECAP amplitudes varied sinusoidally, reflecting the periodicity of the modulated stimuli. MRAs increased as the modulation frequency increased, a trend we attribute to neural adaptation. For low modulation frequencies, there are multiple current steps between the peak and valley of the modulation cycle, which means successive stimuli are more similar to one another and neural responses are more likely to adapt. Higher MRAs were correlated with lower psychophysical thresholds at low modulation frequencies but not at 1000 Hz, implying a central limitation to processing of modulated stimuli.

The Electrically Evoked Compound Action Potential: From Laboratory to Clinic

The electrically evoked compound action potential (eCAP) represents the synchronous firing of a population of electrically stimulated auditory nerve fibers. It can be directly recorded on a surgically exposed nerve trunk in animals or from an intra-cochlear electrode of a cochlear implant. In the past two decades, the eCAP has been widely recorded in both animals and clinical patient populations using different testing paradigms. This paper provides an overview of recording methodologies and response characteristics of the eCAP, as well as its potential applications in research and clinical situations. Relevant studies are reviewed and implications for clinicians are discussed.

Effect of stimulus level on the temporal response properties of the auditory nerve in cochlear implants

Electrically evoked compound action potentials (ECAPs) have been used to examine temporal response patterns of the auditory nerve in cochlear implant (CI) recipients. ECAP responses to individual pulses in a pulse train vary across stimulation rates for individual CI users. For very slow rates, auditory neurons have ample time to discharge, recover, and respond to each pulse in the train. As the pulse rate increases, an alternating ECAP-amplitude pattern occurs. As the stimulation rate increases further, the alternating pattern eventually ceases and the overall ECAP amplitudes are diminished, yielding a relatively stochastic state that presumably reflects a combination of adaptation, desynchronization, and facilitation across fibers. Because CIs operate over a range of current levels in everyday use, it is important to understand auditory-nerve responses to pulse trains over a range of levels. The effect of stimulus level on ECAP temporal response patterns in human CI users has not been well studied. The first goal of this study was to examine the effect of stimulus level on various aspects of ECAP temporal responses to pulse-train stimuli. Because higher stimulus levels yield more synchronous responses and faster recovery, it was hypothesized that: (1) the maximum alternation would occur at slower rates for lower levels and faster rates at higher levels, (2) the alternation depth at its maximum would be smaller for lower levels, (3) the rate that produces a stochastic state ('stochastic rate') would decrease with level, (4) adaptation would be greater for lower levels as a result of slower recovery, and (5) refractory-recovery time constants would be longer (slower) for lower levels, consistent with earlier studies. The second goal of this study was to examine how refractory-recovery time constants relate specifically to maximum alternation and stochastic rate. Data were collected for 12 ears in 10 CI recipients. ECAPs were recorded in response to each of 13 pulses in an equal-amplitude pulse train ranging in rate from 900-3500 pps for three levels (low, medium, high). The results generally supported hypotheses 1-4; there were no significant effects of level on the refractory-recovery time constants (hypothesis 5). When data were pooled across level, there was a significant negative correlation between alternation depth and refractory recovery time. Understanding the effects of stimulus level on auditory-nerve responses may provide further insight into improving the use of objective measures for potentially optimizing speech-processing strategies.