Forward-masked spatial tuning curves in cochlear implant users

Insights Into Electrophysiological Metrics of Cochlear Health in Cochlear Implant Users Using a Computational Model

PURPOSE

The hearing outcomes of cochlear implant users depend on the functional status of the electrode-neuron interface inside the cochlea. This can be assessed by measuring electrically evoked compound action potentials (eCAPs). Variations in cochlear neural health and survival are reflected in eCAP-based metrics. The difficulty in translating promising results from animal studies into clinical use has raised questions about to what degree eCAP-based metrics are influenced by non-neural factors. Here, we addressed these questions using a computational model.

METHODS

A 2-D computational model was designed to simulate how electrical signals from the stimulating electrode reach the auditory nerve fibers distributed along the cochlea, evoking action potentials that can be recorded as compound responses at the recording electrodes. Effects of physiologically relevant variations in neural survival and in electrode-neuron and stimulating-recording electrode distances on eCAP amplitude growth functions (AGFs) were investigated.

RESULTS

In line with existing literature, the predicted eCAP AGF slopes and the inter-phase gap (IPG) effects depended on the neural survival, but only when the IPG effect was calculated as the difference between the slopes of the two AGFs expressed in linear input-output scale. As expected, shallower eCAP AGF slopes were obtained for increased stimulating-recording electrode distance and larger eCAP thresholds for greater electrode-neuron distance. These non-neural factors had also minor interference on the predicted IPG effect.

CONCLUSIONS

The model predictions demonstrate previously found dependencies of eCAP metrics on neural survival and non-neural aspects. The present findings confirm data from animal studies and provide insights into applying described metrics in clinical practice.

On the Effect of High Stimulation Rates on Temporal Loudness Integration in Cochlear Implant Users

Long stimuli have lower detection thresholds or are perceived louder than short stimuli with the same intensity, an effect known as temporal loudness integration (TLI). In electric hearing, TLI for pulse trains with a fixed rate but varying number of pulses, i.e. stimulus duration, has mainly been investigated at clinically used stimulation rates. To study the effect of an overall effective stimulation rate at 100% channel crosstalk, we investigated TLI with (a) a clinically used single-channel stimulation rate of 1,500 pps and (b) a high stimulation rate of 18,000 pps, both for an apical and a basal electrode. Thresholds (THR), a line of equal loudness (BAL), and maximum acceptable levels (MALs) were measured in 10 MED-EL cochlear implant users. Stimulus durations varied from a single pulse to 300 ms long pulse trains. At 18,000 pps, the dynamic range (DR) increased by 7.36 ± 3.16  dB for the 300 ms pulse train. Amplitudes at THR, BAL, and MAL decreased monotonically with increasing stimulus duration. The decline was fitted with high accuracy with a power law function (R 2 = 0.94 ± 0.06 ). Threshold slopes were - 1.05 ± 0.36 and - 1.66 ± 0.30  dB per doubling of duration for the low and high rate, respectively, and were shallower than for acoustic hearing. The electrode location did not affect the amplitudes or slopes of the TLI curves. THR, BAL, and MAL were always lower for the higher rate and the DR was larger at the higher rate at all measured durations.

The Relationship Between Interaural Insertion-Depth Differences, Scalar Location, and Interaural Time-Difference Processing in Adult Bilateral Cochlear-Implant Listeners

Sensitivity to interaural time differences (ITDs) in acoustic hearing involves comparison of interaurally frequency-matched inputs. Bilateral cochlear-implant arrays are, however, only approximately aligned in angular insertion depth and scalar location across the cochleae. Interaural place-of-stimulation mismatch therefore has the potential to impact binaural perception. ITD left-right discrimination thresholds were examined in 23 postlingually-deafened adult bilateral cochlear-implant listeners, using low-rate constant-amplitude pulse trains presented via direct stimulation to single electrodes in each ear. Angular insertion depth and scalar location measured from computed-tomography (CT) scans were used to quantify interaural mismatch, and their association with binaural performance was assessed. Number-matched electrodes displayed a median interaural insertion-depth mismatch of 18° and generally yielded best or near-best ITD discrimination thresholds. Two listeners whose discrimination thresholds did not show this pattern were confirmed via CT to have atypical array placement. Listeners with more number-matched electrode pairs located in the scala tympani displayed better thresholds than listeners with fewer such pairs. ITD tuning curves as a function of interaural electrode separation were broad; bandwidths at twice the threshold minimum averaged 10.5 electrodes (equivalent to 5.9 mm for a Cochlear-brand pre-curved array). Larger angular insertion-depth differences were associated with wider bandwidths. Wide ITD tuning curve bandwidths appear to be a product of both monopolar stimulation and angular insertion-depth mismatch. Cases of good ITD sensitivity with very wide bandwidths suggest that precise matching of insertion depth is not critical for discrimination thresholds. Further prioritizing scala tympani location at implantation should, however, benefit ITD sensitivity.

Tonotopic Selectivity in Cats and Humans: Electrophysiology and Psychophysics

We describe a scalp-recorded measure of tonotopic selectivity, the "cortical onset response" (COR) and compare the results between humans and cats. The COR results, in turn, were compared with psychophysical masked-detection thresholds obtained using similar stimuli and obtained from both species. The COR consisted of averaged responses elicited by 50-ms tone-burst probes presented at 1-s intervals against a continuous noise masker. The noise masker had a bandwidth of 1 or 1/8th octave, geometrically centred on 4000 Hz for humans and on 8000 Hz for cats. The probe frequency was either - 0.5, - 0.25, 0, 0.25 or 0.5 octaves re the masker centre frequency. The COR was larger for probe frequencies more distant from the centre frequency of the masker, and this effect was greater for the 1/8th-octave than for the 1-octave masker. This pattern broadly reflected the masked excitation patterns obtained psychophysically with similar stimuli in both species. However, the positive signal-to-noise ratio used to obtain reliable COR measures meant that some aspects of the data differed from those obtained psychophysically, in a way that could be partly explained by the upward spread of the probe's excitation pattern. Our psychophysical measurements also showed that the auditory filter width obtained at 8000 Hz using notched-noise maskers was slightly wider in cat than previous measures from humans. We argue that although conclusions from COR measures differ in some ways from conclusions based on psychophysics, the COR measures provide an objective, noninvasive, valid measure of tonotopic selectivity that does not require training and that may be applied to acoustic and cochlear-implant experiments in humans and laboratory animals.

Effects of Degrees of Degeneration on the Electrical Excitation of Human Spiral Ganglion Neurons Based on a High-Resolution Computer Model

After hearing loss retrograde degeneration of spiral ganglion neurons (SGNs) has been described. Studies modeling the effects of degeneration mostly omitted peripheral processes (dendrites). Recent experimental observations indicated that degenerating SGNs manifested also a reduced diameter of their dendrites. We simulated populations of 400 SGNs inside a high resolution cochlear model with a cochlear implant, based on μCT scans of a human temporal bone. Cochlear implant stimuli were delivered as biphasic pulses in a monopolar configuration. Three SGN situations were simulated, based on our previous measurements of human SGN dendrites: (A) SGNs with intact dendrites (before degeneration), (B) degenerating SGNs, dendrites with a smaller diameter but original length, (C) degenerating SGNs, dendrites omitted. SGN fibers were mapped to characteristic frequency, and place pitch was estimated from excitation profiles. Results from degenerating SGNs (B, C) were similar. Most action potentials were initiated in the somatic area for all cases (A, B, C), except for areas near stimulating electrodes in the apex with intact SGNs (A), where action potentials were initiated in the distal dendrite. In most cases, degenerating SGNs had lower thresholds than intact SGNs (A) (down to -2 dB). Excitation profiles showed increased ectopic activation, i.e., activation of unintended neuronal regions, as well as similar neuronal regions excited by different apical electrodes, for degenerating SGNs (B, C). The estimated pitch showed cases of pitch reversals in apical electrodes for intact SGNs (A), as well as mostly identical pitches evoked by the four most apical electrodes for degenerating SGNs (B, C). In conclusion, neuronal excitation profiles to electrical stimulation exhibited similar traits in both ways of modeling SGN degeneration. Models showed degeneration of dendrites caused increased ectopic activation, as well as similar excitation profiles and pitch evoked by different apical electrodes. Therefore, insertion of electrodes beyond approximately 450° may not provide any benefit if SGN dendrites are degenerated.

Spectral Resolution Development in Children With Normal Hearing and With Cochlear Implants: A Review of Behavioral Studies

PURPOSE

This review article provides a theoretical overview of the development of spectral resolution in children with normal hearing (cNH) and in those who use cochlear implants (CIs), with an emphasis on methodological considerations. The aim was to identify key directions for future research on spectral resolution development in children with CIs.

METHOD

A comprehensive literature review was conducted to summarize and synthesize previously published behavioral research on spectral resolution development in normal and impaired auditory systems.

CONCLUSIONS

In cNH, performance on spectral resolution tasks continues to improve through the teenage years and is likely driven by gradual maturation of across-channel intensity resolution. A small but growing body of evidence from children with CIs suggests a more complex relationship between spectral resolution development, patient demographics, and the quality of the CI electrode-neuron interface. Future research should aim to distinguish between the effects of patient-specific variables and the underlying physiology on spectral resolution abilities in children of all ages who are hard of hearing and use auditory prostheses.

Polarity Sensitivity of Human Auditory Nerve Fibers Based on Pulse Shape, Cochlear Implant Stimulation Strategy and Array

Neural health is of great interest to determine individual degeneration patterns for improving speech perception in cochlear implant (CI) users. Therefore, in recent years, several studies tried to identify and quantify neural survival in CI users. Among all proposed techniques, polarity sensitivity is a promising way to evaluate the neural status of auditory nerve fibers (ANFs) in CI users. Nevertheless, investigating neural health based on polarity sensitivity is a challenging and complicated task that involves various parameters, and the outcomes of many studies show contradictory results of polarity sensitivity behavior. Our computational study benefits from an accurate three-dimensional finite element model of a human cochlea with realistic human ANFs and determined ANF degeneration pattern of peripheral part with a diminishing of axon diameter and myelination thickness based on degeneration levels. In order to see how different parameters may impact the polarity sensitivity behavior of ANFs, we investigated polarity behavior under the application of symmetric and asymmetric pulse shapes, monopolar and multipolar CI stimulation strategies, and a perimodiolar and lateral CI array system. Our main findings are as follows: (1) action potential (AP) initiation sites occurred mainly in the peripheral site in the lateral system regardless of stimulation strategies, pulse polarities, pulse shapes, cochlear turns, and ANF degeneration levels. However, in the perimodiolar system, AP initiation sites varied between peripheral and central processes, depending on stimulation strategies, pulse shapes, and pulse polarities. (2) In perimodiolar array, clusters formed in threshold values based on cochlear turns and degeneration levels for multipolar strategies only when asymmetric pulses were applied. (3) In the perimodiolar array, a declining trend in polarity (anodic threshold/cathodic threshold) with multipolar strategies was observed between intact or slight degenerated cases and more severe degenerated cases, whereas in the lateral array, cathodic sensitivity was noticed for intact and less degenerated cases and anodic sensitivity for cases with high degrees of degeneration. Our results suggest that a combination of asymmetric pulse shapes, focusing more on multipolar stimulation strategies, as well as considering the distances to the modiolus wall, allows us to distinguish the degeneration patterns of ANFs across the cochlea.

Distortion of Spectral Ripples Through Cochlear Implants Has Major Implications for Interpreting Performance Scores

The spectral ripple discrimination task is a psychophysical measure that has been found to correlate with speech recognition in listeners with cochlear implants (CIs). However, at ripple densities above a critical value (around 2 RPO, but device-specific), the sparse spectral sampling of CI processors results in stimulus distortions resulting in aliasing and unintended changes in modulation depth. As a result, spectral ripple thresholds above a certain number are not ordered monotonically along the RPO dimension and thus cannot be considered better or worse spectral resolution than each other, thus undermining correlation measurements. These stimulus distortions are not remediated by changing stimulus phase, indicating these issues cannot be solved by spectrotemporally modulated stimuli. Speech generally has very low-density spectral modulations, leading to questions about the mechanism of correlation between high ripple thresholds and speech recognition. Existing data showing correlations between ripple discrimination and speech recognition include many observations above the aliasing limit. These scores should be treated with caution, and experimenters could benefit by prospectively considering the limitations of the spectral ripple test.

Word Recognition and Frequency Selectivity in Cochlear Implant Simulation: Effect of Channel Interaction

In cochlear implants (CI), spread of neural excitation may produce channel interaction. Channel interaction disturbs the spectral resolution and, among other factors, seems to impair speech recognition, especially in noise. In this study, two tests were performed with 20 adult normal-hearing (NH) subjects under different vocoded simulations. First, there was a measurement of word recognition in noise while varying the number of selected channels (4, 8, 12 or 16 maxima out of 20) and the degree of simulated channel interaction (“Low”, “Medium” and “High”). Then, there was an evaluation of spectral resolution function of the degree of simulated channel interaction, reflected by the sharpness (Q10dB) of psychophysical tuning curves (PTCs). The results showed a significant effect of the simulated channel interaction on word recognition but did not find an effect of the number of selected channels. The intelligibility decreased significantly for the highest degree of channel interaction. Similarly, the highest simulated channel interaction impaired significantly the Q10dB. Additionally, a strong intra-individual correlation between frequency selectivity and word recognition in noise was observed. Lastly, the individual changes in frequency selectivity were positively correlated with the changes in word recognition when the degree of interaction went from “Low” to “High”. To conclude, the degradation seen for the highest degree of channel interaction suggests a threshold effect on frequency selectivity and word recognition. The correlation between frequency selectivity and intelligibility in noise supports the hypothesis that PTCs Q10dB can account for word recognition in certain conditions. Moreover, the individual variations of performances observed among subjects suggest that channel interaction does not have the same effect on each individual. Finally, these results highlight the importance of taking into account subjects’ individuality and to evaluate channel interaction through the speech processor.

Precompensating for spread of excitation in a cochlear implant coding strategy

Cochlear implant users' limited ability to understand speech in noisy environments has been linked to the poor spatial resolution and the high degree of spectral smearing associated with the spread of neural excitation. A sound coding algorithm that aims to improve the spectro-temporal representation of the sound signal at the implanted ear by precompensating the electrical stimulation for the spread of excitation is presented in this study. The spread precompensation algorithm was integrated into the standard clinical advanced combination encoder (ACE) strategy and the resulting strategy was called SPACE. SPACE was evaluated acutely with a group of six implant users and was compared to their daily used ACE strategy in terms of preference rating and speech recognition in four-talker babble and stationary speech-shaped noise. While no significant differences in preference rating were observed, speech recognition in four-talker babble was improved by SPACE processing. Analysis of the group results revealed a significant improvement in mean speech reception threshold (SRT) over the ACE strategy of 1.4 dB in four-talker babble, whereas the difference of 0.9 dB in stationary noise did not reach statistical significance. Assessment of individual differences showed that four out of six listeners obtained significant SRT improvements with SPACE and that no subject scored significantly worse compared to ACE. The results suggest that the proposed sound coding strategy has the potential to improve speech perception for cochlear implant users in challenging listening situations.

Effect of pulse phase duration on forward masking and spread of excitation in cochlear implant listeners

Previous cochlear implant (CI) research has shown that at a pulse train with a long pulse phase duration (PPD) requires less current but greater charge to obtain the same loudness as a pulse train with a short PPD. This might result in different excitation patterns between long and short PPDs. At equal loudness, long PPDs might produce greater masking due to greater charge. However, because they require less current, long PPDs may produce a smaller spatial spread of excitation (SOE) compared to short PPDs by evoking a greater neural firing probability within the relatively small current field. To investigate the effects of PPD on excitation patterns, overall masking and SOE were compared for equally loud stimuli with short or long PPD in 10 adult CI ears. Forward masking patterns were measured at relatively soft, medium, and loud presentation levels. Threshold shifts were calculated in terms of percent dynamic range (DR) of the probe. The area under the curve (AUC) of the masking functions was significantly larger for the long PPD than for the short PPD masker. The difference in AUC was proportional to the difference in charge between the short and long PPD maskers. To estimate SOE, the masking patterns were first normalized to the peak masking, and then AUC was calculated. SOE was significantly larger for the short PPD than for the long PPD masker. Thus, at equal loudness, long PPDs produced greater overall masking (possibly due to greater charge) but less SOE (possibly due to less current spread) than did short PPDs. The effect of the interaction between masking and SOE by long PPD stimulation remains to be tested.

Auditory Detection Thresholds and Cochlear Resistivity Differ Between Pediatric Cochlear Implant Listeners With Enlarged Vestibular Aqueduct and Those With Connexin-26 Mutations

Purpose The goal of this study was to evaluate differences in the electrode-neuron interface as a function of hearing loss etiology in pediatric cochlear implant (CI) listeners with enlarged vestibular aqueduct (EVA) syndrome and in those with autosomal recessive connexin-26 mutations (DFNB1). Method Fifteen implanted ears (9 participants, 5 ears with EVA, 10 ears with DFNB1) were assessed. Single-channel auditory detection thresholds were measured using broad and spatially focused electrode configurations (steered quadrupolar; focusing coefficients = 0 and 0.9). Cochlear resistivity estimates were obtained via electrode impedances and electrical field imaging. Between-group differences were evaluated using linear mixed-effects models. Results Children with EVA had significantly higher auditory detection thresholds than children with DFNB1, irrespective of electrode configuration. Between-group differences in thresholds were more pronounced on apical electrodes than on basal electrodes. In the apex, electrode impedances and electrical field imaging values were higher for children with EVA than for those with DFNB1. Conclusions The electrode-neuron interface differs between pediatric CI listeners with DFNB1 and those with EVA. It is possible that optimal clinical interventions may depend, in part, on hearing loss etiology. Future investigations with large samples should investigate individualized CI programming strategies for listeners with EVA and DFNB1.

Comparing Rapid and Traditional Forward-Masked Spatial Tuning Curves in Cochlear-Implant Users

A rapid forward-masked spatial tuning curve measurement procedure, based on Bekesy tracking, was adapted and evaluated for use with cochlear implants. Twelve postlingually-deafened adult cochlear-implant users participated. Spatial tuning curves using the new procedure and using a traditional forced-choice adaptive procedure resulted in similar estimates of parameters. The Bekesy-tracking method was almost 3 times faster than the forced-choice procedure, but its test-retest reliability was significantly poorer. Although too time-consuming for general clinical use, the new method may have some benefits in individual cases, where identifying electrodes with poor spatial selectivity as candidates for deactivation is deemed necessary.

Effects of rate and age in processing interaural time and level differences in normal-hearing and bilateral cochlear-implant listeners

Bilateral cochlear implants (BICIs) provide improved sound localization and speech understanding in noise compared to unilateral CIs. However, normal-hearing (NH) listeners demonstrate superior binaural processing abilities compared to BICI listeners. This investigation sought to understand differences between NH and BICI listeners' processing of interaural time differences (ITDs) and interaural level differences (ILDs) as a function of fine-structure and envelope rate using an intracranial lateralization task. The NH listeners were presented band-limited acoustical pulse trains and sinusoidally amplitude-modulated tones using headphones, and the BICI listeners were presented single-electrode electrical pulse trains using direct stimulation. Lateralization range increased as fine-structure rate increased for ILDs in BICI listeners. Lateralization range decreased for rates above 100 Hz for fine-structure ITDs, but decreased for rates lower or higher than 100 Hz for envelope ITDs in both groups. Lateralization ranges for ITDs were smaller for BICI listeners on average. After controlling for age, older listeners showed smaller lateralization ranges and BICI listeners had a more rapid decline for ITD sensitivity at 300 pulses per second. This work suggests that age confounds comparisons between NH and BICI listeners in temporal processing tasks and that some NH-BICI binaural processing differences persist even when age differences are adequately addressed.

Reducing the Device Delay Mismatch Can Improve Sound Localization in Bimodal Cochlear Implant/Hearing-Aid Users

In users of a cochlear implant (CI) together with a contralateral hearing aid (HA), so-called bimodal listeners, differences in processing latencies between digital HA and CI up to 9 ms constantly superimpose interaural time differences. In the present study, the effect of this device delay mismatch on sound localization accuracy was investigated. For this purpose, localization accuracy in the frontal horizontal plane was measured with the original and minimized device delay mismatch. The reduction was achieved by delaying the CI stimulation according to the delay of the individually worn HA. For this, a portable, programmable, battery-powered delay line based on a ring buffer running on a microcontroller was designed and assembled. After an acclimatization period to the delayed CI stimulation of 1 hr, the nine bimodal study participants showed a highly significant improvement in localization accuracy of 11.6% compared with the everyday situation without the delay line ( p < .01). Concluding, delaying CI stimulation to minimize the device delay mismatch seems to be a promising method to increase sound localization accuracy in bimodal listeners.

Effect of channel separation and interaural mismatch on fusion and lateralization in normal-hearing and cochlear-implant listeners

Bilateral cochlear implantation has provided access to some of the benefits of binaural hearing enjoyed by normal-hearing (NH) listeners. However, a gap in performance still exists between the two populations. Single-channel stimulation studies have shown that interaural place-of-stimulation mismatch (IPM) due to differences in implantation depth leads to decreased binaural fusion and lateralization of interaural time and level differences (ITDs and ILDs, respectively). While single-channel studies are informative, multi-channel stimulation is needed for good speech understanding with cochlear implants (CIs). Some multi-channel studies have shown that channel interaction due to current spread can affect ITD sensitivity. In this work, we studied the effect of IPM and channel spacing, along with their potential interaction, on binaural fusion and ITD/ILD lateralization. Experiments were conducted in adult NH listeners and CI listeners with a history of acoustic hearing. Results showed that IPM reduced the range of lateralization for ITDs but not ILDs. CI listeners were more likely to report a fused percept in the presence of IPM with multi-channel stimulation than NH listeners. However, no effect of channel spacing was found. These results suggest that IPM should be accounted for in clinical mapping practices in order to maximize bilateral CI benefits.

Effect of signal processing strategy and stimulation type on speech and auditory perception in adult cochlear implant users

OBJECTIVE

The objective of this study was to investigate the effects of signal processing strategy on speech understanding and auditory function for adult cochlear implant (CI) users with a focus on the effects of sequential versus paired stimulation.

DESIGN

Within-subjects, repeated measures design was utilised to compare performance between processing strategies and stimulation type on various measures of auditory function and subjective sound quality. Testing with subsequent strategies was completed after a total familiarisation time of two weeks.

STUDY SAMPLE

Ten post-lingually deafened adult CI users were recruited from a clinical population. Participants had a minimum of 13 months CI experience. Ages ranged from 25-78 years. All participants had long-term experience with the optima strategy; eight with sequential stimulation and two with paired stimulation.

RESULTS

We found no statistically significant effect of processing strategy. We observed an effect of stimulation type with sequential stimulation yielding significantly higher performance than paired stimulation for speech understanding in quiet and in noise, and subjective estimates of sound quality. No significant differences were noted across strategy or stimulation for music perception, spectral resolution or temporal resolution.

CONCLUSIONS

Many patients utilise paired stimulation - the default stimulation type in the clinical software; however, sequential stimulation yielded significantly higher outcomes on multiple measures.

A Dynamically Focusing Cochlear Implant Strategy Can Improve Vowel Identification in Noise

Supplemental Digital Content is available in the text.

Objectives:

The standard, monopolar (MP) electrode configuration used in commercially available cochlear implants (CI) creates a broad electrical field, which can lead to unwanted channel interactions. Use of more focused configurations, such as tripolar and phased array, has led to mixed results for improving speech understanding. The purpose of the present study was to assess the efficacy of a physiologically inspired configuration called dynamic focusing, using focused tripolar stimulation at low levels and less focused stimulation at high levels. Dynamic focusing may better mimic cochlear excitation patterns in normal acoustic hearing, while reducing the current levels necessary to achieve sufficient loudness at high levels.

Design:

Twenty postlingually deafened adult CI users participated in the study. Speech perception was assessed in quiet and in a four-talker babble background noise. Speech stimuli were closed-set spondees in noise, and medial vowels at 50 and 60 dB SPL in quiet and in noise. The signal to noise ratio was adjusted individually such that performance was between 40 and 60% correct with the MP strategy. Subjects were fitted with three experimental strategies matched for pulse duration, pulse rate, filter settings, and loudness on a channel-by-channel basis. The strategies included 14 channels programmed in MP, fixed partial tripolar (σ = 0.8), and dynamic partial tripolar (σ at 0.8 at threshold and 0.5 at the most comfortable level). Fifteen minutes of listening experience was provided with each strategy before testing. Sound quality ratings were also obtained.

Results:

Speech perception performance for vowel identification in quiet at 50 and 60 dB SPL and for spondees in noise was similar for the three tested strategies. However, performance on vowel identification in noise was significantly better for listeners using the dynamic focusing strategy. Sound quality ratings were similar for the three strategies. Some subjects obtained more benefit than others, with some individual differences explained by the relation between loudness growth and the rate of change from focused to broader stimulation.

Conclusions:

These initial results suggest that further exploration of dynamic focusing is warranted. Specifically, optimizing such strategies on an individual basis may lead to improvements in speech perception for more adult listeners and improve how CIs are tailored. Some listeners may also need a longer period of time to acclimate to a new program.

The Effect of Simulated Interaural Frequency Mismatch on Speech Understanding and Spatial Release From Masking

OBJECTIVE

The binaural-hearing system interaurally compares inputs, which underlies the ability to localize sound sources and to better understand speech in complex acoustic environments. Cochlear implants (CIs) are provided in both ears to increase binaural-hearing benefits; however, bilateral CI users continue to struggle with understanding speech in the presence of interfering sounds and do not achieve the same level of spatial release from masking (SRM) as normal-hearing listeners. One reason for diminished SRM in CI users could be that the electrode arrays are inserted at different depths in each ear, which would cause an interaural frequency mismatch. Because interaural frequency mismatch diminishes the salience of interaural differences for relatively simple stimuli, it may also diminish binaural benefits for spectral-temporally complex stimuli like speech. This study evaluated the effect of simulated frequency-to-place mismatch on speech understanding and SRM.

DESIGN

Eleven normal-hearing listeners were tested on a speech understanding task. There was a female target talker who spoke five-word sentences from a closed set of words. There were two interfering male talkers who spoke unrelated sentences. Nonindividualized head-related transfer functions were used to simulate a virtual auditory space. The target was presented from the front (0°), and the interfering speech was either presented from the front (colocated) or from 90° to the right (spatially separated). Stimuli were then processed by an eight-channel vocoder with tonal carriers to simulate aspects of listening through a CI. Frequency-to-place mismatch ("shift") was introduced by increasing the center frequency of the synthesis filters compared with the corresponding analysis filters. Speech understanding was measured for different shifts (0, 3, 4.5, and 6 mm) and target-to-masker ratios (TMRs: +10 to -10 dB). SRM was calculated as the difference in the percentage of correct words for the colocated and separated conditions. Two types of shifts were tested: (1) bilateral shifts that had the same frequency-to-place mismatch in both ears, but no interaural frequency mismatch, and (2) unilateral shifts that produced an interaural frequency mismatch.

RESULTS

For the bilateral shift conditions, speech understanding decreased with increasing shift and with decreasing TMR, for both colocated and separate conditions. There was, however, no interaction between shift and spatial configuration; in other words, SRM was not affected by shift. For the unilateral shift conditions, speech understanding decreased with increasing interaural mismatch and with decreasing TMR for both the colocated and spatially separated conditions. Critically, there was a significant interaction between the amount of shift and spatial configuration; in other words, SRM decreased for increasing interaural mismatch.

CONCLUSIONS

A frequency-to-place mismatch in one or both ears resulted in decreased speech understanding. SRM, however, was only affected in conditions with unilateral shifts and interaural frequency mismatch. Therefore, matching frequency information between the ears provides listeners with larger binaural-hearing benefits, for example, improved speech understanding in the presence of interfering talkers. A clinical procedure to reduce interaural frequency mismatch when programming bilateral CIs may improve benefits in speech segregation that are due to binaural-hearing abilities.

Effect of Stimulus Polarity on Physiological Spread of Excitation in Cochlear Implants

BACKGROUND

Contemporary cochlear implants (CIs) use cathodic-leading, symmetrical, biphasic current pulses, despite a growing body of evidence that suggests anodic-leading pulses may be more effective at stimulating the auditory system. However, since much of this research on humans has used pseudomonophasic pulses or biphasic pulses with unusually long interphase gaps, the effects of stimulus polarity are unclear for clinically relevant (i.e., symmetric biphasic) stimuli.

PURPOSE

The purpose of this study was to examine the effects of stimulus polarity on basic characteristics of physiological spread-of-excitation (SOE) measures obtained with the electrically evoked compound action potential (ECAP) in CI recipients using clinically relevant stimuli.

RESEARCH DESIGN

Using a within-subjects (repeated measures) design, we examined the differences in mean amplitude, peak electrode location, area under the curve, and spatial separation between SOE curves obtained with anodic- and cathodic-leading symmetrical, biphasic pulses.

STUDY SAMPLE

Fifteen CI recipients (ages 13-77) participated in this study. All were users of Cochlear Ltd. devices.

DATA COLLECTION AND ANALYSIS

SOE functions were obtained using the standard forward-masking artifact reduction method. Probe electrodes were 5-18, and they were stimulated at an 8 (of 10) loudness rating ("loud"). Outcome measures (mean amplitude, peak electrode location, curve area, and spatial separation) for each polarity were compared within subjects.

RESULTS

Anodic-leading current pulses produced ECAPs with larger average amplitudes, greater curve area, and less spatial separation between SOE patterns compared with that for cathodic-leading pulses. There was no effect of polarity on peak electrode location.

CONCLUSIONS

These results indicate that for equal current levels, the anodic-leading polarity produces broader excitation patterns compared with cathodic-leading pulses, which reduces the spatial separation between functions. This result is likely due to preferential stimulation of the central axon. Further research is needed to determine whether SOE patterns obtained with anodic-leading pulses better predict pitch discrimination.

Psychophysical Tuning Curves as a Correlate of Electrode Position in Cochlear Implant Listeners

Speech understanding abilities vary widely among cochlear implant (CI) listeners. A potential source of this variability is the electrode-neuron interface (ENI), which includes peripheral factors such as electrode position and integrity of remaining spiral ganglion neurons. Suboptimal positioning of the electrode array has been associated with poorer speech outcomes; however, postoperative computerized tomography (CT) scans are often not available to clinicians. CT-estimated electrode-to-modiolus distance (distance from the inner wall of the cochlea) has been shown to account for some variability in behavioral thresholds. However, psychophysical tuning curves (PTCs) may provide additional insight into site-specific variation in channel interaction. Thirteen unilaterally implanted adults with the Advanced Bionics HiRes90K device participated. Behavioral thresholds and PTCs were collected for all available electrodes with steered quadrupolar (sQP) configuration, using a modified threshold sweep procedure, used in Bierer et al. (Trends Hear 19:1-12, 2015). PTC bandwidths were quantified to characterize channel interaction across the electrode array, and tip shifts were assessed to identify possible contributions of neural dead regions. Broader PTC bandwidths were correlated with electrodes farther from the modiolus, but not correlated with sQP threshold, though a trend was observed. Both measures were affected by scalar location, and PTC tip shifts were observed for electrodes farther from the modiolus. sQP threshold was the only variable correlated with word recognition. These results suggest PTCs may be used as a site-specific measure of channel interaction that correlates with electrode position in some CI listeners.

Computational Evaluation of Cochlear Implant Surgery Outcomes Accounting for Uncertainty and Parameter Variability

Cochlear implantation (CI) is a complex surgical procedure that restores hearing in patients with severe deafness. The successful outcome of the implanted device relies on a group of factors, some of them unpredictable or difficult to control. Uncertainties on the electrode array position and the electrical properties of the bone make it difficult to accurately compute the current propagation delivered by the implant and the resulting neural activation. In this context, we use uncertainty quantification methods to explore how these uncertainties propagate through all the stages of CI computational simulations. To this end, we employ an automatic framework, encompassing from the finite element generation of CI models to the assessment of the neural response induced by the implant stimulation. To estimate the confidence intervals of the simulated neural response, we propose two approaches. First, we encode the variability of the cochlear morphology among the population through a statistical shape model. This allows us to generate a population of virtual patients using Monte Carlo sampling and to assign to each of them a set of parameter values according to a statistical distribution. The framework is implemented and parallelized in a High Throughput Computing environment that enables to maximize the available computing resources. Secondly, we perform a patient-specific study to evaluate the computed neural response to seek the optimal post-implantation stimulus levels. Considering a single cochlear morphology, the uncertainty in tissue electrical resistivity and surgical insertion parameters is propagated using the Probabilistic Collocation method, which reduces the number of samples to evaluate. Results show that bone resistivity has the highest influence on CI outcomes. In conjunction with the variability of the cochlear length, worst outcomes are obtained for small cochleae with high resistivity values. However, the effect of the surgical insertion length on the CI outcomes could not be clearly observed, since its impact may be concealed by the other considered parameters. Whereas the Monte Carlo approach implies a high computational cost, Probabilistic Collocation presents a suitable trade-off between precision and computational time. Results suggest that the proposed framework has a great potential to help in both surgical planning decisions and in the audiological setting process.

Having Two Ears Facilitates the Perceptual Separation of Concurrent Talkers for Bilateral and Single-Sided Deaf Cochlear Implantees

OBJECTIVES

Listening to speech with multiple competing talkers requires the perceptual separation of the target voice from the interfering background. Normal-hearing listeners are able to take advantage of perceived differences in the spatial locations of competing sound sources to facilitate this process. Previous research suggests that bilateral (BI) cochlear-implant (CI) listeners cannot do so, and it is unknown whether single-sided deaf (SSD) CI users (one acoustic and one CI ear) have this ability. This study investigated whether providing a second ear via cochlear implantation can facilitate the perceptual separation of targets and interferers in a listening situation involving multiple competing talkers.

DESIGN

BI-CI and SSD-CI listeners were required to identify speech from a target talker mixed with one or two interfering talkers. In the baseline monaural condition, the target speech and the interferers were presented to one of the CIs (for the BI-CI listeners) or to the acoustic ear (for the SSD-CI listeners). In the bilateral condition, the target was still presented to the first ear but the interferers were presented to both the target ear and the listener's second ear (always a CI), thereby testing whether CI listeners could use information about the interferer obtained from a second ear to facilitate perceptual separation of the target and interferer.

RESULTS

Presenting a copy of the interfering signals to the second ear improved performance, up to 4 to 5 dB (12 to 18 percentage points), but the amount of improvement depended on the type of interferer. For BI-CI listeners, the improvement occurred mainly in conditions involving one interfering talker, regardless of gender. For SSD-CI listeners, the improvement occurred in conditions involving one or two interfering talkers of the same gender as the target. This interaction is consistent with the idea that the SSD-CI listeners had access to pitch cues in their normal-hearing ear to separate the opposite-gender target and interferers, while the BI-CI listeners did not.

CONCLUSIONS

These results suggest that a second auditory input via a CI can facilitate the perceptual separation of competing talkers in situations where monaural cues are insufficient to do so, thus partially restoring a key advantage of having two ears that was previously thought to be inaccessible to CI users.

Current Focusing to Reduce Channel Interaction for Distant Electrodes in Cochlear Implant Programs

Speech understanding abilities are highly variable among cochlear implant (CI) listeners. Poor electrode-neuron interfaces (ENIs) caused by sparse neural survival or distant electrode placement may lead to increased channel interaction and reduced speech perception. Currently, it is not possible to directly measure neural survival in CI listeners; therefore, obtaining information about electrode position is an alternative approach to assessing ENIs. This information can be estimated with computerized tomography (CT) imaging; however, postoperative CT imaging is not often available. A reliable method to assess channel interaction, such as the psychophysical tuning curve (PTC), offers an alternative way to identify poor ENIs. This study aimed to determine (a) the within-subject relationship between CT-estimated electrode distance and PTC bandwidths, and (b) whether using focused stimulation on channels with suspected poor ENI improves vowel identification and sentence recognition. In 13 CI listeners, CT estimates of electrode-to-modiolus distance and PTCs bandwidths were measured for all available electrodes. Two test programs were created, wherein a subset of electrodes used focused stimulation based on (a) broad PTC bandwidth (Tuning) and (b) far electrode-to-modiolus distance (Distance). Two control programs were also created: (a) Those channels not focused in the Distance program (Inverse-Control), and (b) an all-channel monopolar program (Monopolar-Control). Across subjects, scores on the Distance and Tuning programs were significantly higher than the Inverse-Control program, and similar to the Monopolar-Control program. Subjective ratings were similar for all programs. These findings suggest that focusing channels suspected to have a high degree of channel interaction result in quite different outcomes, acutely.

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.

Simultaneous masking between electric and acoustic stimulation in cochlear implant users with residual low-frequency hearing

Ipsilateral electric-acoustic stimulation (EAS) is becoming increasingly important in cochlear implant (CI) treatment. Improvements in electrode designs and surgical techniques have contributed to improved hearing preservation during implantation. Consequently, CI implantation criteria have been expanded toward people with significant residual low-frequency hearing, who may benefit from the combined use of both the electric and acoustic stimulation in the same ear. However, only few studies have investigated the mutual interaction between electric and acoustic stimulation modalities. This work characterizes the interaction between both stimulation modalities using psychophysical masking experiments and cone beam computer tomography (CBCT). Two psychophysical experiments for electric and acoustic masking were performed to measure the hearing threshold elevation of a probe stimulus in the presence of a masker stimulus. For electric masking, the probe stimulus was an acoustic tone while the masker stimulus was an electric pulse train. For acoustic masking, the probe stimulus was an electric pulse train and the masker stimulus was an acoustic tone. Five EAS users, implanted with a CI and ipsilateral residual low-frequency hearing, participated in the study. Masking was determined at different electrodes and different acoustic frequencies. CBCT scans were used to determine the individual place-pitch frequencies of the intracochlear electrode contacts by using the Stakhovskaya place-to-frequency transformation. This allows the characterization of masking as a function of the difference between electric and acoustic stimulation sites, which we term the electric-acoustic frequency difference (EAFD). The results demonstrate a significant elevation of detection thresholds for both experiments. In electric masking, acoustic-tone thresholds increased exponentially with decreasing EAFD. In contrast, for the acoustic masking experiment, threshold elevations were present regardless of the tested EAFDs. Based on the present findings, we conclude that there is an asymmetry between the electric and the acoustic masker modalities. These observations have implications for the design and fitting of EAS sound-coding strategies.

Binaural sensitivity in children who use bilateral cochlear implants

Children who are deaf and receive bilateral cochlear implants (BiCIs) perform better on spatial hearing tasks using bilateral rather than unilateral inputs; however, they underperform relative to normal-hearing (NH) peers. This gap in performance is multi-factorial, including the inability of speech processors to reliably deliver binaural cues. Although much is known regarding binaural sensitivity of adults with BiCIs, less is known about how the development of binaural sensitivity in children with BiCIs compared to NH children. Sixteen children (ages 9-17 years) were tested using synchronized research processors. Interaural time differences and interaural level differences (ITDs and ILDs, respectively) were presented to pairs of pitch-matched electrodes. Stimuli were 300-ms, 100-pulses-per-second, constant-amplitude pulse trains. In the first and second experiments, discrimination of interaural cues (either ITDs or ILDs) was measured using a two-interval left/right task. In the third experiment, subjects reported the perceived intracranial position of ITDs and ILDs in a lateralization task. All children demonstrated sensitivity to ILDs, possibly due to monaural level cues. Children who were born deaf had weak or absent sensitivity to ITDs; in contrast, ITD sensitivity was noted in children with previous exposure to acoustic hearing. Therefore, factors such as auditory deprivation, in particular, lack of early exposure to consistent timing differences between the ears, may delay the maturation of binaural circuits and cause insensitivity to binaural differences.

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.

Perception of Interaural Phase Differences With Envelope and Fine Structure Coding Strategies in Bilateral Cochlear Implant Users

The ability to detect a target signal masked by noise is improved in normal-hearing listeners when interaural phase differences (IPDs) between the ear signals exist either in the masker or in the signal. To improve binaural hearing in bilaterally implanted cochlear implant (BiCI) users, a coding strategy providing the best possible access to IPD is highly desirable. In this study, we compared two coding strategies in BiCI users provided with CI systems from MED-EL (Innsbruck, Austria). The CI systems were bilaterally programmed either with the fine structure processing strategy FS4 or with the constant rate strategy high definition continuous interleaved sampling (HDCIS). Familiarization periods between 6 and 12 weeks were considered. The effect of IPD was measured in two types of experiments: (a) IPD detection thresholds with tonal signals addressing mainly one apical interaural electrode pair and (b) with speech in noise in terms of binaural speech intelligibility level differences (BILD) addressing multiple electrodes bilaterally. The results in (a) showed improved IPD detection thresholds with FS4 compared with HDCIS in four out of the seven BiCI users. In contrast, 12 BiCI users in (b) showed similar BILD with FS4 (0.6 ± 1.9 dB) and HDCIS (0.5 ± 2.0 dB). However, no correlation between results in (a) and (b) both obtained with FS4 was found. In conclusion, the degree of IPD sensitivity determined on an apical interaural electrode pair was not an indicator for BILD based on bilateral multielectrode stimulation.

Forward-Masked Frequency Selectivity Improvements in Simulated and Actual Cochlear Implant Users Using a Preprocessing Algorithm

Frequency selectivity can be quantified using masking paradigms, such as psychophysical tuning curves (PTCs). Normal-hearing (NH) listeners show sharp PTCs that are level- and frequency-dependent, whereas frequency selectivity is strongly reduced in cochlear implant (CI) users. This study aims at (a) assessing individual shapes of PTCs in CI users, (b) comparing these shapes to those of simulated CI listeners (NH listeners hearing through a CI simulation), and (c) increasing the sharpness of PTCs using a biologically inspired dynamic compression algorithm, BioAid, which has been shown to sharpen the PTC shape in hearing-impaired listeners. A three-alternative-forced-choice forward-masking technique was used to assess PTCs in 8 CI users (with their own speech processor) and 11 NH listeners (with and without listening through a vocoder to simulate electric hearing). CI users showed flat PTCs with large interindividual variability in shape, whereas simulated CI listeners had PTCs of the same average flatness, but more homogeneous shapes across listeners. The algorithm BioAid was used to process the stimuli before entering the CI users’ speech processor or the vocoder simulation. This algorithm was able to partially restore frequency selectivity in both groups, particularly in seven out of eight CI users, meaning significantly sharper PTCs than in the unprocessed condition. The results indicate that algorithms can improve the large-scale sharpness of frequency selectivity in some CI users. This finding may be useful for the design of sound coding strategies particularly for situations in which high frequency selectivity is desired, such as for music perception.

Reducing Channel Interaction Through Cochlear Implant Programming May Improve Speech Perception: Current Focusing and Channel Deactivation

Speech perception among cochlear implant (CI) listeners is highly variable. High degrees of channel interaction are associated with poorer speech understanding. Two methods for reducing channel interaction, focusing electrical fields, and deactivating subsets of channels were assessed by the change in vowel and consonant identification scores with different program settings. The main hypotheses were that (a) focused stimulation will improve phoneme recognition and (b) speech perception will improve when channels with high thresholds are deactivated. To select high-threshold channels for deactivation, subjects’ threshold profiles were processed to enhance the peaks and troughs, and then an exclusion or inclusion criterion based on the mean and standard deviation was used. Low-threshold channels were selected manually and matched in number and apex-to-base distribution. Nine ears in eight adult CI listeners with Advanced Bionics HiRes90k devices were tested with six experimental programs. Two, all-channel programs, (a) 14-channel partial tripolar (pTP) and (b) 14-channel monopolar (MP), and four variable-channel programs, derived from these two base programs, (c) pTP with high- and (d) low-threshold channels deactivated, and (e) MP with high- and (f) low-threshold channels deactivated, were created. Across subjects, performance was similar with pTP and MP programs. However, poorer performing subjects (scoring < 62% correct on vowel identification) tended to perform better with the all-channel pTP than with the MP program (1 > 2). These same subjects showed slightly more benefit with the reduced channel MP programs (5 and 6). Subjective ratings were consistent with performance. These finding suggest that reducing channel interaction may benefit poorer performing CI listeners.

Assessing the Electrode-Neuron Interface with the Electrically Evoked Compound Action Potential, Electrode Position, and Behavioral Thresholds

Variability in speech perception scores among cochlear implant listeners may largely reflect the variable efficacy of implant electrodes to convey stimulus information to the auditory nerve. In the present study, three metrics were applied to assess the quality of the electrode-neuron interface of individual cochlear implant channels: the electrically evoked compound action potential (ECAP), the estimation of electrode position using computerized tomography (CT), and behavioral thresholds using focused stimulation. The primary motivation of this approach is to evaluate the ECAP as a site-specific measure of the electrode-neuron interface in the context of two peripheral factors that likely contribute to degraded perception: large electrode-to-modiolus distance and reduced neural density. Ten unilaterally implanted adults with Advanced Bionics HiRes90k devices participated. ECAPs were elicited with monopolar stimulation within a forward-masking paradigm to construct channel interaction functions (CIF), behavioral thresholds were obtained with quadrupolar (sQP) stimulation, and data from imaging provided estimates of electrode-to-modiolus distance and scalar location (scala tympani (ST), intermediate, or scala vestibuli (SV)) for each electrode. The width of the ECAP CIF was positively correlated with electrode-to-modiolus distance; both of these measures were also influenced by scalar position. The ECAP peak amplitude was negatively correlated with behavioral thresholds. Moreover, subjects with low behavioral thresholds and large ECAP amplitudes, averaged across electrodes, tended to have higher speech perception scores. These results suggest a potential clinical role for the ECAP in the objective assessment of individual cochlear implant channels, with the potential to improve speech perception outcomes.

The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users

OBJECTIVE

The present study evaluated whether the poorer baseline performance of cochlear implant (CI) users or the technical and/or physiological properties of CI stimulation are responsible for the absence of masking release.

DESIGN

This study measured speech reception thresholds (SRTs) in continuous and modulated noise as a function of signal to noise ratio (SNR).

STUDY SAMPLE

A total of 24 subjects participated: 12 normal-hearing (NH) listeners and 12 subjects provided with recent MED-EL CI systems.

RESULTS

The mean SRT of CI users in continuous noise was -3.0 ± 1.5 dB SNR (mean ± SEM), while the normal-hearing group reached -5.9 ± 0.8 dB SNR. In modulated noise, the difference across groups increased considerably. For CI users, the mean SRT worsened to -1.4 ± 2.3 dB SNR, while it improved for normal-hearing listeners to -18.9 ± 3.8 dB SNR.

CONCLUSIONS

The detrimental effect of fluctuating maskers on SRTs in CI users shown by prior studies was confirmed by the current study. Concluding, the absence of masking release is mainly caused by the technical and/or physiological properties of CI stimulation, not just the poorer baseline performance of many CI users compared to normal-hearing subjects. Speech understanding in modulated noise was more robust in CI users who had a relatively large electrical dynamic range.

Procedural Factors That Affect Psychophysical Measures of Spatial Selectivity in Cochlear Implant Users

Behavioral measures of spatial selectivity in cochlear implants are important both for guiding the programing of individual users’ implants and for the evaluation of different stimulation methods. However, the methods used are subject to a number of confounding factors that can contaminate estimates of spatial selectivity. These factors include off-site listening, charge interactions between masker and probe pulses in interleaved masking paradigms, and confusion effects in forward masking. We review the effects of these confounds and discuss methods for minimizing them. We describe one such method in which the level of a 125-pps masker is adjusted so as to mask a 125-pps probe, and where the masker and probe pulses are temporally interleaved. Five experiments describe the method and evaluate the potential roles of the different potential confounding factors. No evidence was obtained for off-site listening of the type observed in acoustic hearing. The choice of the masking paradigm was shown to alter the measured spatial selectivity. For short gaps between masker and probe pulses, both facilitation and refractory mechanisms had an effect on masking; this finding should inform the choice of stimulation rate in interleaved masking experiments. No evidence for confusion effects in forward masking was revealed. It is concluded that the proposed method avoids many potential confounds but that the choice of method should depend on the research question under investigation.

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

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

Relationships Among Peripheral and Central Electrophysiological Measures of Spatial and Spectral Selectivity and Speech Perception in Cochlear Implant Users

OBJECTIVES

The ability to perceive speech is related to the listener's ability to differentiate among frequencies (i.e., spectral resolution). Cochlear implant (CI) users exhibit variable speech-perception and spectral-resolution abilities, which can be attributed in part to the extent of electrode interactions at the periphery (i.e., spatial selectivity). However, electrophysiological measures of peripheral spatial selectivity have not been found to correlate with speech perception. The purpose of this study was to evaluate auditory processing at the periphery and cortex using both simple and spectrally complex stimuli to better understand the stages of neural processing underlying speech perception. The hypotheses were that (1) by more completely characterizing peripheral excitation patterns than in previous studies, significant correlations with measures of spectral selectivity and speech perception would be observed, (2) adding information about processing at a level central to the auditory nerve would account for additional variability in speech perception, and (3) responses elicited with spectrally complex stimuli would be more strongly correlated with speech perception than responses elicited with spectrally simple stimuli.

DESIGN

Eleven adult CI users participated. Three experimental processor programs (MAPs) were created to vary the likelihood of electrode interactions within each participant. For each MAP, a subset of 7 of 22 intracochlear electrodes was activated: adjacent (MAP 1), every other (MAP 2), or every third (MAP 3). Peripheral spatial selectivity was assessed using the electrically evoked compound action potential (ECAP) to obtain channel-interaction functions for all activated electrodes (13 functions total). Central processing was assessed by eliciting the auditory change complex with both spatial (electrode pairs) and spectral (rippled noise) stimulus changes. Speech-perception measures included vowel discrimination and the Bamford-Kowal-Bench Speech-in-Noise test. Spatial and spectral selectivity and speech perception were expected to be poorest with MAP 1 (closest electrode spacing) and best with MAP 3 (widest electrode spacing). Relationships among the electrophysiological and speech-perception measures were evaluated using mixed-model and simple linear regression analyses.

RESULTS

All electrophysiological measures were significantly correlated with each other and with speech scores for the mixed-model analysis, which takes into account multiple measures per person (i.e., experimental MAPs). The ECAP measures were the best predictor. In the simple linear regression analysis on MAP 3 data, only the cortical measures were significantly correlated with speech scores; spectral auditory change complex amplitude was the strongest predictor.

CONCLUSIONS

The results suggest that both peripheral and central electrophysiological measures of spatial and spectral selectivity provide valuable information about speech perception. Clinically, it is often desirable to optimize performance for individual CI users. These results suggest that ECAP measures may be most useful for within-subject applications when multiple measures are performed to make decisions about processor options. They also suggest that if the goal is to compare performance across individuals based on a single measure, then processing central to the auditory nerve (specifically, cortical measures of discriminability) should be considered.

Spectral and temporal analysis of simulated dead regions in cochlear implants

A cochlear implant (CI) electrode in a "cochlear dead region" will excite neighboring neural populations. In previous research that simulated such dead regions, stimulus information in the simulated dead region was either added to the immediately adjacent frequency regions or dropped entirely. There was little difference in speech perception ability between the two conditions. This may imply that there may be little benefit of ensuring that stimulus information on an electrode in a suspected cochlear dead region is transmitted. Alternatively, performance may be enhanced by a broader frequency redistribution, rather than adding stimuli from the dead region to the edges. In the current experiments, cochlear dead regions were introduced by excluding selected CI electrodes or vocoder noise-bands. Participants were assessed for speech understanding as well as spectral and temporal sensitivities as a function of the size of simulated dead regions. In one set of tests, the normal input frequency range of the sound processor was distributed among the active electrodes in bands with approximately logarithmic spacing ("redistributed" maps); in the remaining tests, information in simulated dead regions was dropped ("dropped" maps). Word recognition and Schroeder-phase discrimination performance, which require both spectral and temporal sensitivities, decreased as the size of simulated dead regions increased, but the redistributed and dropped remappings showed similar performance in these two tasks. Psychoacoustic experiments showed that the near match in word scores may reflect a tradeoff between spectral and temporal sensitivity: spectral-ripple discrimination was substantially degraded in the redistributed condition relative to the dropped condition while performance in a temporal modulation detection task degraded in the dropped condition but remained constant in the redistributed condition.

Interaural envelope correlation change discrimination in bilateral cochlear implantees: effects of mismatch, centering, and onset of deafness

Bilateral cochlear implant (CI) listeners can perform binaural tasks, but they are typically worse than normal-hearing (NH) listeners. To understand why this difference occurs and the mechanisms involved in processing dynamic binaural differences, interaural envelope correlation change discrimination sensitivity was measured in real and simulated CI users. In experiment 1, 11 CI (eight late deafened, three early deafened) and eight NH listeners were tested in an envelope correlation change discrimination task. Just noticeable differences (JNDs) were best for a matched place-of-stimulation and increased for an increasing mismatch. In experiment 2, attempts at intracranially centering stimuli did not produce lower JNDs. In experiment 3, the percentage of correct identifications of antiphasic carrier pulse trains modulated by correlated envelopes was measured as a function of mismatch and pulse rate. Sensitivity decreased for increasing mismatch and increasing pulse rate. The experiments led to two conclusions. First, envelope correlation change discrimination necessitates place-of-stimulation matched inputs. However, it is unclear if previous experience with acoustic hearing is necessary for envelope correlation change discrimination. Second, NH listeners presented with CI simulations demonstrated better performance than real CI listeners. If the simulations are realistic representations of electrical stimuli, real CI listeners appear to have difficulty processing interaural information in modulated signals.

A fast method for measuring psychophysical thresholds across the cochlear implant array

A rapid threshold measurement procedure, based on Bekesy tracking, is proposed and evaluated for use with cochlear implants (CIs). Fifteen postlingually deafened adult CI users participated. Absolute thresholds for 200-ms trains of biphasic pulses were measured using the new tracking procedure and were compared with thresholds obtained with a traditional forced-choice adaptive procedure under both monopolar and quadrupolar stimulation. Virtual spectral sweeps across the electrode array were implemented in the tracking procedure via current steering, which divides the current between two adjacent electrodes and varies the proportion of current directed to each electrode. Overall, no systematic differences were found between threshold estimates with the new channel sweep procedure and estimates using the adaptive forced-choice procedure. Test–retest reliability for the thresholds from the sweep procedure was somewhat poorer than for thresholds from the forced-choice procedure. However, the new method was about 4 times faster for the same number of repetitions. Overall the reliability and speed of the new tracking procedure provides it with the potential to estimate thresholds in a clinical setting. Rapid methods for estimating thresholds could be of particular clinical importance in combination with focused stimulation techniques that result in larger threshold variations between electrodes.

Simulating the dual-peak excitation pattern produced by bipolar stimulation of a cochlear implant: effects on speech intelligibility

Several electrophysiological and psychophysical studies have shown that the spatial excitation pattern produced by bipolar stimulation of a cochlear implant (CI) can have a dual-peak shape. The perceptual effects of this dual-peak shape were investigated using noise-vocoded CI simulations in which synthesis filters were designed to simulate the spread of neural activity produced by various electrode configurations, as predicted by a simple cochlear model. Experiments 1 and 2 tested speech recognition in the presence of a concurrent speech masker for various sets of single-peak and dual-peak synthesis filters and different numbers of channels. Similarly as results obtained in real CIs, both monopolar (MP, single-peak) and bipolar (BP + 1, dual-peak) simulations showed a plateau of performance above 8 channels. The benefit of increasing the number of channels was also lower for BP + 1 than for MP. This shows that channel interactions in BP + 1 become especially deleterious for speech intelligibility when a simulated electrode acts both as an active and as a return electrode for different channels because envelope information from two different analysis bands are being conveyed to the same spectral location. Experiment 3 shows that these channel interactions are even stronger in wide BP configuration (BP + 5), likely because the interfering speech envelopes are less correlated than in narrow BP + 1. Although the exact effects of dual- or multi-peak excitation in real CIs remain to be determined, this series of experiments suggest that multipolar stimulation strategies, such as bipolar or tripolar, should be controlled to avoid neural excitation in the vicinity of the return electrodes.

Comparisons between detection threshold and loudness perception for individual cochlear implant channels

OBJECTIVE

The objective of this study was to examine how the level of current required for cochlear implant listeners to detect single-channel electrical pulse trains relates to loudness perception on the same channel. The working hypothesis was that channels with relatively high thresholds, when measured with a focused current pattern, interface poorly to the auditory nerve. For such channels, a smaller dynamic range between perceptual threshold and the most comfortable loudness would result, in part, from a greater sensitivity to changes in electrical field spread compared to low-threshold channels. The narrower range of comfortable listening levels may have important implications for speech perception.

DESIGN

Data were collected from eight, adult cochlear implant listeners implanted with the HiRes90k cochlear implant (Advanced Bionics Corp.). The partial tripolar (pTP) electrode configuration, consisting of one intracochlear active electrode, two flanking electrodes carrying a fraction (σ) of the return current, and an extracochlear ground, was used for stimulation. Single-channel detection thresholds and most comfortable listening levels were acquired using the most focused pTP configuration possible (σ ≥ 0.8) to identify three channels for further testing-those with the highest, median, and lowest thresholds-for each subject. Threshold, equal-loudness contours (at 50% of the monopolar dynamic range), and loudness growth functions were measured for each of these three test channels using various pTP fractions.

RESULTS

For all test channels, thresholds increased as the electrode configuration became more focused. The rate of increase with the focusing parameter σ was greatest for the high-threshold channel compared to the median- and low-threshold channels. The 50% equal-loudness contours exhibited similar rates of increase in level across test channels and subjects. Additionally, test channels with the highest thresholds had the narrowest dynamic ranges (for σ ≥ 0.5) and steepest growth of loudness functions for all electrode configurations.

CONCLUSIONS

Together with previous studies using focused stimulation, the results suggest that auditory responses to electrical stimuli at both threshold and suprathreshold current levels are not uniform across the electrode array of individual cochlear implant listeners. Specifically, the steeper growth of loudness and thus smaller dynamic ranges observed for high-threshold channels are consistent with a degraded electrode-neuron interface, which could stem from lower numbers of functioning auditory neurons or a relatively large distance between the neurons and electrodes. These findings may have potential implications for how stimulation levels are set during the clinical mapping procedure, particularly for speech-processing strategies that use focused electrical fields.

Internalized elevation perception of simple stimuli in cochlear-implant and normal-hearing listeners

In normal-hearing (NH) listeners, elevation perception is produced by the spectral cues imposed by the pinna, head, and torso. Elevation perception in cochlear-implant (CI) listeners appears to be non-existent; this may be a result of poorly encoded spectral cues. In this study, an analog of elevation perception was investigated by having 15 CI and 8 NH listeners report the intracranial location of spectrally simple signals (single-electrode or bandlimited acoustic stimuli, respectively) in both horizontal and vertical dimensions. Thirteen CI listeners and all of the NH listeners showed an association between place of stimulation (i.e., stimulus frequency) and perceived elevation, generally responding with higher elevations for more basal stimulation. This association persisted in the presence of a randomized temporal pitch, suggesting that listeners were not associating pitch with elevation. These data provide evidence that CI listeners might perceive changes in elevation if they were presented stimuli with sufficiently salient elevation cues.

The effect of interaural fluctuation rate on correlation change discrimination

While bilateral cochlear implants (CIs) provide some binaural benefits, these benefits are limited compared to those observed in normal-hearing (NH) listeners. The large frequency-to-electrode allocation bandwidths (BWs) in CIs compared to auditory filter BWs in NH listeners increases the interaural fluctuation rate available for binaural unmasking, which may limit binaural benefits. The purpose of this work was to investigate the effect of interaural fluctuation rate on correlation change discrimination and binaural masking-level differences in NH listeners presented a CI simulation using a pulsed-sine vocoder. In experiment 1, correlation-change just-noticeable differences (JNDs) and tone-in-noise thresholds were measured for narrowband noises with different BWs and center frequencies (CFs). The results suggest that the BW, CF, and/or interaural fluctuation rate are important factors for correlation change discrimination. In experiment 2, the interaural fluctuation rate was systematically varied and dissociated from changes in BW and CF by using a pulsed-sine vocoder. Results indicated that the interaural fluctuation rate did not affect correlation change JNDs for correlated reference noises; however, slow interaural fluctuations increased correlation change JNDs for uncorrelated reference noises. In experiment 3, the BW, CF, and vocoder pulse rate were varied while interaural fluctuation rate was held constant. JNDs increased for increasing BW and decreased for increasing CF. In summary, relatively fast interaural fluctuation rates are not detrimental for detecting changes in interaural correlation. Thus, limiting factors to binaural benefits in CI listeners could be a result of other temporal and/or spectral deficiencies from electrical stimulation.

Vowel identification by cochlear implant users: contributions of static and dynamic spectral cues

Previous research has shown that normal hearing listeners can identify vowels in syllables on the basis of either quasi-static or dynamic spectral cues; however, it is not known how well cochlear implant (CI) users with current-generation devices can make use of these cues. The present study assessed vowel identification in adult CI users and a comparison group of young normal hearing (YNH) listeners. Stimuli were naturally spoken /dVd/ syllables and modified syllables that retained only quasi-static spectral cues from an 80-ms segment of the vowel center ("C80" stimuli) or dynamic spectral cues from two 20-ms segments of the vowel edges ("E20" stimuli). YNH listeners exhibited near-perfect performance for the unmodified (99.8%) and C80 (92.9%) stimuli and maintained good performance for the E20 stimuli (70.2%). CI users exhibited poorer average performance than YNH listeners for the Full stimuli (72.3%) and proportionally larger reductions in performance for the C80 stimuli (41.8%) and E20 stimuli (29.0%). Findings suggest that CI users have difficulty identifying vowels on the basis of spectral cues in the absence of duration cues, and have limited access to brief dynamic spectral cues. Error analyses suggest that CI users may rely strongly on vowel duration cues when those cues are available.

Place specificity measured in forward and interleaved masking in cochlear implants

Interleaved masking in cochlear implants is analogous to acoustic simultaneous masking and is relevant to speech processing strategies that interleave pulses on concurrently activated electrodes. In this study, spatial decay of masking as the distance between masker and probe increases was compared between forward and interleaved masking in the same group of cochlear implant users. Spatial masking patterns and the measures of place specificity were similar between forward and interleaved masking. Unlike acoustic hearing where broader tuning curves are obtained in simultaneous masking, the type of masking experiment did not influence the measure of place specificity in cochlear implants.