Pitch estimation by early-deafened subjects using a multiple-electrode cochlear implant

Action planning and affective states within the auditory peripersonal space in normal hearing and cochlear-implanted listeners

Fast reaction to approaching stimuli is vital for survival. When sounds enter the auditory peripersonal space (PPS), sounds perceived as being nearer elicit higher motor cortex activation. There is a close relationship between motor preparation and the perceptual components of sounds, particularly of highly arousing sounds. Here we compared the ability to recognize, evaluate, and react to affective stimuli entering the PPS between 20 normal-hearing (NH, 7 women) and 10 cochlear-implanted (CI, 3 women) subjects. The subjects were asked to quickly flex their arm in reaction to positive (P), negative (N), and neutral (Nu) affective sounds ending virtually at five distances from their body. Pre-motor reaction time (pm-RT) was detected via electromyography from the postural muscles to measure action anticipation at the sound-stopping distance; the sounds were also evaluated for their perceived level of valence and arousal. While both groups were able to localize sound distance, only the NH group modulated their pm-RT based on the perceived sound distance. Furthermore, when the sound carried no affective components, the pm-RT to the Nu sounds was shorter compared to the P and the N sounds for both groups. Only the NH group perceived the closer sounds as more arousing than the distant sounds, whereas both groups perceived sound valence similarly. Our findings underline the role of emotional states in action preparation and describe the perceptual components essential for prompt reaction to sounds approaching the peripersonal space.

Mandarin Lexical Tone Acquisition in Cochlear Implant Users With Prelingual Deafness: A Review

PURPOSE

The purpose of this review article is to synthesize evidence from the fields of developmental linguistics and cochlear implant technology relevant to the production and perception of Mandarin lexical tone in cochlear implant users with prelingual deafness. The aim of this review was to identify potential factors that determine outcomes for tonal-language speaking cochlear implant users and possible directions for further research.

METHOD

A computerized database search of MEDLINE, CINAHL, Academic Search Premier, Web of Science, and Google Scholar was undertaken in June and July 2014. Search terms used were lexical tone AND tonal language, speech development AND/OR speech production AND/OR speech perception AND cochlear implants, and pitch perception AND cochlear implants, anywhere in the title or abstract.

CONCLUSION

Despite the demonstrated limitations of pitch perception in cochlear implant users, there is some evidence that typical production and perception of lexical tone is possible by cochlear implant users with prelingual deafness. Further studies are required to determine the factors that contribute to better outcomes to inform rehabilitation processes for cochlear implant users in tonal-language environments.

The multi-channel cochlear implant: multi-disciplinary development of electrical stimulation of the cochlea and the resulting clinical benefit

This multi-disciplinary research showed sound could be coded by electrical stimulation of the cochlea and peripheral auditory nervous system. But the temporal coding of frequency as seen in the experimental animal, was inadequate for the important speech frequencies. The data indicated the limitation was due in particular to deterministic firing of neurons and failure to reproduce the normal fine temporo-spatial pattern of neural responses seen with sound. However, the data also showed the need for the place coding of frequency, and this meant multi-electrodes inserted into the cochlea. Nevertheless, before this was evaluated on people we undertook biological safety studies to determine the effects of surgical trauma and electrical stimuli, and how to prevent infection. Then our research demonstrated place of stimulation had timbre and was perceived as vowels. This led to our discovery in 1978 of the formant-extraction speech code that first enabled severely-profoundly deaf people to understand running speech. This result in people who had hearing before becoming severely deaf was an outcome not previously considered possible. In 1985 it was the first multi-channel implant to be approved by the US Food and Drug Administration (FDA). It was also the fore runner of our advanced formant and fixed filter strategies When these codes were used from 1985 for those born deaf or deafened early in life we discovered there was a critical period when brain plasticity would allow speech perception and language to be developed near- normally, and this required in particular the acquisition of place coding. In 1990 this led to the first cochlear implant to be approved by the FDA for use in children. Finally, we achieved binaural hearing in 1989 with bilateral cochlear implants, followed by bimodal speech processing in 1990 with a hearing aid in one ear and implant in the other. The above research has been developed industrially, with for example 250,000 people worldwide receiving the Cochlear device in 2013, and as of December 2012 the NIH estimated that approximately 324,200 people worldwide had received this and other implants (NIH Publication No. 11-4798). This article is part of a Special Issue entitled <Lasker Award>.

Multidimensional scaling between acoustic and electric stimuli in cochlear implant users with contralateral hearing

This study investigated the perceptual relationship between acoustic and electric stimuli presented to CI users with functional contralateral hearing. Fourteen subjects with unilateral profound deafness implanted with a MED-EL CI scaled the perceptual differences between pure tones presented to the acoustic hearing ear and electric biphasic pulse trains presented to the implanted ear. The differences were analyzed with a multidimensional scaling (MDS) analysis. Additionally, speech performance in noise was tested using sentence material presented in different spatial configurations while patients listened with both their acoustic hearing and implanted ears. Results of alternating least squares scaling (ALSCAL) analysis consistently demonstrate that a change in place of stimulation is in the same perceptual dimension as a change in acoustic frequency. However, the relative perceptual differences between the acoustic and the electric stimuli varied greatly across subjects. A degree of perceptual separation between acoustic and electric stimulation (quantified by relative dimensional weightings from an INDSCAL analysis) was hypothesized that would indicate a change in perceptual quality, but also be predictive of performance with combined acoustic and electric hearing. Perceptual separation between acoustic and electric stimuli was observed for some subjects. However, no relationship between the degree of perceptual separation and performance was found.

Effects of stimulation rate on modulation detection and speech recognition by cochlear implant users

OBJECTIVE

This study investigated the effect of low to moderate electrical stimulation rates (275, 350, 500 and 900 pps/ch) on modulation detection ability of cochlear implant subjects, and the relationship between modulation detection and speech perception as a function of rate.

DESIGN

A repeated ABCD experimental design for the four rate conditions was employed. A sinusoidally amplitude modulated acoustic signal was presented to the audio input of a research processor. Stimuli were presented at an acoustic level that produced electrical levels close to the subjects' most comfortable level (MCL) of stimulation and at an acoustic level 20 dB below this.

STUDY SAMPLE

Ten postlingually deaf adult users of the Nucleus CI24 cochlear implant participated.

RESULTS

Acoustic modulation detection thresholds (MDTs), averaged across the subject group, were significantly better for rates of 500 pps/ch compared to the other rates examined for stimuli presented at MCL. In addition, there was a significant relation between speech perception in noise and acoustic MDTs at MCL.

CONCLUSIONS

The benefits obtained in speech perception and modulation detection as a function of rate were attributed to an increased electrical dynamic range as a function of stimulation rate, at least for rates up to 500 pps/ch.

[Early hearing experience and sensitive developmental periods]

This article reviews the studies on functional deficits in the auditory cortex of congenitally deaf animals. It compares their results with psychophysical and imaging data obtained from prelingually deaf humans. The studies demonstrate that the development of the auditory cortex is affected by the absence of hearing experience. In humans, the restoration of hearing after congenital deafness shows a sensitive period of 4 years, whereas even within this sensitive period cortical plasticity is already decreasing with increasing age. The reasons for the sensitive period are developmental changes of synaptic plasticity, developmentally modified synaptogenesis and synaptic pruning as well as changes in connectivity of the auditory cortex. Absence of top-down interactions from higher order auditory areas is another cardinal reason for the sensitive period. All these mechanisms contribute to the decreasing capacity for cortical plasticity during postnatal development. From the developmental and neurophysiological point of view, an early identification of hearing loss is an important prerequisite for effective therapy.

Cochlear implantation in 3 patients with osteogenesis imperfecta: imaging, surgery and programming issues

Osteogenesis imperfecta (OI) is a heterogeneous disease of the connective tissue caused by a defective gene that is responsible for the production of collagen type I, leading to defective bone matrix and connective tissue. Hearing loss affects 35-60% of the patients and will progress to deafness in 2-11% of OI patients for whom cochlear implantation may become the only remaining treatment option. Three patients with OI were retrieved from the Nijmegen Cochlear Implant Centre's database. Most of the specific observations in ear surgery on patients with OI, such as brittle scutum, sclerotic thickening of the cochlea, hyperplastic mucosa in the middle ear and persistent bleeding, were encountered in these 3 patients. In case 3, with severe deformities on the CT scan, misplacement of the electrode array into the horizontal semicircular canal occurred. In all 3 cases, programming was hindered by nonauditory stimulation. Even after reimplantation, nonauditory sensations lead to case 3 becoming a nonuser. Averaged electrode voltages in case 3 were deviant in accordance with an abnormally conductive otic capsule. Spatial spread of neural excitation responses in cases 1 and 2 suggested intracochlear channel interaction for several electrodes, often in combination with facial nerve stimulation (FNS). In case 1, the estimated pitch of the electrodes that caused FNS varied consistently. Despite the electrophysiological changes, after 1-year follow-up, open set phoneme scores of 81% and 78% were reached in cases 1 and 2, respectively. When aware and prepared for the specific changes of the temporal bone in OI, cochlear implantation can be a safe and feasible procedure. Preoperative imaging is recommended to be fully informed on the morphology of the petrosal bone. In case of severe deformities on the CT scan, during counseling the possibility of misplacement should be mentioned. Rehabilitation is often hindered by FNS requiring frequent refitting.

Factors affecting the use of noise-band vocoders as acoustic models for pitch perception in cochlear implants

Although in a number of experiments noise-band vocoders have been shown to provide acoustic models for speech perception in cochlear implants (CI), the present study assesses in four experiments whether and under what limitations noise-band vocoders can be used as an acoustic model for pitch perception in CI. The first two experiments examine the effect of spectral smearing on simulated electrode discrimination and fundamental frequency (FO) discrimination. The third experiment assesses the effect of spectral mismatch in an FO-discrimination task with two different vocoders. The fourth experiment investigates the effect of amplitude compression on modulation rate discrimination. For each experiment, the results obtained from normal-hearing subjects presented with vocoded stimuli are compared to results obtained directly from CI recipients. The results show that place pitch sensitivity drops with increased spectral smearing and that place pitch cues for multi-channel stimuli can adequately be mimicked when the discriminability of adjacent channels is adjusted by varying the spectral slopes to match that of CI subjects. The results also indicate that temporal pitch sensitivity is limited for noise-band carriers with low center frequencies and that the absence of a compression function in the vocoder might alter the saliency of the temporal pitch cues.

Laryngeal muscle responses to mechanical displacement of the thyroid cartilage in humans

Speakers may use laryngeal sensory feedback to adjust vocal fold tension and length before initiating voice. The mechanism for accurately initiating voice at an intended pitch is unknown, given the absence of laryngeal muscle spindles in animals and conflicting findings regarding their existence in humans. Previous reports of rapid changes in voice fundamental frequency following thyroid cartilage displacement suggest that changes in vocal fold length modulate laryngeal muscle contraction in humans. We tested the hypothesis that voice changes resulting from mechanical perturbation are due to rapid responses in the intrinsic laryngeal muscles. Hooked wire electrodes were used to record from the thyroarytenoid, cricothyroid, and sternothyroid muscles along with surface electrodes on the skin overlying the thyroid cartilage in 10 normal adults. Servomotor displacements produced consistent changes in the subjects' vocal fundamental frequency at 70-80 ms, demonstrating changes in vocal fold length and tension. No simultaneous electromyographic responses occurred in the thyroarytenoid or cricothyroid muscles in any subjects. Instead, short-latency responses at 25-40 ms following stimulus onset occurred in the sternothyroid muscles, simultaneous with responses in the surface recordings. The sternothyroid responses may modulate long-latency changes in voice fundamental frequency (approximately 150 ms). The absence of intrinsic laryngeal muscle responses is consistent with a lack of spindles in these muscles. Our results suggest that other sensory receptors, such as mucosal mechanoreceptors, provide feedback for voice control.

Mandarin tone recognition in cochlear-implant subjects

This study examined tone recognition in five cochlear-implant subjects who were native speakers of Mandarin and used a Nucleus-22 device. Psychophysical experiments were conduced to measure rate discrimination in individual electrodes from the most apical to the most basal electrodes. The rate range was from 100 to 200 Hz, which corresponded to the range of variation in fundamental frequency for the tonal tokens used in this study. Speech recognition experiments were also conducted to measure tone recognition as function of the number of electrodes from a 1-electrode map to a 20-electrode map. Large individual variability was observed for both rate discrimination and tone recognition result: Average rate discrimination ranged between 0.2 and 1.2 (Weber's fraction) whereas tone recognition ranged between 30% and 70% correct. A highly significant correlation was found between rate discrimination and tone recognition with the 20-electrode map, but a non-significant correlation was observed with the 1-electrode map due to a floor effect in tone recognition. The present result supports the hypothesis that both spectral and temporal cues contribute to tone recognition. In addition, the present result shows that current cochlear-implant subjects produced significantly lower performance than acoustic simulations in normal-hearing subjects, suggesting that neither temporal nor spectral cues have been adequately and appropriately extracted and encoded in current cochlear implants. New designs are discussed to improve tone recognition in cochlear implant subjects.

Pitch Ranking with Deeply Inserted Electrode Arrays

OBJECTIVE

Electrode pitch ranking was assessed as a function of cochlear region, electrode spacing, and stimulation rate in eight subjects implanted with the MED-EL COMBI 40+ implant. The MED-EL COMBI 40+ electrode array allows deep insertion of the electrode up to the apex of the cochlea and provides a wide electrode spacing of 2.4 mm.

DESIGN

The pitch of a reference electrode was compared with the pitch of two apical and two basal probe electrodes using a two-alternative forced-choice procedure. The reference electrodes were placed in the apical region, in the middle region, and in the basal region of the cochlea. Each condition was tested at pulse rates of 1515 pps, 500 pps, and 250 pps.

RESULTS

Electrode pitch ranking did not depend on electrode spacing, the position of the reference electrode in the cochlea, or stimulation rate.

CONCLUSIONS

These results indicate that a spacing of 2.4 mm seems sufficient to allow good electrode pitch ranking performance for the average user and that electrode pitch ranking is similar in the apical, middle, and basal region of the cochlea, irrespective of the stimulation rate. Most importantly, the results of this study indicate that residual neural structures in the apical region of the cochlea are sensitive to pitch changes provided by different places of electrical stimulation.

Cochlear implants in children: safety as well as speech and language

The development of cochlear implants for children at the University of Melbourne and the Bionic Ear Institute, has consisted of a routine of biological and engineering safety followed by evaluation of speech processing strategies on adults before they are undertaken on children. The initial safety studies were to ensure that insertion was atraumatic, the electrical stimulus parameters did not lead to loss of ganglion cells and that the electrode could be inserted without the risk of middle ear infection leading to meningitis. The initial second formant extraction scheme was shown to produce significant open-set speech understanding in adults and was approved by the US Food and Drug Administration (FDA) in 1985. Following this, an international study was undertaken for the FDA on children using a strategy that also included the first formant, and was approved in 1990. Additional advances in speech processing have been evaluated on adults. However, before using one with high rates of stimulation, it was tested for safety on experimental animals. Further advances have been anticipated in particular through the development of a peri-modiolar array, the Nucleus Contour. Prior to its use on adults, it was tested in the human temporal bone and found to lead to minimal trauma. It was evaluated in adults and found to lead to better current localization and lower thresholds. A study was undertaken in children using a spectral maxima scheme at high rates (advanced combination encoder (ACE)) and the Contour array as it had given best results in adults. It was approved as safe and effective for use in children in 2000. Studies were also undertaken to look at plasticity and visual dominance particularly through cognitive studies and the use of the McGurk effect. This demonstrated that deaf children with implants rely heavily on visual information and there is a great need to have unambiguous auditory stimuli to get best results.

The perception of Cantonese lexical tones by early-deafened cochlear implantees

This study investigated whether cochlear implant users can identify Cantonese lexical tones, which differ primarily in their F0 pattern. Seventeen early-deafened deaf children (age= 4 years, 6 months to 8 years, 11 months; postoperative period= 11-41 months) took part in the study. Sixteen children were fitted with the Nucleus 24 cochlear implant system; one child was fitted with a Nucleus 22 implant. Participants completed a 2AFC picture identification task in which they identified one of the six contrastive Cantonese tones produced on the monosyllabic target word /ji/. Each target stimulus represented a concrete object and was presented within a carrier phrase in sentence-medial position. Group performance was significantly above chance for three contrasts. However, the cochlear implant listeners performed much worse than a 6 1/2-year-old, moderately hearing impaired control listener who was tested on the same task. These findings suggest that this group of cochlear implant users had great difficulty in extracting the pitch information needed to accurately identify Cantonese lexical tones.