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

Binaural responses to a speech syllable are altered in children with hearing loss: Evidence from the frequency-following response

BACKGROUND & RATIONALE

In prior work using non-speech stimuli, children with hearing loss show impaired perception of binaural cues and no significant change in cortical responses to bilateral versus unilateral stimulation. Aims of the present study were to: 1) identify bilateral responses to envelope and spectral components of a speech syllable using the frequency-following response (FFR), 2) determine if abnormalities in the bilateral FFR occur in children with hearing loss, and 3) assess functional consequences of abnormal bilateral FFR responses on perception of binaural timing cues.

METHODS

A single-syllable speech stimulus (/dα/) was presented to each ear individually and bilaterally. Participants were 9 children with normal hearing (MAge = 12.1 ± 2.5 years) and 6 children with bilateral hearing loss who were experienced bilateral hearing aid users (MAge = 14.0 ± 2.6 years). FFR temporal and spectral peak amplitudes were compared between listening conditions and groups using linear mixed model regression analyses. Behavioral sensitivity to binaural cues were measured by lateralization responses as coming from the right or left side of the head.

RESULTS

Both temporal and spectral peaks in FFR responses increased in amplitude in the bilateral compared to unilateral listening conditions in children with normal hearing. These measures of "bilateral advantage" were reduced in the group of children with bilateral hearing loss and associated with decreased sensitivity to interaural timing differences.

CONCLUSION

This study is the first to show that bilateral responses in both temporal and spectral domains can be measured in children using the FFR and is altered in children with hearing loss with consequences to binaural hearing.

Review of Binaural Processing With Asymmetrical Hearing Outcomes in Patients With Bilateral Cochlear Implants

Bilateral cochlear implants (BiCIs) result in several benefits, including improvements in speech understanding in noise and sound source localization. However, the benefit bilateral implants provide among recipients varies considerably across individuals. Here we consider one of the reasons for this variability: difference in hearing function between the two ears, that is, interaural asymmetry. Thus far, investigations of interaural asymmetry have been highly specialized within various research areas. The goal of this review is to integrate these studies in one place, motivating future research in the area of interaural asymmetry. We first consider bottom-up processing, where binaural cues are represented using excitation-inhibition of signals from the left ear and right ear, varying with the location of the sound in space, and represented by the lateral superior olive in the auditory brainstem. We then consider top-down processing via predictive coding, which assumes that perception stems from expectations based on context and prior sensory experience, represented by cascading series of cortical circuits. An internal, perceptual model is maintained and updated in light of incoming sensory input. Together, we hope that this amalgamation of physiological, behavioral, and modeling studies will help bridge gaps in the field of binaural hearing and promote a clearer understanding of the implications of interaural asymmetry for future research on optimal patient interventions.

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

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

Lateralization of interaural time differences with mixed rates of stimulation in bilateral cochlear implant listeners

While listeners with bilateral cochlear implants (BiCIs) are able to access information in both ears, they still struggle to perform well on spatial hearing tasks when compared to normal hearing listeners. This performance gap could be attributed to the high stimulation rates used for speech representation in clinical processors. Prior work has shown that spatial cues, such as interaural time differences (ITDs), are best conveyed at low rates. Further, BiCI listeners are sensitive to ITDs with a mixture of high and low rates. However, it remains unclear whether mixed-rate stimuli are perceived as unitary percepts and spatially mapped to intracranial locations. Here, electrical pulse trains were presented on five, interaurally pitch-matched electrode pairs using research processors, at either uniformly high rates, low rates, or mixed rates. Eight post-lingually deafened adults were tested on perceived intracranial lateralization of ITDs ranging from 50 to 1600 μs. Extent of lateralization depended on the location of low-rate stimulation along the electrode array: greatest in the low- and mixed-rate configurations, and smallest in the high-rate configuration. All but one listener perceived a unitary auditory object. These findings suggest that a mixed-rate processing strategy can result in good lateralization and convey a unitary auditory object with ITDs.

Effect of interaural electrode insertion depth difference and independent band selection on sentence recognition in noise and spatial release from masking in simulated bilateral cochlear implant listening

PURPOSE

Inter-aural insertion depth difference (IEDD) in bilateral cochlear implant (BiCI) with continuous interleaved sampling (CIS) processing is known to reduce the recognition of speech in noise and spatial release from masking (SRM). However, the independent channel selection in the 'n-of-m' sound coding strategy might have a different effect on speech recognition and SRM when compared to the effects of IEDD in CIS-based findings. This study aimed to investigate the effect of bilateral 'n-of-m' processing strategy and interaural electrode insertion depth difference on speech recognition in noise and SRM under conditions that simulated bilateral cochlear implant listening.

METHODS

Five young adults with normal hearing sensitivity participated in the study. The target sentences were spatially filtered to originate from 0° and the masker was spatially filtered at 0°, 15°, 37.5°, and 90° using the Oldenburg head-related transfer function database for behind the ear microphone. A 22-channel sine wave vocoder processing based on 'n-of-m' processing was applied to the spatialized target-masker mixture, in each ear. The perceptual experiment involved a test of speech recognition in noise under one co-located condition (target and masker at 0°) and three spatially separated conditions (target at 0°, masker at 15°, 37.5°, or 90° to the right ear).

RESULTS

The results were analyzed using a three-way repeated measure analysis of variance (ANOVA). The effect of interaural insertion depth difference (F (2,8) = 3.145, p = 0.098, ɳ² = 0.007) and spatial separation between target and masker (F (3,12) = 1.239, p = 0.339, ɳ² = 0.004) on speech recognition in noise was not significant.

CONCLUSIONS

Speech recognition in noise and SRM were not affected by IEDD ≤ 3 mm. Bilateral 'n-of-m' processing resulted in reduced speech recognition in noise and SRM.

Interaural asymmetry of dynamic range: Abnormal fusion, bilateral interference, and shifts in attention

Speech information in the better ear interferes with the poorer ear in patients with bilateral cochlear implants (BiCIs) who have large asymmetries in speech intelligibility between ears. The goal of the present study was to assess how each ear impacts, and whether one dominates, speech perception using simulated CI processing in older and younger normal-hearing (ONH and YNH) listeners. Dynamic range (DR) was manipulated symmetrically or asymmetrically across spectral bands in a vocoder. We hypothesized that if abnormal integration of speech information occurs with asymmetrical speech understanding, listeners would demonstrate an atypical preference in accuracy when reporting speech presented to the better ear and fusion of speech between the ears (i.e., an increased number of one-word responses when two words were presented). Results from three speech conditions showed that: (1) When the same word was presented to both ears, speech identification accuracy decreased if one or both ears decreased in DR, but listeners usually reported hearing one word. (2) When two words with different vowels were presented to both ears, speech identification accuracy and percentage of two-word responses decreased consistently as DR decreased in one or both ears. (3) When two rhyming words (e.g., bed and led) previously shown to phonologically fuse between ears (e.g., bled) were presented, listeners instead demonstrated interference as DR decreased. The word responded in (2) and (3) came from the right (symmetric) or better (asymmetric) ear, especially in (3) and for ONH listeners in (2). These results suggest that the ear with poorer dynamic range is downweighted by the auditory system, resulting in abnormal fusion and interference, especially for older listeners.

Asymmetric temporal envelope sensitivity: Within- and across-ear envelope comparisons in listeners with bilateral cochlear implants

For listeners with bilateral cochlear implants (BiCIs), patient-specific differences in the interface between cochlear implant (CI) electrodes and the auditory nerve can lead to degraded temporal envelope information, compromising the ability to distinguish between targets of interest and background noise. It is unclear how comparisons of degraded temporal envelope information across spectral channels (i.e., electrodes) affect the ability to detect differences in the temporal envelope, specifically amplitude modulation (AM) rate. In this study, two pulse trains were presented simultaneously via pairs of electrodes in different places of stimulation, within and/or across ears, with identical or differing AM rates. Results from 11 adults with BiCIs indicated that sensitivity to differences in AM rate was greatest when stimuli were paired between different places of stimulation in the same ear. Sensitivity from pairs of electrodes was predicted by the poorer electrode in the pair or the difference in fidelity between both electrodes in the pair. These findings suggest that electrodes yielding poorer temporal fidelity act as a bottleneck to comparisons of temporal information across frequency and ears, limiting access to the cues used to segregate sounds, which has important implications for device programming and optimizing patient outcomes with CIs.

Development of Sound Localization in Infants and Young Children with Cochlear Implants

Cochlear implantation as a treatment for severe-to-profound hearing loss allows children to develop hearing, speech, and language in many cases. However, cochlear implants are generally provided beyond the infant period and outcomes are assessed after years of implant use, making comparison with normal development difficult. The aim was to study whether the rate of improvement of horizontal localization accuracy in children with bilateral implants is similar to children with normal hearing. A convenience sample of 20 children with a median age at simultaneous bilateral implantation = 0.58 years (0.42−2.3 years) participated in this cohort study. Longitudinal follow-up of sound localization accuracy for an average of ≈1 year generated 42 observations at a mean age = 1.5 years (0.58−3.6 years). The rate of development was compared to historical control groups including children with normal hearing and with relatively late bilateral implantation (≈4 years of age). There was a significant main effect of time with bilateral implants on localization accuracy (slope = 0.21/year, R2 = 0.25, F = 13.6, p < 0.001, n = 42). No differences between slopes (F = 0.30, p = 0.58) or correlation coefficients (Cohen’s q = 0.28, p = 0.45) existed when comparing children with implants and normal hearing (slope = 0.16/year since birth, p = 0.015, n = 12). The rate of development was identical to children implanted late. Results suggest that early bilateral implantation in children with severe-to-profound hearing loss allows development of sound localization at a similar age to children with normal hearing. Similar rates in children with early and late implantation and normal hearing suggest an intrinsic mechanism for the development of horizontal sound localization abilities.

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.

Computed-Tomography Estimates of Interaural Mismatch in Insertion Depth and Scalar Location in Bilateral Cochlear-Implant Users

HYPOTHESIS

Bilateral cochlear-implant (BI-CI) users will have a range of interaural insertion-depth mismatch because of different array placement or characteristics. Mismatch will be larger for electrodes located near the apex or outside scala tympani, or for arrays that are a mix of precurved and straight types.

BACKGROUND

Brainstem superior olivary-complex neurons are exquisitely sensitive to interaural-difference cues for sound localization. Because these neurons rely on interaurally place-of-stimulation-matched inputs, interaural insertion-depth or scalar-location differences for BI-CI users could cause interaural place-of-stimulation mismatch that impairs binaural abilities.

METHODS

Insertion depths and scalar locations were calculated from temporal-bone computed-tomography scans for 107 BI-CI users (27 Advanced Bionics, 62 Cochlear, 18 MED-EL).

RESULTS

Median interaural insertion-depth mismatch was 23.4 degrees or 1.3 mm. Mismatch in the estimated clinically relevant range expected to impair binaural processing (>75 degrees or 3 mm) occurred for 13 to 19% of electrode pairs overall, and for at least three electrode pairs for 23 to 37% of subjects. There was a significant three-way interaction between insertion depth, scalar location, and array type. Interaural insertion-depth mismatch was largest for apical electrodes, for electrode pairs in two different scala, and for arrays that were both-precurved.

CONCLUSION

Average BI-CI interaural insertion-depth mismatch was small; however, large interaural insertion-depth mismatch-with the potential to degrade spatial hearing-occurred frequently enough to warrant attention. For new BICI users, improved surgical techniques to avoid interaural insertion-depth and scalar mismatch are recommended. For existing BI-CI users with interaural insertion-depth mismatch, interaural alignment of clinical frequency tables might reduce negative spatial-hearing consequences.

Longitudinal auditory data of children with prelingual single-sided deafness managed with early cochlear implantation

Individuals with single-sided deafness (SSD) have no access to binaural hearing, which limits their ability to localize sounds and understand speech in noisy environments. In addition, children with prelingual SSD are at risk for neurocognitive and academic difficulties. Early cochlear implantation may lead to improved hearing outcomes by restoring bilateral hearing. However, its longitudinal impact on the development of children with SSD remains unclear. In the current study, a group of young children with prelingual SSD received a cochlear implant at an early age. From the age of four, the children’s spatial hearing skills could be assessed using a spatial speech perception in noise test and a sound localization test. The results are compared to those of two control groups: children with SSD without a cochlear implant and children with bilateral normal hearing. Overall, the implanted group exhibited improved speech perception in noise abilities and better sound localization skills, compared to their non-implanted peers. On average, the children wore their device approximately nine hours a day. Given the large contribution of maturation to the development of spatial hearing skills, further follow-up is important to understand the long-term benefit of a cochlear implant for children with prelingual SSD.

Cochlear Implantation in the Setting of Menière's Disease After Labyrinthectomy: A Meta-Analysis

OBJECTIVE

Characterize the speech recognition and sound source localization of patients with unilateral Menière's disease who undergo labyrinthectomy for vertigo control with simultaneous or sequential cochlear implantation.

DATABASES REVIEWED

PubMed, Embase, and Cochrane databases.

METHODS

The search was performed on May 6, 2020. The keywords utilized included: "Menière's disease AND cochlear implant;" "cochlear implant AND single sided deafness;" "cochlear implant AND vestibular;" and "labyrinthectomy AND cochlear implant." Manuscripts published in English with a publication date after 1995 that assessed adult subjects (≥18 years of age) were included for review. Subjects must have been diagnosed with Menière's disease unilaterally and underwent labyrinthectomy with simultaneous or sequential cochlear implantation. Reported outcomes with cochlear implant (CI) use included speech recognition as measured with the consonant-nucleus-consonant (CNC) word test and/or sound source localization reported in root-mean squared (RMS) error. The method of data collection and study type were recorded to assess level of evidence. Statistical analysis was performed with Wilcoxon signed ranks test.

RESULTS

Data from 14 CI recipients met the criteria for inclusion. Word recognition comparisons between the preoperative interval and a postactivation interval demonstrated a significant improvement with the CI (p = 0.014), with an average improvement of 23% (range -16 to 50%). Sound source localization postoperatively with the CI demonstrated an average RMS error of 26° (SD 6.8, range 18.7-43.1°) compared to the 42° (SD 19.1, range 18-85°) in the preoperative or CI off condition, these two conditions were not statistically different (p = 0.148).

CONCLUSION

Cochlear implantation and labyrinthectomy in adult patients with Menière's disease can support improvements in speech recognition and sound source localization for some CI users, though observed performance may be poorer than traditional CI candidates.

Enhancement of interaural level differences for bilateral cochlear implant users

Bilateral cochlear implant (BiCI) users do not localize sounds as well as normal hearing (NH) listeners do. NH listeners rely on two binaural cues to localize sounds in the horizontal plane, namely interaural level differences (ILDs) and interaural time differences. BiCI systems, however, convey these cues poorly. In this work, we investigated two methods to improve the coding of ILDs in BiCIs. The first method enhances ILDs by applying an artificial current-versus-angle function to the clinical levels delivered by the basal electrodes of the CI contralateral to the target sound. The second method enhances ILDs by using bilaterally linked N-of-M band selection. Results indicate that the participants were able to discriminate the location of the sound more accurately at narrow azimuths when the ILD enhancement was applied, compared to when they were using natural ILDs. Also, the results show that linking the band selection had a positive effect on left/right discrimination accuracy at larger azimuths for three out of the 10 tested participants, when compared to unlinked band selection. Based on these results, we conclude that ILD enhancement besides linked N-of-M band selection can help some BiCI participants to discriminate sound sources on the frontal horizontal plane.

Sound Localization Bias and Error in Bimodal Listeners Improve Instantaneously When the Device Delay Mismatch Is Reduced

Users of a cochlear implant (CI) in one ear, who are provided with a hearing aid (HA) in the contralateral ear, so-called bimodal listeners, are typically affected by a constant and relatively large interaural time delay offset due to differences in signal processing and differences in stimulation. For HA stimulation, the cochlear travelling wave delay is added to the processing delay, while for CI stimulation, the auditory nerve fibers are stimulated directly. In case of MED-EL CI systems in combination with different HA types, the CI stimulation precedes the acoustic HA stimulation by 3 to 10 ms. A self-designed, battery-powered, portable, and programmable delay line was applied to the CI to reduce the device delay mismatch in nine bimodal listeners. We used an A-B-B-A test design and determined if sound source localization improves when the device delay mismatch is reduced by delaying the CI stimulation by the HA processing delay (τ_HA). Results revealed that every subject in our group of nine bimodal listeners benefited from the approach. The root-mean-square error of sound localization improved significantly from 52.6° to 37.9°. The signed bias also improved significantly from 25.2° to 10.5°, with positive values indicating a bias toward the CI. Furthermore, two other delay values (τ_HA –1 ms and τ_HA +1 ms) were applied, and with the latter value, the signed bias was further reduced in some test subjects. We conclude that sound source localization accuracy in bimodal listeners improves instantaneously and sustainably when the device delay mismatch is reduced.

Spatial Release From Masking in Pediatric Cochlear Implant Recipients With Single-Sided Deafness

Purpose Children with single-sided deafness (SSD) experience difficulty understanding speech in multisource listening situations. Case reports and retrospective studies have indicated that a cochlear implant (CI) may improve masked speech recognition in children with SSD. This prospective study was conducted to determine whether providing a CI to children with SSD supports spatial release from masking (SRM), an improvement in speech recognition associated with separating the target and masker sources. Method Twenty children with at least a moderate-to-profound hearing loss in one ear and normal hearing in the contralateral ear underwent cochlear implantation. The average age of implantation was 5.5 years (range: 3.5-12.7). After 12 months of CI use, subjects completed a sentence recognition task in multitalker masker with and without the CI. The target was presented from the front, and the masker was either colocated with the target (0°) or from the side (+90° or -90°). A two-way repeated-measures analysis of variance was completed to investigate SRM with and without the CI. Results Pediatric CI recipients experienced significant SRM when the masker was directed to the normal-hearing ear or to the affected ear. Conclusions The results indicate that cochlear implantation in children with SSD supports binaural skills required for speech recognition in noise. These results are consistent with improved functional communication in multisource environments, like classrooms.

Electro-Haptic Stimulation: A New Approach for Improving Cochlear-Implant Listening

Cochlear implants (CIs) have been remarkably successful at restoring speech perception for severely to profoundly deaf individuals. Despite their success, several limitations remain, particularly in CI users' ability to understand speech in noisy environments, locate sound sources, and enjoy music. A new multimodal approach has been proposed that uses haptic stimulation to provide sound information that is poorly transmitted by the implant. This augmenting of the electrical CI signal with haptic stimulation (electro-haptic stimulation; EHS) has been shown to improve speech-in-noise performance and sound localization in CI users. There is also evidence that it could enhance music perception. We review the evidence of EHS enhancement of CI listening and discuss key areas where further research is required. These include understanding the neural basis of EHS enhancement, understanding the effectiveness of EHS across different clinical populations, and the optimization of signal-processing strategies. We also discuss the significant potential for a new generation of haptic neuroprosthetic devices to aid those who cannot access hearing-assistive technology, either because of biomedical or healthcare-access issues. While significant further research and development is required, we conclude that EHS represents a promising new approach that could, in the near future, offer a non-invasive, inexpensive means of substantially improving clinical outcomes for hearing-impaired individuals.

Benefits of triple acoustic beamforming during speech-on-speech masking and sound localization for bilateral cochlear-implant users

Bilateral cochlear-implant (CI) users struggle to understand speech in noisy environments despite receiving some spatial-hearing benefits. One potential solution is to provide acoustic beamforming. A headphone-based experiment was conducted to compare speech understanding under natural CI listening conditions and for two non-adaptive beamformers, one single beam and one binaural, called "triple beam," which provides an improved signal-to-noise ratio (beamforming benefit) and usable spatial cues by reintroducing interaural level differences. Speech reception thresholds (SRTs) for speech-on-speech masking were measured with target speech presented in front and two maskers in co-located or narrow/wide separations. Numerosity judgments and sound-localization performance also were measured. Natural spatial cues, single-beam, and triple-beam conditions were compared. For CI listeners, there was a negligible change in SRTs when comparing co-located to separated maskers for natural listening conditions. In contrast, there were 4.9- and 16.9-dB improvements in SRTs for the beamformer and 3.5- and 12.3-dB improvements for triple beam (narrow and wide separations). Similar results were found for normal-hearing listeners presented with vocoded stimuli. Single beam improved speech-on-speech masking performance but yielded poor sound localization. Triple beam improved speech-on-speech masking performance, albeit less than the single beam, and sound localization. Thus, triple beam was the most versatile across multiple spatial-hearing domains.

Comparing Methods for Pairing Electrodes Across Ears With Cochlear Implants

OBJECTIVES

Currently, bilateral cochlear implants (CIs) are independently programmed in clinics using frequency allocations based on the relative location of a given electrode from the end of each electrode array. By pairing electrodes based on this method, bilateral CI recipients may have decreased sensitivity to interaural time differences (ITD) and/or interaural level differences (ILD), two cues critical for binaural tasks. There are multiple different binaural measures that can potentially be used to determine the optimal way to pair electrodes across the ears. Previous studies suggest that the optimal electrode pairing between the left and right ears may vary depending on the binaural task used. These studies, however, have only used one reference location or a single bilateral CI user. In both instances, it is difficult to determine if the results that were obtained reflect a measurement error or a systematic difference across binaural tasks. It is also difficult to determine from these studies if the differences between the three cues vary across electrode regions, which could result from differences in the availability of binaural cues across frequency regions. The purpose of this study was to determine if, after experience-dependent adaptation, there are systematic differences in the optimal pairing of electrodes at different points along the array for the optimal perception of ITD, ILD, and pitch.

DESIGN

Data from seven bilateral Nucleus users was collected and analyzed. Participants were tested with ITD, ILD, and pitch-matching tasks using five different reference electrodes in one ear, spaced across the array. Comparisons were conducted to determine if the optimal bilateral electrode pairs systematically differed in different regions depending on whether they were measured based on ITD sensitivity, ILD sensitivity, or pitch matching, and how those pairs differed from the pairing in the participants' clinical programs.

RESULTS

Results indicate that there was a significant difference in the optimal pairing depending on the cue measured, but only at the basal end of the array.

CONCLUSION

The results suggest that optimal electrode pairings differ depending on the cue measured to determine optimal pairing, at least for the basal end of the array. This also suggests that the improvements seen when using optimally paired electrodes may be tied to the particular percept being measured both to determine electrode pairing and to assess performance, at least for the basal end of the array.

Effectiveness of Place-based Mapping in Electric-Acoustic Stimulation Devices

BACKGROUND

The default mapping procedure for electric-acoustic stimulation (EAS) devices uses the cochlear implant recipient's unaided detection thresholds in the implanted ear to derive the acoustic settings and assign the lowest frequency filter of electric stimulation. Individual differences for speech recognition with EAS may be due to discrepancies between the electric frequency filters of individual electrode contacts and the cochlear place of stimulation, known as a frequency-to-place mismatch. Frequency-to-place mismatch of greater than 1/2 octave has been demonstrated in up to 60% of EAS users. Aligning the electric frequency filters via a place-based mapping procedure using postoperative imaging may improve speech recognition with EAS.

METHODS

Masked sentence recognition was evaluated for normal-hearing subjects (n = 17) listening with vocoder simulations of EAS, using a place-based map and a default map. Simulation parameters were based on audiometric and imaging data from a representative 24-mm electrode array recipient and EAS user. The place-based map aligned electric frequency filters with the cochlear place frequency, which introduced a gap between the simulated acoustic and electric output. The default map settings were derived from the clinical programming software and provided the full speech frequency range.

RESULTS

Masked sentence recognition was significantly better for simulated EAS with the place-based map as compared with the default map.

CONCLUSION

The simulated EAS place-based map supported better performance than the simulated EAS default map. This indicates that individualizing maps may improve performance in EAS users by helping them achieve better asymptotic performance earlier and mitigate the need for acclimatization.

A Comparison of Place-Pitch-Based Interaural Electrode Matching Methods for Bilateral Cochlear-Implant Users

Interaural place-of-stimulation mismatch for bilateral cochlear-implant (BI-CI) listeners is often evaluated using pitch-comparison tasks that can be susceptible to procedural biases. Bias effects were compared for three sequential interaural pitch-comparison tasks in six BI-CI listeners using single-electrode direct stimulation. The reference (right ear) was a single basal, middle, or apical electrode. The comparison electrode (left ear) was chosen from one of three ranges: basal half, full array, or apical half. In Experiment 1 (discrimination), interaural pairs were chosen randomly (method of constant stimuli). In Experiment 2 (ranking), an efficient adaptive procedure rank ordered 3 reference and 6 or 11 comparison electrodes. In Experiment 3 (matching), listeners adjusted the comparison electrode to pitch match the reference. Each experiment was evaluated for testing-range bias (point of subjective equality [PSE] vs. comparison-range midpoint) and reference-electrode slope bias (PSE vs. reference electrode). Discrimination showed large biases for both metrics; matching showed a smaller but significant reference-electrode bias; ranking showed no significant biases in either dimension. Ranking and matching were also evaluated for starting-point bias (PSE vs. adaptive-track starting point), but neither showed significant effects. A response-distribution truncation model explained a nonsignificant bias for ranking but it could not fully explain the observed biases for discrimination or matching. It is concluded that (a) BI-CI interaural pitch comparisons are inconsistent across test methods; (b) biases must be evaluated in more than one dimension before accepting the results as valid; and (c) of the three methods tested, ranking was least susceptible to biases and therefore emerged as the optimal approach.

The Temporal Limits Encoder as a Sound Coding Strategy for Bilateral Cochlear Implants

The difference in binaural benefit between bilateral cochlear implant (CI) users and normal hearing (NH) listeners has typically been attributed to CI sound coding strategies not encoding the acoustic fine structure (FS) interaural time differences (ITD). The Temporal Limits Encoder (TLE) strategy is proposed as a potential way of improving binaural hearing benefits for CI users in noisy situations. TLE works by downward-transposition of mid-frequency band-limited channel information and can theoretically provide FS-ITD cues. In this work, the effect of choice of lower limit of the modulator in TLE was examined by measuring performance on a word recognition task and computing the magnitude of binaural benefit in bilateral CI users. Performance listening with the TLE strategy was compared with the commonly used Advanced Combinational Encoder (ACE) CI sound coding strategy. Results showed that setting the lower limit to ≥200 Hz maintained word recognition performance comparable to that of ACE. While most CI listeners exhibited a large binaural benefit (≥6 dB) in at least one of the conditions tested, there was no systematic relationship between the lower limit of the modulator and performance. These results indicate that the TLE strategy has potential to improve binaural hearing abilities in CI users but further work is needed to understand how binaural benefit can be maximized.